Diagnosis

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About one-third of women infected with trichomoniasis have no noticeable symptoms. Most symptoms, if they develop, occur within five to 28 days after exposure to an infected partner. However, in some cases, the symptoms may be delayed for much longer. The most common symptoms are vaginal discharge, irritation, itching and burning during urination.

Trichomoniasis most often presents as a yellowish-green vaginal discharge with a strong odor. Itching and soreness of the vagina and vulva also are common. Some women experience vague abdominal pain. Trichomoniasis can be coupled with other infections, particularly pelvic inflammatory disease and bacterial vaginosis.

The majority of men infected with trichomonas never have symptoms. The most common symptom is discharge from the penis or burning with urination. The penis also may become inflamed. When men have symptoms, they often subside without treatment after a week or more.

For both men and women, making a diagnosis on symptoms alone is inadequate, particularly because of the broad range of symptoms, many of which are shared with other inflammatory conditions of the vagina and cervix.

For women, the most common ways to diagnose trichomoniasis is by physical examination of the pelvic area by a health care professional and by looking at a sample of vaginal fluid under a microscope (called "wet mounts") for the presence of protozoa. A pelvic examination can reveal small red ulcerations on the vaginal wall or cervix. The wet mount technique, however, is accurate only about half to 70 percent of the time, as protozoa may be hard to find or mistaken for normal cells. More reliable tests have been developed, including a new culture test, which is more accurate. One disadvantage of the culture test, however, is that a culture can take days to process, and an undiagnosed case of trichomoniasis can be transmitted to a partner in the meantime if treatment has not been started. In addition, several rapid diagnostic kits that use DNA and monoclonal antibodies have been developed, and these tests can be useful in areas where microscopy and cultures are not available, such as inner-city STD clinics. There is also a rapid results test available called the OSOM Trichomonas Rapid Test with a sensitivity of 88 percent that physicians can read in as little as 10 minutes. Polymerase chain reaction (PCR) tests are being used in research but have not yet been FDA-approved in the United States for clinical use. Recent studies have shown them to be the most accurate diagnostic method available.