From the Guidelines
Trichomonas infection in men is often asymptomatic, with most men not having symptoms, but when symptoms do occur, they typically include urethral discharge, burning or irritation inside the penis, and itching or irritation inside the penis, and treatment involves a single dose of metronidazole (2 grams) or tinidazole (2 grams), or a 7-day course of metronidazole (500 mg twice daily) 1.
Symptoms of Trichomonas Infection in Men
- Urethral discharge that may be clear, white, or yellowish
- Burning or irritation inside the penis
- Burning during urination
- Itching or irritation inside the penis
- Discomfort during ejaculation
- Mild testicular pain or swelling These symptoms usually appear within 5-28 days after infection. Even without symptoms, infected men can still transmit the parasite to sexual partners.
Treatment and Prevention
Treatment involves a single dose of metronidazole (2 grams) or tinidazole (2 grams), or a 7-day course of metronidazole (500 mg twice daily) 1. It's essential for all sexual partners to be treated simultaneously to prevent reinfection, and to abstain from sexual activity until treatment is complete and symptoms have resolved. Men should seek medical attention if they experience any urethral symptoms or if their sexual partner has been diagnosed with trichomoniasis. The infection is caused by the parasite Trichomonas vaginalis, which primarily infects the urogenital tract and is almost exclusively transmitted through sexual contact.
Key Considerations
- Most men who are infected with T. vaginalis do not have symptoms, although a minority of men have nongonococcal urethritis (NGU) 1.
- Treatment of patients and sex partners results in relief of symptoms, microbiologic cure, and reduction of transmission 1.
- Patients should be treated with oral metronidazole, and the recommended regimens have resulted in cure rates of about 90 to 95 percent 1.
From the Research
Trichomonas Symptoms in Men
- The most common symptoms of trichomoniasis in men are urethral discharge and urethral irritation, as reported in a study of 325 men with confirmed urethral trichomoniasis 2.
- Symptoms can persist for more than four weeks in 78% of patients, which is a longer duration compared to nontrichomonal nongonococcal urethritis 2.
- The discharge is often milky white and fluid in nature, with small clumps of material visible on a glass slide 2.
- Microscopic examination of the gram-stained smear shows relatively few polymorphonuclear leukocytes but many epithelial cells 2.
Prevalence and Clinical Manifestations
- Trichomoniasis is common among sexually active men, with a prevalence of 11% in a study of 447 men at risk for a sexually transmitted disease 3.
- Infected men often complain of urethral discharge, which can be mild or moderately severe 3.
- Elimination of Trichomonas vaginalis is associated with resolution of urethritis 3.
- Trichomoniasis is an important consideration in sexually active men with urethral symptoms or inflammation but with little or no evidence of discharge on physical examination 3.
Diagnosis and Treatment
- Diagnosis is usually made from wet mount microscopy and direct visualization, which are insensitive 4.
- DNA amplification techniques perform with good sensitivity, but are not yet approved for diagnostic purposes 4.
- A single dose of metronidazole is effective in the majority of cases, but metronidazole resistance is an emerging problem 4.
- Treatment with 400 mg of metronidazole thrice daily for five days can give a cure rate of 100% 2.
- The addition of metronidazole to the syndromic management of male urethritis can eliminate infection with T vaginalis and may help to reduce the transmission of HIV 5.