What are the symptoms and treatment options for trichomoniasis in both men and women?

Symptoms of Trichomoniasis

Clinical Presentation in Women

In women, trichomoniasis typically causes a diffuse, malodorous, yellow-green vaginal discharge with vulvar irritation, though up to 50% may remain asymptomatic. 1, 2

Symptomatic Women Present With:

• Profuse, frothy, yellow-green vaginal discharge with a characteristic malodorous (fishy or musty) smell 1, 3, 4
• Vulvar and vaginal irritation including pruritus (itching) and burning 1, 3, 4
• Vaginal or vulvar erythema (redness) 4
• Dyspareunia (painful intercourse) 4
• External dysuria (stinging or burning on urination) 4
• Vulvar soreness 1

Important Clinical Pitfall:

Women often confuse trichomoniasis with vulvovaginal candidiasis (thrush) and self-treat with antifungals without success, delaying proper diagnosis and treatment. 5 The key distinguishing feature is the profuse, frothy, yellow-green discharge rather than the thick white discharge of candidiasis. 3, 4

Clinical Presentation in Men

Approximately 80% of men with T. vaginalis infection are asymptomatic, making them efficient vectors for transmission without knowing they are infected. 6, 2

When Symptomatic, Men May Present With:

• Urethritis (urethral discharge and irritation) 6, 3
• Epididymitis 6
• Prostatitis 6

These remain localized genitourinary infections rather than systemic disease. 6

Associated Complications Affecting Morbidity and Mortality

Pregnancy-Related Complications:

• Premature rupture of membranes 6, 7
• Preterm delivery and preterm labor 1, 6, 7
• Low birth weight 6, 7, 5

Reproductive Tract Complications:

• Pelvic inflammatory disease (PID) in some cases 6, 3
• Postabortal infection 7
• Post-cesarean infection 7
• Cervicitis and endocervicitis 8, 3

HIV and STI Transmission:

• Trichomoniasis significantly increases the risk of HIV transmission and acquisition 6, 5
• May facilitate transmission of other sexually transmitted infections 6
• Often coexists with chlamydia and gonorrhoea 5

Asymptomatic Disease

Both men and women can harbor asymptomatic infections, making screening essential in high-risk populations and before reproductive tract procedures. 2, 3, 7 The high rate of asymptomatic carriage, particularly in men, contributes to ongoing transmission and reinfection of partners. 2, 8

Screening Recommendations:

Practitioners should consider routinely screening before any reproductive tract surgery (cesarean section, therapeutic abortion, hysterectomy, etc.), after changing sexual partners, and during pregnancy. 7