Don't be tricked by 'Trich

WOMEN'S REPRODUCTIVE HEALTH Don't be tricked by "Trich" By Heather Shannon, MS, CNM, WHNP, MPH H ow many of you have heard of “trich” or trichomoniasis? I am sure many of you have not. According to the Center for Disease Control (CDC), 2019, “trich” is the most prevalent non-viral sexually transmitted infection (STI) in the United States that affects 3.7 million persons annually. According to our New York State Department of Health (NYS DOH), trichomoniasis is the number one cause of vaginal infections and is spread through sex. It affects both men and women. However, most men do not show symptoms and therefore do not receive treatment making it very difficult to slow the spread of this STI. Unfortunately, 70 to 85 percent of infected persons have minimal to no symptoms, according to the CDC, making this a very difficult infection to treat and stop the spread. What is “Trich”? Before we go any further, we need to learn more about the trichomoniasis. It is a small protozoan parasite called Trichomonas vaginalis (T. vaginalis), Figure 1. It is passed through sexual contact by either penis to vagina sex, vagina-to-vagina sex, penis to anus sex or through oral sex. It thrives in moist, dark environments like the vagina, urethra, rectum, penis or throat. Interestingly, older women are more likely to become infected than younger women are. Scientists are not sure why this occurs, but suspect overall health plays a role. As we age, our immune system weakens and we are more prone to chronic health conditions. How do I know if I have ‘Trich’? As previously mentioned, over 70 percent of people do not have signs or symptoms. However, those that do have symptoms might have itching, burning, redness, green/yellow/gray foamy discharge with a strong fishy odor from the vagina. Some will have lower pelvic pain, pain with urinating or pain with sex. Unfortunately, these symptoms are similar to common, nonSTI infections like yeast or bacteria. If you have new or unusual symptoms, you should see your women’s health care provider for evaluation. A culture or sample of your discharge will be obtained and evaluated in the office or sent to the lab or both. It is recommended that you have cultures done with your annual GYN exam visit, regardless if you are in a monogamous, longterm relationship or actively dating. Remember, approximately 30 percent of people will have symptoms, where 70 percent will not. Is Trich curable? Yes, it is! You and your partner(s) will be treated with oral Metronidazole (Flagyl) or Tindazole in one single oral dose.

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An adverse reaction can occur when you take either of these medications with alcohol. You may experience nausea, vomiting, cramps and headaches that can be quite severe. Alcohol should be avoided up to three days after finishing medication. It is recommended that you avoid sex for seven days after treatment to prevent recontamination. Condom use is also recommended, even after treatment, since condoms can greatly reduce transmission. If you continue to have symptoms, you should follow up with your provider for retesting. Otherwise, you should be retested six weeks to three months after treatment, to be sure you are cured and did not become re-infected. Be aware, you can get this infection again and 1 in 5 people will be infected again within three months from being treated (CDC)! Complications of Trich You are at a much higher risk of getting other STIs like gonorrhea or chlamydia with a positive trichomoniasis result. There is also a higher risk to contracting HIV because of the inflamed tissue compromising its integrity to protect. Trich can be a problem in pregnancy in that it can cause preterm labor and birth (<37 weeks). Babies born early are more likely to be of low birth weight (<5.5lbs). Babies are at risk for other complications associated with being born too early and weigh less. It is usual practice for obstetrical offices to test for trichomoniasis during the pregnancy. If you are pregnant, you might want to ask about testing for trich at your next OB visit. Prevent Trich The only way to prevent trich or other STIs is to not have vaginal, anal or oral sex. I understand this is not always possible or realistic. However, if you are sexually active and in a long-term relationship, be open to STI testing when you go for your GYN exam. If you are not in a monogamous relationship, use latex condoms correctly, every time you have sex to reduce your risk of exposure. Remember to talk to your partner(s) about STIs and be proactive in getting testing before having sex. Also, make an appointment to see your provider with any symptoms discussed in this article. As always, talk to you GYN health care provider to understand you risks and your sexual health needs. SWM

Resources: Center for Disease Control and Prevention. (2019). https://www.cdc.gov/ std/trichomonas/stdfact-trichomoniasis.htm. New York State Department of Health. (2012). Trichomoniasis a common, curable STD. Brochure number 3839.