Ask a doctor: WTF is trichomoniasis, the most common non-viral STD in the world?

Like many other infections in the body, sexually transmitted diseases (STDS) can be viral (caused by viruses) or non-viral (not caused by viruses).

Examples of viral STDs include herpes, HIV, HPV, and hepatitis B and C, while those of non-viral STDs include chlamydia, gonorrhoea and syphilis.

You may be familiar with these conditions because of how prevalent they are, or how life-threatening they can be.

But have you heard of trichomoniasis? Although not as widely known as many other STDs, it's actually the most common non-viral one in the world.

WHAT IS TRICHOMONIASIS?

It's a bacterial infection that affects both men and women. However, while women can contract the disease from both men and women, men typically only acquire it from women.

"A study tested 600 men who have sex with men for trichomonas and found that none of them were positive. Hence, the deduction was that men do not typically, and very rarely, transmit the parasite to other men," says Dr Ezlyn Izharuddin, a resident doctor at DTAP Clinic.

She adds that it still isn't understood why this is the case, but that as such, many more women are affected than men.

According to her, there have thus far been no large-scale studies to prove the possibility of non-sexual transmission, so it's virtually always sexually transmitted.

Also, the parasite doesn't reside in saliva and cannot survive in blood, so an infection only happens in the urogential tract, which can be found in the vagina, urethra, cervix, prostate and bladder.

WHAT ARE THE SYMPTOMS OF TRICHOMONIASIS?

Even if you're infected with trichomoniasis, you may not be aware because only 11 to 17 per cent of infected women exhibit symptoms.

If there are signs, the most common one is vaginal discharge that is thin and foul-smelling and that resembles yellow pus.

It's usually accompanied by a burning sensation, itch or pain during urination and sexual intercourse, and pain in the lower abdomen.

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Interestingly, though, the age distribution of the infection in women appears to differ from other STDs.

"A study found that the peak rate of detection for trichomoniasis occurred in older women aged 47 to 53 years, compared to ages 14 to 20 years for chlamydia infections," says Dr Izharuddin.

"It also seems to occur in a bimodal distribution fashion, with infection peaking at women ages 21 to 22 years and 48 to 51 years."

She shares that while the reasons are still unclear, it has been postulated that:

1. The vaginal changes after menopause puts the environment at risk of a trichomonas infection
2. Menopausal changes provide protection against infections such as chlamydia and gonorrhoea
3. The parasite remains latent until after menopause, during which it reactivates.

WHAT ARE THE EFFECTS OF TRICHOMONIASIS, AND HOW CAN IT BE TREATED?

If left untreated, trichomoniasis can lead to an infection of the bladder and urethra. It can also affect your reproductive health by way of abnormal growth in the cervix, or increasing chances of acquiring an HIV infection by up to twofold.

If a woman is pregnant, the infection can result in premature rupture of membranes, preterm delivery (the risks up to 42 per cent), and delivery of low birth weight infants.

Newborns with the infection may have fever, urinary tract infection, respiratory issues, and girls may also have vaginal discharge.

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Treatment is by use of antibiotics (metronidazole) and is offered to all patients with or without symptoms.

"It's also offered to those without symptoms to reduce the risk of the women transmitting the infection to their sexual partners, and because up to one-third of women without symptoms may develop symptoms within six months," says Dr Izharuddin.

A follow-up repeat test is usually carried out around two weeks after treatment and within three months of its completion.

As with all STDs, your chances of contracting trichomoniasis are significantly lowered with the use of condoms. So unless you're in a committed relationship, make sure you put a wrapper on it.

This article was first published in CLEO Singapore.