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Trichomoniasis Transmission: Sexual and Non-Sexual Routes

Trichomoniasis is a sexually transmitted infection (STI) caused by the protozoan parasite Trichomonas vaginalis. It is the most common curable STI worldwide (~156 million cases annually).

Transmission Routes

  1. Sexual contact (primary):
    • Penile-vaginal intercourse (most efficient).
    • Vulva-to-vulva contact (WSW transmission documented).
    • Penile-anal, vaginal-anal (less studied but plausible).
    • Shared sex toys (without cleaning/condoms between partners).
  2. Vertical transmission: Mother to neonate during delivery (rare; ~2–17% of exposed infants). Causes respiratory/genital infection in newborn.
  3. Fomite transmission (theoretical/rare): Damp towels, washcloths, toilet seats — T. vaginalis survives hours in moist environments. Not well-documented as significant route.

    4. What Does NOT Transmit

    • Casual contact (hugging, kissing, sharing utensils)
    • Swimming pools, hot tubs (chlorine kills trophozoites)
    • Blood transfusion

    Clinical Features

    • Women (50–70% symptomatic): Frothy yellow-green discharge, vulvar itching/burning, dysuria, dyspareunia, "strawberry cervix" (colpitis macularis — pathognomonic).
    • Men (often asymptomatic): Urethritis (discharge, irritation), prostatitis, epididymitis.

    Diagnosis and Treatment

    • NAAT (PCR): Gold standard (sensitivity >95%). Vaginal/endocervical/urine (women); urethral/urine (men).
    • Microscopy (wet mount): Motile trichomonads — sensitivity 50–70%.
    • Treatment: Metronidazole 2g single dose OR 500 mg BID × 7 days. Tinidazole 2g single dose (better tolerated). Treat all partners simultaneously.
    • Abstain until treatment complete + symptoms resolved.
    • Re-test at 3 months (high reinfection rate).

    Public Health

    Associated with ↑ HIV acquisition/transmission, preterm birth, PID. Reportable in many jurisdictions. Partner notification essential.

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