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Trichomoniasis Clinical Presentation

  • Author: Darvin Scott Smith, MD, MSc, DTM&H; Chief Editor: Michael Stuart Bronze, MD  more...
Updated: Oct 21, 2015


Trichomoniasis is typically found in sexually active patients. Transmission occurs predominantly via sexual intercourse. The organism is most commonly isolated from vaginal secretions in women and urethral secretions in men. It has not been isolated from oral sites, and rectal prevalence appears to be low in men who have sex with men.[5] While it is possible to contract trichomoniasis without engaging in sexual intercourse, it is less common. In the NHANES 2001-2004 study conducted among females aged 14-49 years, 1% of women with trichomoniasis had no history of sexual intercourse.[33]

Nearly half of infected females and nearly all infected males are asymptomatic.[14, 42] One third of asymptomatic women become symptomatic within 6 months.[14]


Trichomoniasis symptoms in women range from none to severe pelvic inflammatory disease (PID). Women with trichomoniasis frequently report an abnormal vaginal discharge, which may be purulent, frothy, or bloody. Frothy vaginal discharge, which is thought to be the classic presentation of trichomoniasis, may be observed in only 12% of patients with this infection.

Women with trichomoniasis also commonly report abnormal vaginal odor (often described as musty); vulvovaginal itching, burning, or soreness; dyspareunia (pain during sexual intercourse), which is often the major complaint; and dysuria (pain during urination).[11, 43] Patients may also complain of postcoital bleeding and lower abdominal pain.

Cervicitis due to trichomoniasis is characterized by 2 major signs: purulent discharge in the endocervical canal and easily induced endocervical bleeding.[6] However, it may also be asymptomatic.

T vaginalis infection is one of the top 3 causes of vaginitis.[6] Vaginitis is usually characterized by vaginal discharge, which may be accompanied by vulvar itching, irritation, and odor. The two other most common causes of vaginal discharge are anaerobic bacterial overgrowth of normal flora and candidiasis (infection with Candida albicans).[6]


Men with trichomoniasis may be divided into the following 3 groups on the basis of their symptoms[14] :

  • Asymptomatic carrier state (comprising the majority of patients)
  • Mild symptomatic disease
  • Acute trichomoniasis

Trichomoniasis symptoms in men range from none to urethritis complicated by prostatitis. Nongonococcal nonchlamydial urethritis is the most common symptom reported by men with trichomoniasis. Symptoms of urethritis include discharge (purulent to mucoid in character), dysuria, and urethral pruritus.[6] Some patients report pain in the urethra, testicular pain, or lower abdominal pain.

Most symptomatic infections are intermittent and self-limiting.


Physical Examination


Vaginal discharge is found in 42% of infected women.[11] The discharge is classically described as thin and frothy; however, this is only seen in about 10% of patients.[11] The discharge is often yellow and sometimes is thick enough to be confused with that seen in candidiasis. Abnormal vaginal odor was found in 50% of infected women, and edema or erythema was found in 22-37%.[11] Vaginal pH is often elevated (>4.5).[44]

Colpitis macularis, or strawberry cervix, describes a diffuse or patchy macular erythematous lesion of the cervix. This is a specific sign for trichomoniasis but is visible in only 1-2% of cases without the aid of colposcopy; with colposcopy, colpitis macularis is detected in up to 45% of cases.[39] Together, colpitis macularis and frothy vaginal discharge have a specificity of 99%; individually, they have positive predictive values of 90% and 62%, respectively.

Lower-abdominal tenderness may be present; however, this is described in fewer than 10% of patients. If this occurs, coexisting salpingitis or an intra-abdominal pathology is possible.

Coexisting Neisseria gonorrhoeae infection, candidiasis, and bacterial vaginosis are common and may produce a mixed clinical picture.

Most of the symptoms described above are not specific for trichomoniasis and can occur in other vaginal or cervical infections. In one study, the clinician’s ability to accurately diagnose Tvaginalis infection on the basis of physical findings alone had a positive predictive value of only 47%.[45] Relying on physical examination findings alone misses the diagnosis of most patients with trichomoniasis. Definitive diagnosis requires appropriate laboratory testing.


Most men with trichomoniasis have no physical findings. Infrequently, infected men have abnormal penile discharge. However, the discharge usually is only scant and thin. Trichomoniasis in men may be associated with local inflammatory states, including balanitis and balanoposthitis. Physical findings of epididymitis and prostatitis may also occur.


In female newborns, T vaginalis acquired during birth may cause vaginal discharge during the first week of life. Respiratory infection of the newborn is also possible.[9] An infected infant may present with fever.

Prepubertal children with trichomoniasis may present with symptoms similar to those seen in the adolescent and adult patient. T vaginalis infection in prepubertal children is suggestive of sexual abuse.



In women, vaginitis is the most common manifestation of infection. Other complications include infection of the adnexa, endometrium, and Skene and Bartholin glands. Pelvic inflammatory disease and tubo-ovarian abscess may also occur.

Research has shown that infection with T vaginalis increases the risk of HIV transmission in both men and women.[1, 3] It is estimated that in women alone, 747 new HIV cases per year are a result of the facilitative effects of T vaginalis on the transmission of HIV.[46] Overall, persons with trichomoniasis are twice as likely to develop HIV infection as the general population.[29] Treatment of trichomoniasis has been shown to decrease the rate of viral shedding in HIV patients.[3, 47]

In addition to HIV, T vaginalis infection also increases the susceptibility to other viruses, including herpes and human papillomavirus (HPV). T vaginalis may increase the rate of infection or reactivation of HPV, although it may shorten the duration of infection.[48]

An association with cervical intraepithelial neoplasia has also been demonstrated.[49] Trichomoniasis has also been associated with postoperative infections.

An increased risk of posthysterectomy infection, including cuff cellulitis, cuff abscess, and wound infection, has been documented.[50] Rare cases of trichomonal peritonitis have been reported.[51]

In pregnant women, T vaginalis infection has been associated with an increased risk of low birth weight, preterm delivery, and intrauterine infection.[1, 52] Systemic immune response has been demonstrated in pregnant women infected with T vaginalis; a significant increase in granulocyte-macrophage colony-stimulating factor (GM-CSF) and C-reactive protein (CRP) was noted.[43]

Neonatal trichomoniasis has been described.[53] Respiratory or genital infection in the newborn may also occur.[6]

In men, when symptoms occur, T vaginalis infection usually manifests as urethritis. As many as 11% of nongonococcal urethritis cases in men are caused by T vaginalis.[54] Complications of untreated trichomoniasis in men include prostatitis, epididymitis, urethral stricture disease, and infertility, potentially resulting from decreased sperm motility and viability.[4, 55] Symptomatic men with comorbid T vaginalis and HIV infections have been found to have significantly higher numbers of HIV RNA particles in their seminal fluid.[3]

Contributor Information and Disclosures

Darvin Scott Smith, MD, MSc, DTM&H Adjunct Associate Clinical Professor, Department of Microbiology and Immunology, Stanford University School of Medicine; Chief of Infectious Diseases and Geographic Medicine, Department of Internal Medicine, Kaiser Redwood City Hospital

Darvin Scott Smith, MD, MSc, DTM&H is a member of the following medical societies: American Medical Association, American Society of Tropical Medicine and Hygiene, Infectious Diseases Society of America, International Society of Travel Medicine

Disclosure: Nothing to disclose.


Natalia Ramos, MD, MPH Fellow, University of California, Los Angeles, David Geffen School of Medicine

Disclosure: Nothing to disclose.

Chief Editor

Michael Stuart Bronze, MD David Ross Boyd Professor and Chairman, Department of Medicine, Stewart G Wolf Endowed Chair in Internal Medicine, Department of Medicine, University of Oklahoma Health Science Center; Master of the American College of Physicians; Fellow, Infectious Diseases Society of America

Michael Stuart Bronze, MD is a member of the following medical societies: Alpha Omega Alpha, American Medical Association, Oklahoma State Medical Association, Southern Society for Clinical Investigation, Association of Professors of Medicine, American College of Physicians, Infectious Diseases Society of America

Disclosure: Nothing to disclose.


Judith C Brillman, MD Professor Emerita, Emergency Medicine Department, University of New Mexico School of Medicine

Judith C Brillman, MD is a member of the following medical societies: American Academy of Emergency Medicine, American Association of Women Emergency Physicians, and Society for Academic Emergency Medicine

Disclosure: Nothing to disclose.

John L Brusch, MD, FACP Assistant Professor of Medicine, Harvard Medical School; Consulting Staff, Department of Medicine and Infectious Disease Service, Cambridge Health Alliance

John L Brusch, MD, FACP is a member of the following medical societies: American College of Physicians and Infectious Diseases Society of America

Disclosure: Nothing to disclose.

Benjamin W Friedman, MD Staff Physician, Department of Emergency Medicine, Jacobi/Montefiore Medical Centers

Benjamin W Friedman, MD is a member of the following medical societies: American Academy of Emergency Medicine and Society for Academic Emergency Medicine

Disclosure: Nothing to disclose.

Theodore J Gaeta, DO, MPH, FACEP Clinical Associate Professor, Department of Emergency Medicine, Weill Cornell Medical College; Vice Chairman and Program Director of Emergency Medicine Residency Program, Department of Emergency Medicine, New York Methodist Hospital; Academic Chair, Adjunct Professor, Department of Emergency Medicine, St George's University School of Medicine

Theodore J Gaeta, DO, MPH, FACEP is a member of the following medical societies: Alliance for Clinical Education, American College of Emergency Physicians, Clerkship Directors in Emergency Medicine, Council of Emergency Medicine Residency Directors, New York Academy of Medicine, and Society for Academic Emergency Medicine

Disclosure: Nothing to disclose.

Rick Kulkarni, MD Attending Physician, Department of Emergency Medicine, Cambridge Health Alliance, Division of Emergency Medicine, Harvard Medical School

Rick Kulkarni, MD is a member of the following medical societies: Alpha Omega Alpha, American Academy of Emergency Medicine, American College of Emergency Physicians, American Medical Association, American Medical Informatics Association, Phi Beta Kappa, and Society for Academic Emergency Medicine

Disclosure: WebMD Salary Employment

Ashir Kumar, MD, MBBS, FAAP Professor Emeritus, Department of Pediatrics and Human Development, Michigan State University College of Human Medicine

Ashir Kumar, MD, MBBS, FAAP is a member of the following medical societies: American Association of Physicians of Indian Origin and Infectious Diseases Society of America

Disclosure: Nothing to disclose

Mark L Plaster, MD, JD Executive Editor, Emergency Physicians Monthly

Mark L Plaster, MD, JD is a member of the following medical societies: American Academy of Emergency Medicine and American College of Emergency Physicians

Disclosure: M L Plaster Publishing Co LLC Ownership interest Management position

Binita R Shah, MD, FAAP, Professor of Clinical Pediatrics and Emergency Medicine, SUNY Health Sciences Center at Brooklyn; Director of Pediatric Emergency Medicine, Departments of Emergency Medicine and Pediatrics, Kings County Hospital Center

Binita R Shah, MD, FAAP is a member of the following medical societies: American Academy of Pediatrics

Disclosure: Nothing to disclose.

Richard H Sinert, DO Associate Professor of Emergency Medicine, Clinical Assistant Professor of Medicine, Research Director, State University of New York College of Medicine; Consulting Staff, Department of Emergency Medicine, Kings County Hospital Center

Richard H Sinert, DO is a member of the following medical societies: American College of Physicians and Society for Academic Emergency Medicine

Disclosure: Nothing to disclose.

Russell W Steele, MD Head, Division of Pediatric Infectious Diseases, Ochsner Children's Health Center; Clinical Professor, Department of Pediatrics, Tulane University School of Medicine

Russell W Steele, MD is a member of the following medical societies: American Academy of Pediatrics, American Association of Immunologists, American Pediatric Society, American Society for Microbiology, Infectious Diseases Society of America, Louisiana State Medical Society, Pediatric Infectious Diseases Society, Society for Pediatric Research, and Southern Medical Association

Disclosure: Nothing to disclose

Francisco Talavera, PharmD, PhD Adjunct Assistant Professor, University of Nebraska Medical Center College of Pharmacy; Editor-in-Chief, Medscape Drug Reference

Disclosure: Medscape Reference Salary Employment

Robert W Tolan Jr, MD Chief, Division of Allergy, Immunology and Infectious Diseases, The Children's Hospital at Saint Peter's University Hospital; Clinical Associate Professor of Pediatrics, Drexel University College of Medicine

Robert W Tolan Jr, MD is a member of the following medical societies: American Academy of Pediatrics, American Medical Association, American Society for Microbiology, American Society of Tropical Medicine and Hygiene, Infectious Diseases Society of America, Pediatric Infectious Diseases Society, Phi Beta Kappa, and Physicians for Social Responsibility

Disclosure: Novartis Honoraria Speaking and teaching

R Gentry Wilkerson, MD Assistant Professor, Director of Research, Emergency Medicine Residency Program, University of South Florida College of Medicine, Tampa General Hospital

R Gentry Wilkerson, MD is a member of the following medical societies: American College of Emergency Physicians

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Renee Wilson, MD, Clinical Assistant Instructor, Department of Emergency Medicine, SUNY-Downstate and Kings County Hospital

Renee Wilson, MD is a member of the following medical societies: Society for Academic Emergency Medicine

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Mary L Windle, PharmD Adjunct Associate Professor, University of Nebraska Medical Center College of Pharmacy; Editor-in-Chief, Medscape Drug Reference

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Martin Weisse, MD Program Director, Associate Professor, Department of Pediatrics, West Virginia University

Martin Weisse, MD is a member of the following medical societies: Ambulatory Pediatric Association, American Academy of Pediatrics, and Pediatric Infectious Diseases Society

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Jeffrey M Zaks, MD Clinical Associate Professor of Medicine, Wayne State University School of Medicine; Vice President, Medical Affairs, Chief Medical Officer, Department of Internal Medicine, Providence Hospital

Jeffrey M Zaks, MD is a member of the following medical societies: American College of Cardiology, American College of Healthcare Executives, American College of Physician Executives, and American Medical Association

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The authors wish to thank Amy Cai, MD, for the video and for sharing patient samples and insights.

  1. Forna F, Gülmezoglu AM. Interventions for treating trichomoniasis in women. Cochrane Database Syst Rev. 2003. CD000218. [Medline].

  2. Van der Pol B. Trichomonas vaginalis infection: the most prevalent nonviral sexually transmitted infection receives the least public health attention. Clin Infect Dis. 2007 Jan 1. 44(1):23-5. [Medline].

  3. Wang CC, McClelland RS, Reilly M, Overbaugh J, Emery SR, Mandaliya K, et al. The effect of treatment of vaginal infections on shedding of human immunodeficiency virus type 1. J Infect Dis. 2001 Apr 1. 183(7):1017-22. [Medline].

  4. Soper D. Trichomoniasis: under control or undercontrolled?. Am J Obstet Gynecol. 2004 Jan. 190(1):281-90. [Medline].

  5. Francis SC, Kent CK, Klausner JD, Rauch L, Kohn R, Hardick A, et al. Prevalence of rectal Trichomonas vaginalis and Mycoplasma genitalium in male patients at the San Francisco STD clinic, 2005-2006. Sex Transm Dis. 2008 Sep. 35(9):797-800. [Medline].

  6. [Guideline] Workowski KA, Berman SM. Sexually transmitted diseases treatment guidelines, 2006. MMWR Recomm Rep. 2006 Aug 4. 55:1-94. [Medline].

  7. Krieger JN, Tam MR, Stevens CE, Nielsen IO, Hale J, Kiviat NB, et al. Diagnosis of trichomoniasis. Comparison of conventional wet-mount examination with cytologic studies, cultures, and monoclonal antibody staining of direct specimens. JAMA. 1988 Feb 26. 259(8):1223-7. [Medline].

  8. Radonjic IV, Dzamic AM, Mitrovic SM, Arsic Arsenijevic VS, Popadic DM, Kranjcic Zec IF. Diagnosis of Trichomonas vaginalis infection: The sensitivities and specificities of microscopy, culture and PCR assay. Eur J Obstet Gynecol Reprod Biol. 2006 May 1. 126(1):116-20. [Medline].

  9. Centers for Disease Control and Prevention. Sexually Transmitted Diseases Treatment Guidelines, 2010: Diseases Characterized by Vaginal Discharge. Centers for Disease Control and Prevention. Available at Accessed: June 1, 2012.

  10. Eckert J. Protozoa. In: Kayser FH, Bienz KA, Eckert J, et al, eds. Color Atlas of Medical Microbiology. 2nd ed. New York, NY: Thieme; 2005:

  11. Schwebke JR, Burgess D. Trichomoniasis. Clin Microbiol Rev. 2004 Oct. 17(4):794-803, table of contents. [Medline]. [Full Text].

  12. Magnus M, Clark R, Myers L, Farley T, Kissinger PJ. Trichomonas vaginalis among HIV-Infected women: are immune status or protease inhibitor use associated with subsequent T. vaginalis positivity?. Sex Transm Dis. 2003 Nov. 30(11):839-43. [Medline].

  13. Hobbs MM, Kazembe P, Reed AW, Miller WC, Nkata E, Zimba D, et al. Trichomonas vaginalis as a cause of urethritis in Malawian men. Sex Transm Dis. 1999 Aug. 26(7):381-7. [Medline].

  14. Petrin D, Delgaty K, Bhatt R, Garber G. Clinical and microbiological aspects of Trichomonas vaginalis. Clin Microbiol Rev. 1998 Apr. 11(2):300-17. [Medline]. [Full Text].

  15. Dan M, Sobel JD. Trichomoniasis as seen in a chronic vaginitis clinic. Infect Dis Obstet Gynecol. 1996. 4(2):77-84. [Medline]. [Full Text].

  16. Miller M, Liao Y, Gomez AM, Gaydos CA, D'Mellow D. Factors associated with the prevalence and incidence of Trichomonas vaginalis infection among African American women in New York city who use drugs. J Infect Dis. 2008 Feb 15. 197(4):503-9. [Medline].

  17. Weinstock H, Berman S, Cates W Jr. Sexually transmitted diseases among American youth: incidence and prevalence estimates, 2000. Perspect Sex Reprod Health. 2004 Jan-Feb. 36(1):6-10. [Medline].

  18. Gerbase AC, Rowley JT, Mertens TE. Global epidemiology of sexually transmitted diseases. Lancet. 1998. 351 Suppl 3:2-4. [Medline].

  19. Bachmann LH, Hobbs MM, Seña AC, Sobel JD, Schwebke JR, Krieger JN, et al. Trichomonas vaginalis genital infections: progress and challenges. Clin Infect Dis. 2011 Dec. 53 Suppl 3:S160-72. [Medline].

  20. Goyal M, Hayes K, McGowan KL, Fein JA, Mollen C. Prevalence of Trichomonas vaginalis infection in symptomatic adolescent females presenting to a pediatric emergency department. Acad Emerg Med. 2011 Jul. 18(7):763-6. [Medline].

  21. Sobel JD. What's new in bacterial vaginosis and trichomoniasis?. Infect Dis Clin North Am. 2005 Jun. 19(2):387-406. [Medline].

  22. Garcia A, Exposto F, Prieto E, Lopes M, Duarte A, Correia da Silva R. Association of Trichomonas vaginalis with sociodemographic factors and other STDs among female inmates in Lisbon. Int J STD AIDS. 2004 Sep. 15(9):615-8. [Medline].

  23. Shuter J, Bell D, Graham D, Holbrook KA, Bellin EY. Rates of and risk factors for trichomoniasis among pregnant inmates in New York City. Sex Transm Dis. 1998 Jul. 25(6):303-7. [Medline].

  24. Joyner JL, Douglas JM Jr, Ragsdale S, Foster M, Judson FN. Comparative prevalence of infection with Trichomonas vaginalis among men attending a sexually transmitted diseases clinic. Sex Transm Dis. 2000 Apr. 27(4):236-40. [Medline].

  25. Schwebke JR, Hook EW 3rd. High rates of Trichomonas vaginalis among men attending a sexually transmitted diseases clinic: implications for screening and urethritis management. J Infect Dis. 2003 Aug 1. 188(3):465-8. [Medline].

  26. Krieger JN. Trichomoniasis in men: old issues and new data. Sex Transm Dis. 1995 Mar-Apr. 22(2):83-96. [Medline].

  27. World Health Organization. Global Prevalence and Incidence of Selected Curable Sexually Transmitted Infections: Overviews and Estimates. WHO/HIV_AIDS/2001.02. Geneva: World Health Organization. 2001.

  28. Klouman E, Masenga EJ, Klepp KI, Sam NE, Nkya W, Nkya C. HIV and reproductive tract infections in a total village population in rural Kilimanjaro, Tanzania: women at increased risk. J Acquir Immune Defic Syndr Hum Retrovirol. 1997 Feb 1. 14(2):163-8. [Medline].

  29. Laga M, Manoka A, Kivuvu M, Malele B, Tuliza M, Nzila N, et al. Non-ulcerative sexually transmitted diseases as risk factors for HIV-1 transmission in women: results from a cohort study. AIDS. 1993 Jan. 7(1):95-102. [Medline].

  30. Leroy V, De Clercq A, Ladner J, Bogaerts J, Van de Perre P, Dabis F. Should screening of genital infections be part of antenatal care in areas of high HIV prevalence? A prospective cohort study from Kigali, Rwanda, 1992-1993. The Pregnancy and HIV (EGE) Group. Genitourin Med. 1995 Aug. 71(4):207-11. [Medline]. [Full Text].

  31. Huppert JS. Trichomoniasis in teens: an update. Curr Opin Obstet Gynecol. 2009 Oct. 21(5):371-8. [Medline].

  32. Danesh IS, Stephen JM, Gorbach J. Neonatal Trichomonas vaginalis infection. J Emerg Med. 1995 Jan-Feb. 13(1):51-4. [Medline].

  33. Sutton M, Sternberg M, Koumans EH, McQuillan G, Berman S, Markowitz L. The prevalence of Trichomonas vaginalis infection among reproductive-age women in the United States, 2001-2004. Clin Infect Dis. 2007 Nov 15. 45(10):1319-26. [Medline].

  34. Miller WC, Swygard H, Hobbs MM, Ford CA, Handcock MS, Morris M, et al. The prevalence of trichomoniasis in young adults in the United States. Sex Transm Dis. 2005 Oct. 32(10):593-8. [Medline].

  35. Kaydos-Daniels SC, Miller WC, Hoffman I, Price MA, Martinson F, Chilongozi D, et al. The use of specimens from various genitourinary sites in men, to detect Trichomonas vaginalis infection. J Infect Dis. 2004 May 15. 189(10):1926-31. [Medline].

  36. Hobbs MM, Lapple DM, Lawing LF, Schwebke JR, Cohen MS, Swygard H, et al. Methods for detection of Trichomonas vaginalis in the male partners of infected women: implications for control of trichomoniasis. J Clin Microbiol. 2006 Nov. 44(11):3994-9. [Medline]. [Full Text].

  37. Shafir SC, Sorvillo FJ, Smith L. Current issues and considerations regarding trichomoniasis and human immunodeficiency virus in African-Americans. Clin Microbiol Rev. 2009 Jan. 22(1):37-45, Table of Contents. [Medline]. [Full Text].

  38. Peterman TA, Tian LH, Metcalf CA, et al. High incidence of new sexually transmitted infections in the year following a sexually transmitted infection: a case for rescreening. Ann Intern Med. 2006 Oct 17. 145(8):564-72. [Medline].

  39. Wølner-Hanssen P, Krieger JN, Stevens CE, Kiviat NB, Koutsky L, Critchlow C, et al. Clinical manifestations of vaginal trichomoniasis. JAMA. 1989 Jan 27. 261(4):571-6. [Medline].

  40. Soper DE, Bump RC, Hurt WG. Bacterial vaginosis and trichomoniasis vaginitis are risk factors for cuff cellulitis after abdominal hysterectomy. Am J Obstet Gynecol. 1990 Sep. 163(3):1016-21; discussion 1021-3. [Medline].

  41. Grodstein F, Goldman MB, Ryan L, Cramer DW. Relation of female infertility to consumption of caffeinated beverages. Am J Epidemiol. 1993 Jun 15. 137(12):1353-60. [Medline].

  42. Fouts AC, Kraus SJ. Trichomonas vaginalis: reevaluation of its clinical presentation and laboratory diagnosis. J Infect Dis. 1980 Feb. 141(2):137-143. [Medline].

  43. Anderson BL, Cosentino LA, Simhan HN, Hillier SL. Systemic immune response to Trichomonas vaginalis infection during pregnancy. Sex Transm Dis. 2007 Jun. 34(6):392-6. [Medline].

  44. Bell C, Hough E, Smith A, Greene L. Targeted screening for Trichomonas vaginalis in women, a pH-based approach. Int J STD AIDS. 2007 Jun. 18(6):402-3. [Medline].

  45. Ryan KA, Zekeng L, Roddy RE, et al. Prevalence and Prediction of Sexually Transmitted Disease Among Sex Workers in Cameroon. Int. H STD AIDS. 1998;9:403-7:

  46. Chesson HW, Blandford JM, Pinkerton SD. Estimates of the annual number and cost of new HIV infections among women attributable to trichomoniasis in the United States. Sex Transm Dis. 2004 Sep. 31(9):547-51. [Medline].

  47. Kissinger P, Amedee A, Clark RA, Dumestre J, Theall KP, Myers L, et al. Trichomonas vaginalis treatment reduces vaginal HIV-1 shedding. Sex Transm Dis. 2009 Jan. 36(1):11-6. [Medline].

  48. Watts DH, Fazzari M, Minkoff H, Hillier SL, Sha B, Glesby M, et al. Effects of bacterial vaginosis and other genital infections on the natural history of human papillomavirus infection in HIV-1-infected and high-risk HIV-1-uninfected women. J Infect Dis. 2005 Apr 1. 191(7):1129-39. [Medline].

  49. Viikki M, Pukkala E, Nieminen P, Hakama M. Gynaecological infections as risk determinants of subsequent cervical neoplasia. Acta Oncol. 2000. 39(1):71-5. [Medline].

  50. Soper DE, Bump RC, Hurt WG. Bacterial vaginosis and trichomoniasis vaginitis are risk factors for cuff cellulitis after abdominal hysterectomy. Am J Obstet Gynecol. 1990 Sep. 163(3):1016-21; discussion 1021-3. [Medline].

  51. Zalonis CA, Pillay A, Secor W, Humburg B, Aber R. Rare case of trichomonal peritonitis. Emerg Infect Dis. 2011 Jul. 17(7):1312-3. [Medline].

  52. Cotch MF, Pastorek JG 2nd, Nugent RP, Hillier SL, Gibbs RS, Martin DH, et al. Trichomonas vaginalis associated with low birth weight and preterm delivery. The Vaginal Infections and Prematurity Study Group. Sex Transm Dis. 1997 Jul. 24(6):353-60. [Medline].

  53. Trintis J, Epie N, Boss R, Riedel S. Neonatal Trichomonas vaginalis infection: a case report and review of literature. Int J STD AIDS. 2010 Aug. 21(8):606-7. [Medline].

  54. Kreiger JN. Trichomoniasis in Men: Old Issues and New Data. Sex Trans Dis. 1995;22:83-96.:

  55. Martínez-García F, Regadera J, Mayer R, Sanchez S, Nistal M. Protozoan infections in the male genital tract. J Urol. 1996 Aug. 156(2 Pt 1):340-9. [Medline].

  56. Dopkins Broecker JE, Huppert JS. Trichomoniasis in adolescents: routine screening is advised for your patients at risk. Contemp Pediatr. Sept 2011;28-46.

  57. Huppert JS, Hesse EA, Bernard MA, Xiao Y, Huang B, Gaydos CA, et al. Acceptability of self-testing for trichomoniasis increases with experience. Sex Transm Infect. 2011 Oct. 87(6):494-500. [Medline]. [Full Text].

  58. James JA, Thomason JL, Gelbart SM, Osypowski P, Kaiser P, Hanson L. Is trichomoniasis often associated with bacterial vaginosis in pregnant adolescents?. Am J Obstet Gynecol. 1992 Mar. 166(3):859-63. [Medline].

  59. Thomason JL, Gelbart SM, Sobun JF, Schulien MB, Hamilton PR. Comparison of four methods to detect Trichomonas vaginalis. J Clin Microbiol. 1988 Sep. 26(9):1869-70. [Medline]. [Full Text].

  60. Kingston MA, Bansal D, Carlin EM. Shelf life' of Trichomonas vaginalis. Int J STD AIDS. 2003 Jan. 14(1):28-9. [Medline].

  61. Kissinger PJ, Dumestre J, Clark RA, Wenthold L, Mohammed H, Hagensee ME, et al. Vaginal swabs versus lavage for detection of Trichomonas vaginalis and bacterial vaginosis among HIV-positive women. Sex Transm Dis. 2005 Apr. 32(4):227-30. [Medline].

  62. Seattle STD/HIV Prevention Training Network. Examination of Vaginal Wet Preps. Available at Accessed: Dec 30, 2005.

  63. Patel SR, Wiese W, Patel SC, Ohl C, Byrd JC, Estrada CA. Systematic review of diagnostic tests for vaginal trichomoniasis. Infect Dis Obstet Gynecol. 2000. 8(5-6):248-57. [Medline]. [Full Text].

  64. Schwebke JR, Venglarik MF, Morgan SC. Delayed versus immediate bedside inoculation of culture media for diagnosis of vaginal trichomonosis. J Clin Microbiol. 1999 Jul. 37(7):2369-70. [Medline]. [Full Text].

  65. Ohlemeyer CL, Hornberger LL, Lynch DA, Swierkosz EM. Diagnosis of Trichomonas vaginalis in adolescent females: InPouch TV culture versus wet-mount microscopy. J Adolesc Health. 1998 Mar. 22(3):205-8. [Medline].

  66. Lobo TT, Feijó G, Carvalho SE, Costa PL, Chagas C, Xavier J, et al. A comparative evaluation of the Papanicolaou test for the diagnosis of trichomoniasis. Sex Transm Dis. 2003 Sep. 30(9):694-9. [Medline].

  67. Lara-Torre E, Pinkerton JS. Accuracy of detection of trichomonas vaginalis organisms on a liquid-based papanicolaou smear. Am J Obstet Gynecol. 2003 Feb. 188(2):354-6. [Medline].

  68. Wiese W, Patel SR, Patel SC, Ohl CA, Estrada CA. A meta-analysis of the Papanicolaou smear and wet mount for the diagnosis of vaginal trichomoniasis. Am J Med. 2000 Mar. 108(4):301-8. [Medline].

  69. Amsel R, Totten PA, Spiegel CA, Chen KC, Eschenbach D, Holmes KK. Nonspecific vaginitis. Diagnostic criteria and microbial and epidemiologic associations. Am J Med. 1983 Jan. 74(1):14-22. [Medline].

  70. Andrea SB, Chapin KC. Comparison of Aptima Trichomonas vaginalis transcription-mediated amplification assay and BD affirm VPIII for detection of T. vaginalis in symptomatic women: performance parameters and epidemiological implications. J Clin Microbiol. 2011 Mar. 49(3):866-9. [Medline]. [Full Text].

  71. Huppert JS, Batteiger BE, Braslins P, Feldman JA, Hobbs MM, Sankey HZ, et al. Use of an immunochromatographic assay for rapid detection of Trichomonas vaginalis in vaginal specimens. J Clin Microbiol. 2005 Feb. 43(2):684-7. [Medline]. [Full Text].

  72. Huppert JS, Mortensen JE, Reed JL, Kahn JA, Rich KD, Miller WC, et al. Rapid antigen testing compares favorably with transcription-mediated amplification assay for the detection of Trichomonas vaginalis in young women. Clin Infect Dis. 2007 Jul 15. 45(2):194-8. [Medline].

  73. Campbell L, Woods V, Lloyd T, Elsayed S, Church DL. Evaluation of the OSOM Trichomonas rapid test versus wet preparation examination for detection of Trichomonas vaginalis vaginitis in specimens from women with a low prevalence of infection. J Clin Microbiol. 2008 Oct. 46(10):3467-9. [Medline]. [Full Text].

  74. Nye MB, Schwebke JR, Body BA. Comparison of APTIMA Trichomonas vaginalis transcription-mediated amplification to wet mount microscopy, culture, and polymerase chain reaction for diagnosis of trichomoniasis in men and women. Am J Obstet Gynecol. 2009 Feb. 200(2):188.e1-7. [Medline].

  75. Brown HL, Fuller DA, Davis TE, Schwebke JR, Hillier SL. Evaluation of the Affirm Ambient Temperature Transport System for the detection and identification of Trichomonas vaginalis, Gardnerella vaginalis, and Candida species from vaginal fluid specimens. J Clin Microbiol. 2001 Sep. 39(9):3197-9. [Medline]. [Full Text].

  76. Hollman D, Coupey SM, Fox AS, Herold BC. Screening for Trichomonas vaginalis in high-risk adolescent females with a new transcription-mediated nucleic acid amplification test (NAAT): associations with ethnicity, symptoms, and prior and current STIs. J Pediatr Adolesc Gynecol. 2010 Oct. 23(5):312-6. [Medline].

  77. Diaz N, Dessì D, Dessole S, Fiori PL, Rappelli P. Rapid detection of coinfections by Trichomonas vaginalis, Mycoplasma hominis, and Ureaplasma urealyticum by a new multiplex polymerase chain reaction. Diagn Microbiol Infect Dis. 2010 May. 67(1):30-6. [Medline].

  78. Simpson P, Higgins G, Qiao M, Waddell R, Kok T. Real-time PCRs for detection of Trichomonas vaginalis beta-tubulin and 18S rRNA genes in female genital specimens. J Med Microbiol. 2007 Jun. 56:772-7. [Medline].

  79. Madico G, Quinn TC, Rompalo A, McKee KT Jr, Gaydos CA. Diagnosis of Trichomonas vaginalis infection by PCR using vaginal swab samples. J Clin Microbiol. 1998 Nov. 36(11):3205-10. [Medline]. [Full Text].

  80. Mayta H, Gilman RH, Calderon MM, Gottlieb A, Soto G, Tuero I, et al. 18S ribosomal DNA-based PCR for diagnosis of Trichomonas vaginalis. J Clin Microbiol. 2000 Jul. 38(7):2683-7. [Medline]. [Full Text].

  81. Van Der Pol B, Kraft CS, Williams JA. Use of an adaptation of a commercially available PCR assay aimed at diagnosis of chlamydia and gonorrhea to detect Trichomonas vaginalis in urogenital specimens. J Clin Microbiol. 2006 Feb. 44(2):366-73. [Medline]. [Full Text].

  82. Schwebke JR, Lawing LF. Improved detection by DNA amplification of Trichomonas vaginalis in males. J Clin Microbiol. 2002 Oct. 40(10):3681-3. [Medline]. [Full Text].

  83. Schwebke JR, Desmond RA. A randomized controlled trial of partner notification methods for prevention of trichomoniasis in women. Sex Transm Dis. 2010 Jun. 37(6):392-6. [Medline].

  84. Kissinger P, Mena L, Levison J, et al. A randomized treatment trial: single versus 7-day dose of metronidazole for the treatment of Trichomonas vaginalis among HIV-infected women. J Acquir Immune Defic Syndr. 2010 Dec 15. 55(5):565-71. [Medline]. [Full Text].

  85. Kissinger P, Secor WE, Leichliter JS, Clark RA, Schmidt N, Curtin E, et al. Early repeated infections with Trichomonas vaginalis among HIV-positive and HIV-negative women. Clin Infect Dis. 2008 Apr 1. 46(7):994-9. [Medline].

  86. Niccolai LM, Kopicko JJ, Kassie A, Petros H, Clark RA, Kissinger P. Incidence and predictors of reinfection with Trichomonas vaginalis in HIV-infected women. Sex Transm Dis. 2000 May. 27(5):284-8. [Medline].

  87. Klebanoff MA, Carey JC, Hauth JC, et al. Failure of metronidazole to prevent preterm delivery among pregnant women with asymptomatic Trichomonas vaginalis infection. N Engl J Med. 2001 Aug 16. 345(7):487-93. [Medline].

  88. Kigozi GG, Brahmbhatt H, Wabwire-Mangen F, et al. Treatment of Trichomonas in pregnancy and adverse outcomes of pregnancy: a subanalysis of a randomized trial in Rakai, Uganda. Am J Obstet Gynecol. 2003 Nov. 189(5):1398-400. [Medline].

  89. Cudmore SL, Delgaty KL, Hayward-McClelland SF, Petrin DP, Garber GE. Treatment of infections caused by metronidazole-resistant Trichomonas vaginalis. Clin Microbiol Rev. 2004 Oct. 17(4):783-93, table of contents. [Medline]. [Full Text].

  90. Mammen-Tobin A, Wilson JD. Management of metronidazole-resistant Trichomonas vaginalis--a new approach. Int J STD AIDS. 2005 Jul. 16(7):488-90. [Medline].

  91. Das S, Huengsberg M, Shahmanesh M. Treatment failure of vaginal trichomoniasis in clinical practice. Int J STD AIDS. 2005 Apr. 16(4):284-6. [Medline].

  92. Diav-Citrin O, Shechtman S, Gotteiner T, Arnon J, Ornoy A. Pregnancy outcome after gestational exposure to metronidazole: a prospective controlled cohort study. Teratology. 2001 May. 63(5):186-92. [Medline].

  93. Burtin P, Taddio A, Ariburnu O, Einarson TR, Koren G. Safety of metronidazole in pregnancy: a meta-analysis. Am J Obstet Gynecol. 1995 Feb. 172(2 Pt 1):525-9. [Medline].

  94. Carey JC and Klebanoff M, for the NICHD MFMU Network. Metronidazole treatment increased the risk of preterm birth in asymptomatic women with Trichomonas. Presented at the 20th Annual Meeting of the Society of Maternal-Fetal Medicine, Miami, FL, February 2000.

  95. Mann JR, McDermott S, Zhou L, Barnes TL, Hardin J. Treatment of trichomoniasis in pregnancy and preterm birth: an observational study. J Womens Health (Larchmt). 2009 Apr. 18(4):493-7. [Medline].

  96. Moodley P, Wilkinson D, Connolly C, Moodley J, Sturm AW. Trichomonas vaginalis is associated with pelvic inflammatory disease in women infected with human immunodeficiency virus. Clin Infect Dis. 2002 Feb 15. 34(4):519-22. [Medline].

  97. Hager WD. Treatment of metronidazole-resistant Trichomonas vaginalis with tinidazole: case reports of three patients. Sex Transm Dis. 2004 Jun. 31(6):343-5. [Medline].

  98. duBouchet L, Spence MR, Rein MF, Danzig MR, McCormack WM. Multicenter comparison of clotrimazole vaginal tablets, oral metronidazole, and vaginal suppositories containing sulfanilamide, aminacrine hydrochloride, and allantoin in the treatment of symptomatic trichomoniasis. Sex Transm Dis. 1997 Mar. 24(3):156-60. [Medline].

  99. Kim SR, Kim JH, Park SJ, Lee HY, Kim YS, Kim YM, et al. Comparison between mixed lysate antigen and α-actinin antigen in ELISA for serodiagnosis of trichomoniasis. Parasitol Int. 2015 Oct. 64 (5):405-7. [Medline].

Trichomonas vaginalis on a saline wet mount at 40X on the microscope. Several motile parasites transit through the field, surrounded by white blood cells and squamous epithelial cells.
Life cycle of Trichomonas vaginalis. T vaginalis trophozoite resides in female lower genital tract and in male urethra and prostate (1), where it replicates by binary fission (2). The parasite does not appear to have a cyst form and does not survive well in the external environment. T vaginalis is transmitted among humans, the only known host, primarily via sexual intercourse (3). Image courtesy of Centers for Disease Control and Prevention.
Trichomonas vaginalis. (A) Two trophozoites of T vaginalis obtained from in vitro culture, stained with Giemsa. (B) Trophozoite of T vaginalis in vaginal smear, stained with Giemsa. Images courtesy of Centers for Disease Control and Prevention.
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