by Rima Himelstein, M.D.

Heard about "trich"? Trichomoniasis is one of the most common sexually transmitted diseases (STDs). It is caused by Trichomonas vaginalis, a type of tiny parasite. When I find the infection in my patients, I often show them the trich under the microscope. Seeing the infection can be the key to getting teens to change their risky behaviors -- sometimes being spooked changes teens' behaviors.

It's a creepy infection, which is easily spread. Trich is passed from one person to another through unprotected sexual contact. Both females and males can get this infection.   And because the organism can survive for about one and a half hours on a wet sponge, transmission can possibly occur through shared washcloths, communal bathing, or during routine child care.

Many people have this skeleton in their closet. By some estimates, millions of people have trichomoniasis. It is the most common treatable STD. Experts estimate that at least one out of four new infections occurs in teen girls. In one study of 467 asymptomatic teen girls, 14% were infected with trich. There is evidence that it is more common than gonorrhea in adolescent girls. But unlike gonorrhea, state departments of health do not require reporting of trich, so we can’t be sure how many people have it.

It’s the ghost STD.  Up to half of all infected females and more than 90% of males have no symptoms.  In females, trich may be confused with another type of vaginal infection known as bacterial vaginosis.

Trich symptoms may be masked and remain hidden for days or months after infection.

Females may experience:

  • A bad-smelling discharge from the vagina
  • Vaginal burning and itching
  • Worsening of symptoms with menstruation

Males may experience:

  • Irritation and itching in the penis
  • Pus coming from the tip of the penis

Both females and males may experience pain or discomfort with urination and during sexual intercourse.

Beware! The risk of trich increases with:

  • Multiple partners
  • History of other sexually transmitted diseases
  • Previous episodes of trich

A positive test is an eerie sight. Doctors usually diagnose trich by looking at a sample of vaginal fluid under the microscope and identifying the wiggling organisms. (Males are not routinely tested.) Microscopic examination only identifies about half of infections because it requires that a large number of the parasites be present. That is why it is important to get reexamined if symptoms persist.

Untreated trich can hang around for a spell. Without treatment the infection can linger for years. Untreated trich is linked to pelvic inflammatory disease and can increase the risk of getting HIV. The good news is that trich can be treated with an antibiotic taken by mouth (usually metronidazole) in one megadose. Treatment with a vaginal cream is not as effective and is not recommended. The infected person’s sexual partner should be treated at the same time or reinfection may occur. Reinfection is common; one in five people gets the infection again after being treated. 

Unlike Halloween, sex is not for kids. Trich itself is not a life-threatening illness, and it is easy to treat.  But it shows that someone is having unprotected sex and is taking big risks.  So they may actually have other STDs—maybe one that is not treatable—at the same time. Like any other STD, the best way to prevent trich is to abstain from sex. To lower risk, condoms should be used.

Does your teen know the risks of trich?

Rima Himelstein, M.D., is a Crozer-Keystone Health System pediatrician and adolescent medicine specialist.

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