This STD Breaststrokes
Do you occasionally itch down there? Not every itch has to be a disease of course! But, there may be a common parasite breaststroking around in your vagina. This parasite is called Trichomonas vaginalis, or just the nickname “trich” to the initiated into the logo of those of us in the medical ‘know.’
1. Trichomonas vaginalis, also called Trich, is an STD, caught through sexual contact. but it’s not a virus or a bacteria but a parasite that exclusively infects the urogenital tract. It has four short front arms (flagella, if you must know) and a 5th appendage that is more tail than leg, as pictured below. The tail propels it through the marsh of the vaginal moisture and the arms sort of flail around in fairly jerky movements that wouldn’t be considered good technique in any pool, but it is kind of like a breaststroke. But then they are fairly easy to recognize when your gynecologist peers into a microscope onto a saline flooded drop of this moisture.
2. Trichamonas vaginalis is the most common curable STD world wide. When asked what is the most common STD a patient is likely to have, we usually turn to statistics, and then try to skirt around the HPV issue. HPV is prevalent in millions, but mostly we do not test for it, and few people usually site HPV when they consider STDs. If the vaccines have any promise at all, it would be to make HPV again a very rare disease. But we have often thought that chlamydia was then next most common STD followed by gonorrhea. But a new study shows that in at least one group of patients actually Trichomonas vaginalis, is more common than Chlamydia. But what is most important is to get checked, for any STDs every time you have a new partner. You and your gyno can get together and decide which tests are best and how frequently to have them.
3. Trichamonas vaginalis is easy to treat, don’t ignore symptoms. Do we recommend scratching and bearing it? Resoundingly no, and for the rest of you who carry trich and are asymptomatic, you need treatment too. Untreated, yes, it probably will go away; but spontaneous clearance can take 5 years! While often asymptomatic, it is no less contagious than when symptomatic. Sex when bleeding? It is not ever prohibited to have sex when you bleed, but interestingly you can catch it more easily on your period as the iron in the menstrual blood makes trich more easily attach to the vaginal wall which is the initial onslaught of attack.
4. Women who have had hysterectomies can catch and transmit Trichamonas vaginalis too. And all these critters need is the vaginal wall to attach, so after a hysterectomy it is much more difficult to get the GC and CT infections formally known by lots of colorful expletive such as the Clap, and after a hysterectomy you can still catch the critters: there is no reduced risk to getting trich after the uterus has been removed. It is generally very treatable, although a few of the trich species have become resistant to the
5. Other STDs are more easily acquired if exposed when a guy or you have Trichamonas vaginalis. While always regarded as more of an annoyance than a serious disease, there is new evidence to the contrary. Not only do women have an easier time picking up STDs like herpes (HSV), HIV, and HPV (Human Papilloma Virus), they have a harder time clearing organisms the immune system may often be able to resolve. For those who don’t clear the HPV virus they are more likely to have precancerous changes of the cervix. At best estimate trich can be responsible for just a minute number of cervical cancer cases each year, and probably only a co-factor if this data is even accurate.
6. This infection can produce odor., but not in everyone, as some vaginal odors come from actual vaginal chemistry. And what about odor, and more odor? Even if you’ve been cleared of any prior infection, some just persist in having an odor without any more breaststrokers swimming around in the vagina. Apparently your genetics can factor into this odor problem and if you have the sort of biochemistry that makes you unable to metabolize this stuff called trimethylaminine and concentrations build up and even spill into your urine causing: trimethylaminuria, or cause the stuff to pour out of your sweat glands. So some women may get odor without infection, or have worse odor with even mild infections, or just due to normal fluctuations in the bacteria counts. And your diet provides the precursors that your body makes into this odorous compounds. Reducing dietary precursors, like taking the antibiotic orally might help those women get rid of their odor although clearing the infection works just as well with the antibiotic vaginal creams.
7. Discharge can be caused by this infection. And it can cause a fairly raging discharge and discomfort, or just be sitting quietly around for your gyno to stumble on during your pap smear. And it can be similar in men: from lots of symptoms to not many symptoms of infection at all. There are no FDA approved DNA tests that help us make that diagnosis, but often the organism can be found scooting across the slide during direct microscopic examination of vaginal discharge. When gynos examine the discharge they perform a test called a wet mount which suspends the discharge in a droplet of saline fluid so that the organisms can be seen better. So come in for an appointment! 217-356-3736.
8. Resistant infections are still treatable. There are some infections that seem to stubbornly persist in spite of standard treatment, because they are resistant to common antibiotics. A report from Medscape claims that Trich is getting exceedingly common, in fact new statistics indicate T vaginalis infections in the USA is estimated to be 3.1% overall and is higher in certain risk groups. It’s not just important to treat Trich before it is spread to your sex partner; it is important to treat because trichomoniasis is associated with other adverse gyno outcomes of pregnancy and increased risk for HIV infection. You may suspect you have this if your discharge is frothy and either yellow or green and a lot of irritation and some itching.It has been a standard to use metronidazole for treatment, but we are seeing some resistance and we now also use tindazole. The vaginal gels do not have the potency of oral medication, and we are getting away from recommending the vaginal gel just for Trich.
9. Alternative treatments are possible. For those women who are resistant to the standard medicines we can try compounded medication using paromomycin cream can be an alternative, as can using vaginal boric acid. Use of the spermacide nonoxynol-9 and betadine douches do work in some cases, but usually not. the resistance of trichomonas to standard treatments is going to be a topic we will be watching to gab about with you, so tune back from time to time on this topic!