Explaining T.V.

Trichomonas vaginalis is a common infection of the female genital tract that you might have to explain to a patient during your career/OSCEs/particularly awkward bus journey. Here are the main points and how you might want to go about explaining them to a lay person.

What is it?

TV is an infection caused by a parasite that sits in the vagina in women, and the water pipe in both men and women.

How did I get it?

It’s passed along through sexual contact, possibly by sharing sex toys as well, and it can also be transferred from a pregnant mother to her baby. You can’t get it from oral sex, anal sex, kissing, other physical contact or sharing (external) cutlery/seats/xbox controllers

How do I know if I’ve got it?

Half the time both men and women can be completely symptom-free, but usually symptoms will show themselves within a month of the infection occurring. Women might notice abnormal vaginal discharge with a strong smell, burning when you pee and sore itchiness around the vagina. Men might notice a thin white discharge from the penis and a burning sensation when peeing.

Can I be tested for it?

Yes. We offer the test to people with symptoms of TV or whose sexual partner has TV. Note that even if your partner tests negative you may still have it. It is often worth checking for other infections while you’re at it, as multiple ones can be transmitted at once. For women, we take a swab sample from the inside of the vagina, and we might ask for a urine sample too. For men we take a swab sample from the entrance to the water pipe and again, may require a urine sample. It might be a little uncomfortable but it doesn’t hurt.

When should I get the test?

As soon as you can, usually TV will show up within a few days of transmission. You can go to a genitourinary medicine (GUM) clinic, your GP or a sexual health clinic.

When will I get the results?

The results may be available immediately, if they can be looked at under the microscope straight away, otherwise it can take up to ten days.

How accurate are the results?

The tests are very good, but no test is 100% accurate, so sometimes you might get a negative result when you actually do have TV. This may be why people get different results from different clinics or why a partner may show as negative when you show as positive. It is very unlikely that it will say that you do have the infection when you don’t, however.

What’s the treatment? 

The treatment is either a single dose or week course of antibiotic tablets. If you take it as prescribed it’s 95% effective. Don’t drink alcohol for the duration of the treatment and for 48 hours afterwards. We might give you the antibiotics before the results are back if it looks clinically like it is TV. Your symptoms should go away within a few days.

When should I come back?

• If you notice pain in your tummy, then it may be something else causing the problem and we’ll need to check it out
• If you think you may have been infected again, or had unprotected sex before the course of antibiotics is finished
• If you vomited after taking the tablets
• If the symptoms don’t go away after a few days
• If your test was negative but you start to get symptoms

Can I treat it without antibiotics?

In short, no. If you don’t treat it you have a greater risk of contracting HIV and it can cause problems with pregnancy. In men if left untreated it can increase the risk of prostate cancer. Complimentary therapies have not been shown to work, and it doesn’t tend to go away by itself.

Can I have sex?

Avoid sex of any kind until you and your partner have completed a course of antibiotics. If you have to have sex, use a condom, but know that you can still pass on the infection.

Do I need to tell my partner?

It is very important that your current and/or recent sexual partners are informed so that they can get tested. If you are uncomfortable about contacting them yourself, the clinic can do it for you, anonymously. It is not a legal requirement to tell them, but it is very strongly advised, and I imagine you’d prefer to be told?

Will it affect my fertility?

There is no evidence to suggest that it affects your fertility, however it can affect a pregnancy. Some evidence suggests it can cause a premature birth, or a small baby. The baby can also be born with the infection.

How do I avoid it in future?

• Use condoms
• Avoid sharing sex toys, or use a new condom each time

Trichomoniasis Vaginalis

• Organism
  • protozoan
  • produces mechanical stress on cells and ingests fragments after cell death
• Symptoms usually 5-30 days after infection
  • asymptomatic
  • dysuria
  • vaginitis
  • urethritis
  • dyspareunia
  • fishy vaginal discharge
• Tests
  • Saline microscopy – 60-70% sensitive
  • Culture – 70-89%
  • NAATs – 80-90% 
• Prevention
  • condoms
• Treatment
  • Metronidazole PO single dose/week
  • Week course better for women with HIV