Fast Five Quiz: Sexually Transmitted Infections

Michael Stuart Bronze, MD


February 28, 2022

Trichomoniasis symptoms in women range from none to severe pelvic inflammatory disease. Women with trichomoniasis frequently report an abnormal vaginal discharge, which may be purulent, frothy, or bloody. Although frothy vaginal discharge is thought to be the classic presentation of trichomoniasis, women with trichomoniasis also commonly report:

  • Abnormal vaginal odor (often described as musty)

  • Vulvovaginal itching, burning, or soreness

  • Dyspareunia (pain during sexual intercourse), often the major complaint

  • Dysuria (pain during urination)

  • Postcoital bleeding

  • Lower abdominal pain

Trichomonas vaginalis is most commonly isolated from vaginal secretions in women and urethral secretions in men. Although T vaginalis has not been isolated from oral sites, evidence suggests that it may cause sexually transmitted oral infection in rare cases. Rectal prevalence of T vaginalis among men who have sex with men appears low.

Nearly half of infected women and nearly all infected men are asymptomatic. One third of asymptomatic women become symptomatic within 6 months. Because of this, a lack of sexual history should not be used to rule out T vaginalis infection as a possible diagnosis. Men with trichomoniasis are more likely than women to be asymptomatic and tend to have much faster natural disease resolution.

Topical metronidazole and other antimicrobials are not efficacious and should not be used to treat trichomoniasis. According to the latest CDC guidelines, the recommended treatment regimens for trichomoniasis are:

  • Women: metronidazole 500 mg orally twice daily for 7 days

  • Men: metronidazole 2 g orally in a single dose

  • Alternative regimen for women and men: tinidazole 2 g orally in a single dose

Learn more about the presentation of trichomoniasis.


Comments on Medscape are moderated and should be professional in tone and on topic. You must declare any conflicts of interest related to your comments and responses. Please see our Commenting Guide for further information. We reserve the right to remove posts at our sole discretion.