Causes and Risk Factors of Trichomoniasis

trichomoniasis causes
© Verywell, 2018 

Trichomoniasis is a sexually transmitted disease caused by a sexually transmitted organism known as Trichomonas vaginalis or T. vaginalis. The good news is that trichomoniasis is the most common curable sexually transmitted infection in the United States and around the world.

However, when left untreated, it is associated with an increased risk of a number of long-term health problems. These include HIV, pelvic inflammatory disease, and various complications of pregnancy.

Unfortunately, many cases of trichomoniasis are left untreated because the disease is often asymptomatic. Therefore, it frequently goes undetected in populations where there isn't routine screening. 

Common Causes

Trichomoniasis is caused by Trichomonas vaginalis. Unlike many organisms that cause sexually transmitted diseases (STDs),  T. vaginalis is neither a bacteria or a virus. It is a protozoa. More specifically, it is a protozoan flagellate. That means that trichomonas is a one-celled organism with a tail (flagellum) that it uses to swim around. Under a microscope, these parasites are easy to recognize on a vaginal swab. The big round head and long tail of T. vaginalis looks like nothing else that is commonly found in a vaginal sample. 

The trichomonas parasite is transmitted by exposure to infected secretions, generally vaginal fluid or semen. The parasite can infect the cervix, vagina, and the urethra in women and the urethra in men.

It may also be able to infect the rectum or the throat.

Trichomoniasis symptoms may never appear, or they may appear months or years after infection. Women are more likely to have symptoms than men, and they are also more likely to be treated. This can be problematic as having an untreated partner means there is a high risk of re-infection.

This is also why people are encouraged to be sexually abstinent during treatment.

Lifestyle Risk Factors

Reliably and consistently practicing safe sex has been shown to be an effective way of preventing trichomoniasis. If you use condoms or other barriers every time you have sex, it is relatively unlikely that you will be exposed to this disease. Similarly, if both you and your partner have been screened for STDs, test negative for trichomoniasis, and are in a mutually monogamous relationship, your risk is negligible. 

There are several groups who have higher than average rates of trichomoniasis. These groups include:

  • non-Hispanic black women
  • incarcerated individuals
  • STD clinic patients
  • recent drug users
  • people infected with HIV

It is thought that most cases of trichomoniasis are spread through heterosexual vaginal intercourse. Research suggests that it is possible to transmit trichomoniasis through both oral sex and anal sex. However, it is unclear whether people have sustained infections at those sites. Unfortunately, our understanding of the role of anal and oral sex in trichomoniasis transmission is complicated by the fact that doctors rarely test for trichomoniasis at those sites. 

Sources:

Ladd J, Hsieh YH, Barnes M, Quinn N, Jett-Goheen M, Gaydos CA. Female users of internet-based screening for rectal STIs: descriptive statistics and correlates of positivity. Sex Transm Infect. 2014 Sep;90(6):485-90. 

Meites E, Gaydos CA, Hobbs MM, Kissinger P, Nyirjesy P, Schwebke JR, Secor WE, Sobel JD, Workowski KA. A Review of Evidence-Based Care of Symptomatic Trichomoniasis and Asymptomatic Trichomonas vaginalis Infections. Clin Infect Dis. 2015 Dec 15;61 Suppl 8:S837-48. doi: 10.1093/cid/civ738. 

Press N, Chavez VM, Ticona E, Calderon M, Apolinario IS, Culotta A, Arevalo J, Gilman RH; Working Group on AIDS in Peru. Screening for sexually transmitted diseases in human immunodeficiency virus-positive patients in Peru reveals an absence of Chlamydia trachomatis and identifies Trichomonas vaginalis in pharyngeal specimens. Clin Infect Dis. 2001 Mar 1;32(5):808-14.

Rogers SM, Turner CF, Hobbs M, Miller WC, Tan S, Roman AM, Eggleston E, Villarroel MA, Ganapathi L, Chromy JR, Erbelding E. Epidemiology of undiagnosed trichomoniasis in a probability sample of urban young adults. PLoS One. 2014 Mar  13;9(3):e90548. 

Secor WE, Meites E, Starr MC, Workowski KA. Neglected parasitic infections in the United States: trichomoniasis. Am J Trop Med Hyg. 2014 May;90(5):800-4.