Sex After a Trichomoniasis Treatment

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Question: Why Do I Have to Wait to Have Sex After a Trichomoniasis Treatment?

Worldwide, trichomoniasis is the most common curable sexually transmitted disease (STD). It is caused by the parasite Trichomonas vaginalis. Trichomoniasis  usually causes itching and a foul-smelling discharge in women. It also causes pain during urination or sex. In men, trichomoniasis is often asymptomatic. In other words, men with trichomoniasis often have no symptoms.

This means they may not learn they are infected unless they have a female partner who tests positive. 

Trichomoniasis can be diagnosed through a number of different tests including urine tests. It can also be diagnosed using cultures. These can be performed on samples taken by a doctor or on self-collected vaginal and urethral swabs. However, trichomoniasis is most commonly diagnosed by direct observation under a microscope. This is done using a test known as a wet mount. For a wet mount, a vaginal smear is placed on a slide and then examined. 

Trichomoniasis can be more difficult to diagnose in men than in women. Therefore, some doctors will presumptively treat an infected woman's male sexual partner. That means they treat him without waiting for a positive test as well as if he does not test positive. The goal is to keep him from reinfecting her after she finishes treatment.

Answer: Because You Don't Want to Be Reinfected

Sometimes STD treatment isn't just about taking a drug.

When you're being treated for trichomoniasis, you also have to give the drug enough time to eradicate the parasite from your system. This is why when you're undergoing trichomoniasis treatment, you are generally told to wait at least a week after you and your partner have begun treatment to start having sex.

It takes that long to cure trichomoniasis. Your doctor wants to make certain that the STD treatment has enough time to work in both of your bodies. That way you can avoid reinfecting each other.

Another reason to wait a week after treatment to start having sex is to see if STD symptoms reappear. Trichomoniasis treatment is not always 100 percent effective. Sometimes an infection is knocked back but not eliminated. In such cases, a week gives symptoms some chance to show up again. Then one or both partners can return for treatment. Treatment failure is more common with single-dose treatments than it is with multiple-dose treatments. In addition, there is some data suggesting that tinidazole is more effective treatment than metronidazole. Using tinidazole may decrease the chance of a recurrence.

It is a better idea to hold off on sex until treatment has time to work and the infection has been eliminated. However, if you simply can't wait to have sex, you can still make it safer. You just have to consistently practice safe sex during treatment. That's not ideal. Still, with STDs that are transmitted by fluids and treated with antibiotics, the risk of re-infection is usually relatively low.

However, if you are being treated with a topical creme or suppository, safe sex may not be an option. Some of those products degrade latex condoms and other barriers.

If you are concerned about your ability to abstain from sex during STD treatment, talk to your doctor. Discuss the potential risks for you and your partner. Seek his or her advice about how to minimize them.

An Important Note About Trichomoniasis and HIV: There is some research suggesting that trichomoniasis infections can elevate viral load in HIV patients. This could increase the possibility of spreading HIV to a sexual partner.

Research also suggests that individuals with trichomoniasis  have a higher susceptibility to HIV infection than people who do not have trichomoniasis.

The complex relationship between trichomoniasis and HIV is important to be aware of. It means trichomoniasis treatment could play an important role in reducing the spread of HIV in high-risk populations. Therefore, proper treatment is important. Studies have shown an increased efficacy fpr multi-dose trichomoniasis treatments in HIV-positive women. Therefore, HIV-positive women with trich might want to ask for a seven-day treatment regimen instead of a single-dose treatment. However, if you do not believe that you are capable of taking seven days of pills correctly, be honest with your doctor. You should stick to the single-dose treatment and consider being re-tested after a month to see if it worked.

Sources:

Bachmann LH, Hobbs MM, Seña AC, Sobel JD, Schwebke JR, Krieger JN, McClelland RS, Workowski KA. Trichomonas vaginalis genital infections: progress and challenges. Clin Infect Dis. 2011 Dec;53 Suppl 3:S160-72. doi: 10.1093/cid/cir705.

Howe K, Kissinger PJ. Single-Dose Compared With Multidose Metronidazole for the Treatment of Trichomoniasis in Women: A Meta-Analysis. Sex Transm Dis. 2017 Jan;44(1):29-34.

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