Trichomoniasis is a sexually transmitted infection (STI) that can cause infertility and increase susceptibility to HIV infection. Both men and women can get it, but women are infected at higher rates than men. On a global scale, it is more common than chlamydia or gonorrhoea, and yet most people have never heard of it. GP and specialist in womens' health Dr Caoimhe Hartley spoke to Claire Byrne about the condition:
"It is the most common viral STI and it’s definitely not talked about as much as we would talk about things like chlamydia and gonorrhoea that we would be more familiar with. In Ireland, it’s actually a reportable condition, so if you get a positive test that has to be reported. So we do have figures to work with on this."
One of the issues with trichomoniasis is that it can easily go undetected, Dr Hartley says:
"You can carry it, you can have it, you can have an infecton with it, and have no symptoms whatsoever."
Dr Caoimhe quotes some recent statistics on the gender breakdown of the disease and proportion of people living with trichomoniasis who probably don’t know they have it:
"Women tend to be infected a lot more than men. In Ireland, for example in 2021 about 93% of the cases were actually female and obviously, a much smaller 7% then were male. But of the women who were infected, 70% tend to be asymptomatic, so they have no symptoms whatsoever."
People won’t present for testing if they are unaware of the infection, Dr Hartley says. This is unfortunate, as she says the infection can cause long term health problems.
Trichomoniasis can flare up immediately in its acute form; or it can lie dormant in the body and flare up later. With the acute version, Dr Hartley says, nasty symptoms start to show up straight away in both men and women, including discharge and pain when urinating or having sex – listen back to Claire’s the full interview with Dr Hartley for more details on what to look out for. In the non-acute version, Dr Hartley says, the disease can incubate in the body for up to three months before there are any outward signs of infection.
In infected women, the protozoa (the parasite that causes trichomoniasis) can attack the pelvic area and reduce or even destroy fertility, as Caoimhe explains:
"It can cause a condition called pelvic inflammatory disease. So pelvic inflammatory disease is where we see inflammation in the gynaecological tract. So in the womb, in the fallopian tubes, in the pelvis. And this can lead to, or increase the risk of sub-fertility or infertility."
Further complications include a range of urinary infections such as cystitis. Complications of trichomoniasis can increase the likelihood of becoming infected with another STI, Dr Hartley says:
"It can increase how likely you are to develop HIV."
For women in Ireland who think they might have trichomoniasis, testing is available through the local G.P. The doctor takes a vaginal swab and sends it to a lab. It then takes time for the sample to be processed and the result sent back. In the US, they have a more convenient option, which Caoimhe says has featured in a recent report:
"In the article that came out recently, what they were talking about was a new test that you can do at home. This is a blood test that takes a little drop of blood and what it looks for is an antibody that is specific to trichomoniasis. So you’ll only develop this antibody if you have this infection. The results are displayed a bit like a Covid test or a pregnancy test."
This test isn’t widely available yet, but Dr Hartley says that when it is, it could have an impact on some of the medical conditions caused by trichomoniasis:
"It will be interesting to see what the knock-on effect of people being able to test at home is, in terms of fertility rates and pelvic inflammatory disease and so on."
Dr Hartley talks about the wider picture on STIs in Ireland and how Covid may have affected both testing and rates of infection. She says the use of contraception has been on the increase over the past 10 years, but she says that methods to prevent pregnancy don’t necessarily protect against disease:
"We might see a decline in condom use as well, because people are sometimes using condoms thinking, OK, I’m going to prevent pregnancy with this, but might not realise that, if you’ve other contraception on board, you still need to use a barrier method like a condom to protect yourself from developing an STI."
Dr Hartley talks about the male contraceptive pill and the signs and symptoms or trichomoniasis in the full interview here.