Trichomoniasis and Other
Sexually Transmitted Diseases
FACTS ABOUT TRICHOMONIA-
SIS AND OTHER SEXUALLY
TRANSMITTED DISEASES: Tricho-
moniasis and other sexually trans-
mitted diseases (STDs) may pose
both long- and short-term health risks
to men and women. A brief descrip-
tion of the most STDs, specific facts
about trichomoniasis, and informa-
tion on vaginal infections are listed
below:
Question: What is trichomoniasis?
Answer: Trichomoniasis is one of
the most widespread sexually trans-
mitted diseases in the United States.
Its incidence in the population was
estimated at 2.3 million in 1977 and
may have reached 2.8 million during
1978. It is an infection found in the
genital and urinary tracts of both men
and women usually between the ages
of 16 and 35, when sexual activity is at
a peak.
Question: What causes trichomoni-
asis?
Answer: Unlike other forms of sex-
ually transmitted disease, tricho-
moniasis is caused by the presence of
a parasite known as the trichomonad.
Despite good hygienic practices,
once transmitted, the genital or u ri-
nary tract makes a perfect environ-
ment for the parasite to exist and
multiply.
Question: What are the symptoms
of trichomoniasis in the female?
Answer: According to Danforth's
text on Obstetrics and Gynecology
(1977), symptoms may include some
or all of the following: itching and
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irritation of the vulva, and a greenish-
gray discharge often containing small
bubbles. Some women have noted a
slight burning sensation during uri-
nation.
Question: What are symptoms of
trichomoniasis in the male?
Answer: Males are usually asymp-
tomatic carriers of the disease - that
is, they experience no symptoms but
can unknowingly infect or reinfect
their sexual partners. This is why it is
important that men be informed if the
female sexual partner contracts the
disease. Occasionally the male may
experience painful urination in asso-
ciation with trichomoniasis.
Question: What are sexually trans-
mitted diseases?
Answer: These are diseases which
may be spread by sexual contact.
STDs, as they are commonly known,
may occu r because of the presence of
a parasite (as in trichomoniasis) or
due to a bacterial infection (such as
those that cause gonorrhea or syphi-
lis). Often, sexually transmitted dis-
eases have a ping-pong effect. They
can be transferred from one sexual
partner to another and back again
unless both receive proper treatment.
Question: What is the difference
between a sexually transmitted dis-
ease and a venereal disease?
Answer: Physicians believe that
venereal diseases are always sexually
transmitted, while some STDs may be
contracted via contact with toi lets,
articles of clothing or towels which an
infected person has recently used.
Question: Doesn't the government
monitor the incidence of venereal
disease?
Answer:Yes. The Center for Dis-
ease Control (CDC) receives weekly
reports on the incidence of five
venereal diseases from local public
health offices. For CDC reporting
purposes, gonorrhea, syphilis, chan-
croid, granuloma inguinale, and
lymphogranuloma venereum (LGV),
are defi ned as "reported venereal
diseases." However, other sexually
transmitted diseases may also be
hazardous, even though they are not
monitored by CDC.
Question: Why is the rate of reinfec-
tion of sexually transmitted diseases
like trichomoniasis so high?
Answer: Trichomoniasis and other
sexually transmitted diseases are
nearly impossible to eradicate unless
both sexual partners are treated. The
high rate of reinfection undoubtedly
means that one or more sexual part-
ners has not been informed and
treated.
Question: What kinds of medication
are available for treatment of t richo-
moniasis?
Answer: The most effective treat-
ment currently available is the oral
drug Flagyl (metronidazole). Al-
though topical creams may reduce
the incidence of swelling or itching in
the vulva, they rarely eradicate the
parasite causing the infection.
Question: Can Flagyl cause adverse
side effects, such as cancer?
Answer: A recent study conducted
at the Mayo Clinic revealed no inci-
dence of cancer in 767 women given
at least one prescri ption of metroni-
dazole for trichomoniasis infection
between 1960 and 1969. Studies in
rodents involving long-term adminis-
tration of metronidazole at dosage
levels markedly in excess of the
therapeutic dose have shown evi-
dence of tumorigenic activity. Evi-
dence of human tumorigenic poten-
tial attri butable to Flagyl has not been
confirmed during more than 16 years
of clinical experience.
Question: What medications are
used in the treatment of other sexually
transmitted diseases?
Answer: Usual treatment for gonor-
rhea and syphilis is penicillin, or other
antibiotics if the person is allergic to
penicillin. Both gonorrhea and syphi-
lis may cause damage to an unborn
child during the prenatal or delivery
stages if left untreated in the mother.
Question: What preventive methods
can women use to avoid trichomonia-
sis and other forms of sexually trans-
mitted diseases?
Answer: Dr. Leonard Cibley, Assis-
tant Clinical Professor, Boston Uni-
versity School of Medicine, advises
his patients to avoid the use of tight
support garments and panty hose,
which may aggravate infection by
interfering with good hygiene. Use of
a condom during intercourse can also
help prevent infection. However, the
most important way to prevent the
spread of STDs is to make sure all
infected partners are informed and
seek medical treatment.
Question: What are some other
sexually transmitted diseases men
and women should be aware of?
Answer: Herpes simplex" (genital
herpes) is a virus. It is different from
herpes simplex I which produces cold
sores and fever blisters. Both men
and women can contract herpes II.
Lesions appear on the penis or ureth-
ra in men and on the external genital
area, cervix or vagina in women.
Herpes II can also be passed to babies
via the birth canal, and can be fatal to
the newborn infant.
Occupational Health Nursing, August 1979
Non-Gonococcal Urethritis or
NGU is sometimes caused by forms
of the chlamydia trachomatis bac-
teria, but 50 percent of NGU infec-
tions are not identifiable. However,
none are caused by the gonococcus
bacteria found in gonorrhea, hence
the name NGU. Approximately 2.5
million men were diagnosed as car-
riers of NGU in 1977, of which 15
percent were thought to have tricho-
moniasis. Women may have no signs
of NGU but can pass the disease to
offspring during delivery.
Lymphogranuloma venereum or
LG V is the result of another strain of
chlamydia trachomatis and is con-
sidered a reportable venereal disease
by the Center for Disease Control. It
affects both men and women but is
not as widespread as gonorrhea,
syphilis or trichomoniasis.
Chancroid is probably sexually
transmitted in both sexes through
open lesions caused by this bacterial
infection. It is also considered a
venereal disease by the CDC and can
be treated with antibiotics.
Non-specific Vaginitis is a relatively
mild but very common vaginal infec-
tion that may be spread by sexual
contact. Caused by bacteria, hemo-
phylous vaginal is, sym ptoms may
include a grayish, malodorous dis-
charge and slight irritation. It is
treated with antibiotics.
Crab lice and scabies may occur in
both sexes as a result of direct
contact with an infected person, not
necessarily via intercourse. These
mites cause severe itching and in
some cases lesions. Both are treated
with topical ointments.
Question: What are vaginal infec-
tions?
Answer: Vaginal infections are the
most common of all gynecologic
infections; in fact most women will
have at least one type of vaginal
infection during their lifetime. Vaginal
infections such as monilia or candida
albicans can be influenced by many
factors: infection or reactions to
harsh douches, poor hygiene, agents
such as soap, detergents, deodorants,
toilet paper dyes, and locally applied
medications. Factors that occasion-
ally may contribute to the growth of
vaginal infections are diabetes, anti-
biotics, onset of pregnancy and oral
contraceptives. Avoidance of tight
fitting garments, especially during
warm weather also helps reduce
chance of vaginal infections.
SEXUALL Y TRANSMITTED DIS-
EASE DIAGNOSED IN 20 PERCENT
MORE PA TlENTS IN 1978: Diag-
nosed cases of trichomoniasis, one of
the most widespread sexually trans-
mitted diseases in the United States,
may have increased more than 20
percent in 1978 over the previous
year, according to figures released by
G.D. Searle & Co.
Available statistics indicate that
more then 2.8 million cases of tricho-
moniasis were identified and treated
during the year. This compares with
fewer than 1 million reported cases of
gonorrhea and 21,000 reported cases
of syphilis in the same period.
The estimate is based on marketing
data for medications used in treating
the disease, which appears to have
reached serious proportions in recent
years. The U.S. Center for Disease
Control recently warned that tricho-
moniasis and other little-known vene-
real diseases, not reported to health
authorities in many states, are
becoming a major health problem.
Caused by a microscopic parasite,
trichomoniasis produces an irritating
vaginal infection in women, but usu-
ally causes no symptoms in men.
Thus men frequently go untreated
and are unsuspecting carriers of the
disease.
"Males rarely experience the itch-
ing, burning and other discomfort
females do, and therefore may not
realize they have contracted tricho-
moniasis," said Dr. Frederick Fleury
of Southern Illinois University. "For
this reason, both partners should
consult their physicians and receive
treatment if necessary."
Dr. Fleury pointed out that the trend
toward more frequent diagnosis of
the disease may be an important step
toward its eradication.
The most effective treatment avail-
able is a drug called Flagyl (metro-
nidazole), which can be taken orally
by both men and women. Dr. Allen
Charles of Michael Reese Hospital in
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TRICHOMONIASIS AND OTHER STDs
Chicago commented on his clinical
experience with the drug:
"Topical creams may well eliminate
the itching and burning women
experience, but are not sufficient to
kill the parasite in both partners.
Since concu rrent treatment is the
only way to stem the high rate of
reinfection, metronidazole (Flagyl)
should be prescribed."
Dr. Charles noted that trichomonia-
sis can rarely be cured by douching or
other hygienic practices since the
parasite may invade the urogenital
tract of both sexes.
According to Dr. Rodney P. Gwinn
of Searle, which manufactures Flagyl,
the drug is the only treatment for
trichomoniasis in the United States
which has been demonstrated effec-
tive in clinical studies.
He pointed out that patients should
not consume alcohol while using
Flagyl, and that use of the drug
should be avoided during early preg-
nancy. He said the prescription drug
has rarely been associated with seri-
ous side effects in humans since its
introduction in 1963.
ONE IN FIVE AMERICAN WOMEN
MA Y SUFFER FROM TRICHOMONI-
ASIS DURING LIFETIME: During
their lifetimes as many as one in five
American women may suffer from
trichomoniasis, a sexually transmit-
ted disease caused by the tricho-
monad parasite, according to a recent
report in Medical Times. According to
physicians, the condition isespecially
common in men and women between
the ages of 16 and 35 who are sexually
active.
Trichomoniasis, according to Dr.
John Hume, author of the article, is
present in all segments of the popula-
tion. Private practice physicians cur-
rently see two cases oftrichomoniasis
for every case of gonorrhea. Since it is
usually sexually transmitted, there
may also be a high rate of reinfection
if all partners do not receive treat-
ment.
In a study recently completed by
the U.S. Center for Disease Control,
eight clinics specializing in treatment
of sexually transmitted disease
(STDs) were monitored. The eight
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ranged from large urban areas like
Detroit, Michigan, to smaller popula-
tions such as DeKalb County, Geor-
gia. The incidence of trichomoniasis
ranked as one of the three most
prevalent STDs treated, along with
gonorrhea and non-specific vagi nitis.
The presence of trichomonads in
the genital and urinary tracts may
also signal the possibility of other
infections.
"Patients with trichomoniasis are at
a greater risk of havi ng other diseases
than the population at large," com-
mented Dr. Hume, who is dean emeri-
tus of The Johns Hopkins University
School of Hygiene and Public Health.
"The association of trichomoniasis
and vaginal candidiasis, for example,
has long been recognized. Studies
consistently show that 10-20 percent
of women with trichomoniasis also
have candida."
Common symptoms of trichomoni-
asis in the female include itching, a
greenish-gray discharge often con-
taining small bubbles and a burning
sensation during urination.
TRICHOMONIASIS IN THE MALE
- A SILENT THREAT TO SEXUAL
HEAL TH: Although men seldom
experience the pain or discomfort
from trichomoniasis that women do,
there is new evidence that untreated
males may not only infect their sexual
partners but could also suffer sig nifi-
cant health problems of their own.
According to Dr. Michael Rein,
Assistant Professor of Medicine at the
University of Virginia:
"Trichomoniasis can cause estab-
lished infection in men and may be
responsible for inhibiting the move-
ment of sperm because of toxic
products produced by the parasite."
Moreover, the untreated male with
trichomoniasis is frequently a "car-
rier" of the disease. Because he
usually experiences no symptoms, he
unknowingly infects or reinfects the
female, who usually seeks treatment
because of the annoying symptoms
experienced in women. Female
symptoms include itching, burning
and vaginal discharge of a grey-green
color.
The disease can often bediagnosed
in male sexual partners through sim-
ple diagnostic procedures performed
in the doctor's office, and highly
effective treatment is available.
An alarming reinfection rate
through sexual contact has caused
trichomoniasis to reach epidemic
proportions, now estimated at about
2.8 million cases annually in the
United States in 1978. According to
the American College of Obstetri-
cians and Gynecologists, greater
responsibility and knowledge among
men that trichomoniasis could
threaten their own long-term health
- as well as that of their sexual
partners - is essential in the elimina-
tion of the disease among both sexes.
SUCCESSFUL DIAGNOSIS OF
TRICHOMONIASIS KEY TO
TREA TMENT: Trichomoniasis, an
infection caused by the presence of a
parasite, is one of the most wide-
spread forms of vaginitis. Most forms
of vaginitis are accompanied by
annoying physical symptoms, but
unless proper diagnosis is obtained it
is easy to confuse one type for
another.
Most physicians recommend a pro-
cedure called a "wet smear" for
detecting trichomoniasis. A small
drop of vaginal discharge, taken while
the patient undergoes routine exami-
nation, is mixed with saline on a slide.
Under the microscope the parasite
appears to be pear-shaped with four
hair-like flagella on one end and a
whip-like tail on the other.
A common myth is that trichomoni-
asis can be detected in a Pap Smear.
Dr. Frederick Fleury of Southern
Illinois University School of Medicine
comments on this:
"Pap smears are clearly an inade-
quate diagnostic procedure for tri-
chomonas. In one series where tri-
chomonas was reported on Pap
smears, the diagnosis was not con-
firmed in 37 percent of the patients
who were re-examined by wet smear
and culture for that organism. In the
same report, the Pap smears of 43
percent of those patients with proven
trichomoniasis showed no evidence
of trichomonas."
Patients can aid in successful diag-
nosis by cooperating with their physi-
cian. According to Dr. Herman L.
Gardner, clinical professor of Obstet-
rics and Gynecology at Baylor Uni-
versity College of Medicine, the most
meaningful examination is at the time
the patient is experiencing symptoms,
when she has not douched for at least
two or three days, and when she has
not used a vaginal medication or
contraceptive cream or jelly for sever-
al days.
Immediate and correct diagnosis,
using the wet smear technique, is
important in treating and curing the
patient of this sexually transm itted
disease.
EFFECTIVE TREATMENT OF
TRICHOMONIASIS DEMANDS CO-
OPERA TlON OF THE MALE: The
scene in the gynecologist's office is a
familiar one since the onset of the
"sexual revolution." A 26-year-old
married woman, Mary H , has experi-
ence a grey-green frothy discharge
as well as itching and burning in the
genital area for six weeks. Reason for
postponing treatment: her husband
had asked for a trial separation
because he suspected she had other
sexual partners.
The solution to the problem is not
easy for either patient or physician,
but the rising incidence of sexually
transmitted diseases may affect the
short- and long-term health of both
sexes. Rising health problems of this
type include gonorrhea, syphilis,
herpes genitalis and trichomoniasis.
Since the man can carry some
diseases without experiencing symp-
toms, there is a danger of a "ping-
The Great American Smokeout
Take a day off from smoking - Nov. 15, 1979 ~
Occupational Health Nursing, August 1979
pong" or reinfection syndrome unless
he is examined and treated if the
disease is present. In Mary H's case,
her doctor found the presence of the
parasite which causes trichomonia-
sis. Her husband might be carrying
the disease without knowing it, and
need treatment to prevent further
reinfection.
Mary's physician solved this prob-
lem in part by alleviating her fears
about long-term consequences of
trichomoniasis and by giving her a
prescription for Flagyl (metronida-
zole) and a letter asking her husband
to seek examination and treatment.
Her doctor also pointed out that, in
addition to being a sexually trans-
mitted disease, trichomoniasis may
be contracted by other means - such
as from swimming pools or by sharing
washroom facilities.
At a follow-up visit two weeks later
there was no sign of the parasite
causing infection in Mary's vaginal
discharge. A brief discussion revealed
her husband had seen a doctor and
taken the prescribed Flagyl treatment
as well. Without this cooperation by
the male, the recu rrence of tricho-
moniasis due to reinfection could be a
continuing problem for both partners.
MALE TREA TMENT KEY TO END-
ING CYCLE OF TRICHOMONIASIS
REINFEC TlON: One of the primary
reasons that diagnosis of trichomoni-
asis may have risen more than 20
percent in the past year appears to be
that infected but untreated men are
spreading the disease faster than
their partners can be cured.
An estimated 70 percent of male
sex partners of infected women will
harbor the trichomoniasis organism,
according to a report prepared by Dr.
Sumner E. Thompson, chief, clinical
research section of the U.S. Center
for Disease Control.
"This trend can only be reversed if
all sexual partners are treated," noted
Dr. Michael F. Rein, assistant profes-
sor of medicine at the University of
Virginia.
"Men acquire trichomoniasis, vir-
tually without exception, from sexual
relations. Cure rates in women who
are treated may be as high as 100
percent, but this can mean little or
nothing since they can be easily
reinfected in just one exposure to a
man who is carrying the disease.
"It follows that since Flagyl is the
only medication available in the U.S.
that has proven effective in eradicat-
ing the parasite, it should be used to
treat all diagnosed partners," Dr. Rein
said.
One of the biggest obstacles in
ending the cycle of reinfection - or
the "ping-pong" effect, as it is some-
times called - is the asymptomatic
nature of the disease in the male. Men
may be unaware they are carriers
unless informed by a female in whom
the condition has been diagnosed.
Trichomoniasis was first reported
in men in 1894. The most common
site of infection is the urethra, the
passageway from both the urinary
and reproductive systems of the male
to the outside of the body. A test
performed in a physician's office can
help to determine if a man has
contracted trichomoniasis.
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