Maybe you’ve heard of it — but there’s a good chance you haven’t. Caused by infection with a microscopic parasite called Trichomonas vaginalis, TV infection or trichomoniasis is an often overlooked but very common sexually transmitted disease — and the most common nonviral sexually transmitted infection.
According to a recent study by researchers at Johns Hopkins University, it also disproportionately affects blacks in the U.S. The research published in the journal Clinical Infectious Diseases in March relied on data from the 2013–2014 National Health and Nutrition Examination Survey, published by the Centers for Disease Control and Prevention, to evaluate TV infection rates in individuals 18 to 59 years old.
What was most dramatic about this “neglected” STI is the overall prevalence, or rate of infection, among the black population compared with everyone else, says Dr. Aaron Tobian, an associate professor of pathology at the Johns Hopkins University School of Medicine in Baltimore and the study’s senior author. “In the African-American population it’s 4 percent among the men and almost 9 percent among [women].” That compares with a rate of 0.03 and 0.8, or less than 1 percent, among males and females of other races or ethnicities.
“It really is a public health crisis in the African-American population,” Tobian asserts. “It’s so common, and it also shows that there are real social and structural disparities that are likely leading to this disproportionate infection rate. It’s likely due to lower access of health care, less education about the infection — and there really should be targeted public health education to prevent this infection.” While the study notes that individual factors — like favoring sexual partners of the same race — may contribute to continued TV infection disparities, researchers also highlight the potential role of what’s called structural racism — referring to the many different ways in which societies foster racial discrimination in areas ranging from housing to health care. “It cannot be overlooked that structural racism could be a contributing factor to the racial disparity in TV infection,” the study authors note, citing past research.
[See: 13 Ways Social Determinants Affect Health.]
Though trichomoniasis is typically found to be more common in women than men, some health experts say that the disparity by sex — like that found using national survey data — may, at least in part, be explained away by the use of a less sensitive urine test in men to detect TV infection. Previous research has found that TV infection sometimes goes away on its own, or resolves without treatment in men, but that hasn’t been found to be the case for women. “The disparity in TV infection by sex in this study, however, may also be due to measurement error,” the researchers note.
What’s more, while debate continues regarding whether trichomoniasis should be made a so-called reportable disease that’s closely monitored on a local, state and national level, experts say there’s reason for women and men who are concerned they might have this STI to get tested.
“I think it’s traditionally been thought of as a minor nuisance infection where people get a little bit of discharge and get some itching, and people don’t really give it much thought,” says Dr. Paul Nyirjesy, professor of OB-GYN at Drexel University College of Medicine in Philadelphia and director of Drexel Vaginitis Center, which specializes in the diagnosis and treatment of women with chronic vaginal infections. In fact, the CDC reports that about 70 percent of those infected with TV don’t have any symptoms, but those who are symptomatic can experience anything from mild irritation to severe inflammation.
What’s more, experts point out that trichomoniasis has been linked with other health concerns, too. In women, it’s been associated with issues ranging from pelvic infection to urethral symptoms such as pain and burning with urination and sometimes an abnormal discharge, Nyirjesy points out. It’s also associated with the human papillomavirus, or HPV, a group of viruses that can cause cervical cancer and other cancers. And it’s “linked to an increased risk of both acquiring and transmitting HIV infection as well,” he says.
Though it’s not been precisely determined why TV infection is linked to other health issues like HIV, experts say that the body’s inflammatory response to try to fight off the infection may play a role; and problems can extend to pregnant women who have a greater likelihood of pre-term birth with TV infection, according to the CDC.
[See: 10 Questions Doctors Wish Their Patients Would Ask.]
“It’s a treatable STD,” Nyirjesy emphasizes. “So why in the world wouldn’t you pay attention to it and try to get rid of it?” For the vast majority, a single dose of an antibiotic called metronidazole is all that’s needed to remedy the infection, he says — noting that it’s well over 90 percent effective. It’s recommended that women who are HIV-positive take metronidazole for seven days, he adds.
For men, TV most commonly infects the inside of the penis. Those who have symptoms may notice itching or irritation inside the penis, burning after urination or ejaculation and discharge from the penis, according to the CDC. Though it’s known to cause inflammation of the prostate, there isn’t a lot of research — and much less is known — in regards to how trichomoniasis may affect other areas of men’s health.
However, clinicians recommend anyone who has symptoms and suspect it may be trichomoniasis see a health care provider to get tested. “In men you actually have to swab three different areas to pick up whether or not men have an infection, because they can be infected either in their urine or the skin of the penis or in semen,” Nyirjesy says, while only testing urine — which is sometimes done — can miss infections. “Whereas with women, if you just test the vagina, you only need to test one area to get a diagnosis,” he says. In its STD treatment guidelines, the CDC recommends the use of highly sensitive tests for detecting TV infection. It notes that, among women, the molecular testing method called nucleic acid amplification is highly sensitive, often detecting three to five times more TV infections than wet-mount microscopy — involving looking for the parasite under a microscope — which the CDC describes as “a method with poor sensitivity.”
In addition to the advice that anyone who thinks they might have trichomoniasis get tested, the CDC recommends screening for TV infection if a person has HIV. But given the disparities with TV infection disproportionately affecting blacks, Tobian thinks screening recommendations should be extended accordingly to improve detection and treatment of the STI. “Especially in the minority community where you have a prevalence approaching 9 percent among females, you need to be screening this entire group of individuals and immediately treating it,” he suggests.
[See: What Only Your Partner Knows About Your Health.]
While experts differ on what screening recommendations should be, most agree that raising awareness about the STI and making testing and treatment more accessible to those who need it is key. In addition, to prevent transmission, clinicians urge condom use. And it’s recommended that partners of individuals diagnosed with trichomoniasis also get tested, and as necessary, treated to prevent reinfection.
The good news, experts reiterate, is that besides being very common, trichomoniasis is very curable. “This disease,” Tobian emphasizes, “is incredibly easy to treat.”
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What’s Trichomoniasis — and Could You Have It? originally appeared on usnews.com
