Trichomonas vaginalis structure.

Trichomoniasis is the most common non-viral STI in the U.S. An estimated 4 to 8 million people already have it and over 1 million new infections are diagnosed every year. Eighty-five per cent of women found to have trichomoniasis report no symptoms.

When I was in college, I had a boyfriend I’ll call Buzz. Fun guy, intelligent, good looking, life of the party. Everybody loved him. Towards the end of senior year, a lovely young French woman came to visit our circle of friends. She and Buzz, who could speak French but rarely had the opportunity to use it, hit it off right away. She hung around with us for a few weeks or more. At some point, I found myself getting irritated – and itchy. Sure enough, I was diagnosed with a trichomonas infection. That was when I realized they’d had an affair. I told Buzz about the infection. He looked sheepish. Planned Parenthood had given me medication to bring home to treat both of us. We took our medicine together, we talked through it, and we got on with our lives. La jeune femme had moved on by then, leaving only her French trichomonads behind.

“Trich” (pronounced ‘trick’) is more common in women than in men, and more common in “older” women (>25) than in younger women. It is uncommon to find trichomonads in men who have sex with men but woman to woman transmission is common.

If symptoms are present, they will likely be itching, burning, redness, or soreness of the vulva and vagina, burning with urination and sexual intercourse, and/or thin, whitish-yellow frothy vaginal discharge with a strong fishy odor. Lower abdominal pain can occur and may be an indication of pelvic inflammatory disease (PID). These symptoms, if ignored, may eventually lessen into a chronic asymptomatic infection which can persist for months or years and cause further damage.

Parasitic protozoas called trichomonads are responsible for the infection. They are specific to humans (they don’t infect animals) and are the most common protozoan infection in humans in the developed world.

In 1836, Alexandre Donne, a French microscopist, studied “genitourinary discharges in both sexes.” He was a curious fellow who identified a curious creature swimming around in the vaginal fluid under his microscope. He named it trico-monas and he thought it did no harm. In 1894, when it was also discovered in the male urethra, it was suggested that it might be shared sexually but was still thought to be of little consequence. In 1916, the suggestion was made that it might cause vaginitis. And in the 1930’s it was finally added to the list of venereal diseases.

How could the little swimmers have been ignored for so long? Because they were so commonly found in the vagina. And few men were complaining. The thinking at the time was that they were just a normal inhabitant of the urethra and vagina. They are not.

In the 1900s, the common treatment for abnormal vaginal discharge, whether or not it was caused by trichomonads, was arsenic. Anywhere from six to 70 tablets were recommended for insertion in the vagina every week. The higher dose was responsible for the death of many woman as recently as 1959. But because of the high rate of recurrence (due to both the ineffectiveness of the treatments and reinfection from untreated asymptomatic partners), other treatments were tried. These included sulpha-drugs (which worked for gonorrhea but not for trich), ultra-violet radiation of the vagina, or, that commonly prescribed treatment for so many female ailments, psychotherapy.

During the late 1950s, a drug first synthesized in France was found to be effective in killing the trichomonad protozoa. In 1962, when a woman’s trichomonas infection was fortuitously cured along with the bacterial gingivitis she had been treated for, it was determined that metronidazole (marketed as Flagyl) had the rare quality of being both antiparasitic and antibacterial. It had been over 120 years between the time it was discovered under the microscope and the time an effective treatment was found. An appreciative woman physician wrote that since the introduction of metronidazole, “a whole generation has no knowledge of the suffering of women with trichomoniasis before its introduction – the indignities and discomfort of the perpetual local treatment, douches, paintings, insufflations, and insertion of pessaries. All these things women suffered for months and sometimes years on end, only to relapse when the treatment was discontinued.”

Metronidazole is now used to effectively treat a number of bacterial and parasitic diseases throughout the world but is especially effective against trichomonads. (Unfortunately, resistance to this antibiotic is emerging.)

The discovery was considered such a landmark in the history of the disease that a request was sent from Scotland for “a photograph of the man who discovered ‘Flagyl,’ because gynecologists wished to hang it on the wall of their Society’s headquarters in recognition of the greatest contribution to gynecology of the last fifty years.”

—  References Available upon Request  —

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