🧭 When to suspect

Trichomoniasis is a sexually transmitted infection caused by Trichomonas vaginalis, a flagellated protozoan parasite of the genital tract.

• In women it colonises the vagina, urethra and paraurethral glands (the urethra is involved in around 90% of infected women).

• In men it is almost always confined to the urethra.

• Transmission is almost exclusively sexual, so a diagnosis in one partner mandates assessment and treatment of the other.

Suspect it in any sexually active person with a vaginal or urethral discharge – classically frothy, yellow-green and offensive with vulval itch and soreness.

• The caveat: the infection is frequently silent, and roughly 10–50% of women and 15–50% of men are asymptomatic.

• Men are most often identified through partner notification rather than presenting in their own right.

Typical features in women
• Vaginal discharge – classically frothy, yellow-green and offensive, but this appearance occurs in only a minority.
• Vulval itching, soreness, dysuria and offensive odour.
• Occasionally lower abdominal discomfort or vulval ulceration.
• 10–50% asymptomatic.

Typical features in men
• Urethral discharge and/or dysuria – usually scanty; the commonest symptomatic presentation.
• Urethral irritation or urinary frequency.
• Rarely balanoposthitis or features of prostatitis.
• 15–50% asymptomatic – usually a contact of an infected partner.

Source: BASHH 2021

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