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Sexual health

Trichomoniasis: Symptoms, Diagnosis, and Treatment

Trichomoniasis is a curable STI caused by the parasite Trichomonas vaginalis. In people with vaginas it typically causes yellow-green, frothy, foul-smelling discharge with itching and burning; in people with penises it's usually silent. A single course of antibiotics clears it, but both partners must be treated.

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What does trichomoniasis feel like?

In people with vaginas, trich most often causes a discharge that is yellow-green, frothy, and has a strong unpleasant smell sometimes described as fishy. Itching, burning, or redness of the vulva and vagina is common, and urination or sex may be uncomfortable. On examination, the cervix can have a 'strawberry' appearance — a visible sign of inflammation.

In people with penises, trich is usually silent — no symptoms at all, or only mild burning after urination or ejaculation, and occasionally a slight clear discharge 1. The absence of symptoms in people with penises is a major reason trich spreads so easily: someone can carry and transmit it without knowing 1.

How does trichomoniasis spread?

Trich spreads through vaginal, oral, or anal sex with an infected person. It does not spread through casual contact — sharing toilet seats, towels, or utensils does not transmit it 1. You can carry and transmit trich without any symptoms, which is why testing after any new or untested partner matters regardless of how you feel.

How is trichomoniasis diagnosed?

Testing requires a specific swab — vaginal, cervical, or urethral — sent for a nucleic acid amplification test (NAAT), a rapid antigen test, or examined under a microscope 1. A standard STI panel does not always automatically include a trichomoniasis test, so it is worth asking your clinician to add it specifically 2.

A vaginal pH test and whiff test can also point toward trich versus bacterial vaginosis, but they are not confirmatory on their own.

What are the treatment options?

Treatment is straightforward: a single oral dose of a nitroimidazole-class antibiotic is effective in most cases 1. Both partners must be treated at the same time. Treating one person while the other remains untreated leads to immediate reinfection — a very common reason trich seems to 'come back.' Both partners should abstain from sex until both have completed treatment 1.

If you have an allergy to nitroimidazoles, alternative options exist but are more limited — tell your clinician.

What conditions can look like trichomoniasis?

Several other vaginal conditions cause similar symptoms and are worth knowing:

Bacterial vaginosis (BV): Also very common. BV causes a thin gray-white discharge with a fishy smell that is stronger after sex, but usually without significant external itching or redness 2.

Chlamydia or gonorrhea: Common STIs that can co-occur with trich and cause discharge or burning. They are often co-tested at the same visit 1.

Yeast infection (vulvovaginal candidiasis): Causes thick, cottage-cheese-like discharge with intense itching but without a strong smell. It is the most common thing people try first with over-the-counter treatment — if OTC treatment does not work, trich or BV is worth testing for 2.

Why does trich matter even when it feels minor?

Untreated trich increases the risk of acquiring or transmitting HIV [1, 3]. In pregnancy, trich is associated with preterm birth, and prompt treatment is recommended 1. It is also a common unrecognized cause of persistent vaginal odor or discharge — people often cycle through OTC yeast treatments that do not work before getting tested and discovering trich is the cause.

The good news: trich responds well to treatment, and reinfection is preventable with simultaneous partner treatment and consistent condom use going forward.

Common questions

Can you have trichomoniasis without any symptoms?

Yes. Many people — especially those with penises — have no symptoms at all. This is one reason trich is so common and spreads easily. Testing is the only way to know.

Does my partner need treatment if they have no symptoms?

Yes. Both partners need to be treated at the same time, regardless of symptoms. An untreated partner will reinfect you, even if they feel fine.

Is trich included in a standard STI panel?

Not always. Ask your clinician specifically to include a trichomoniasis test, as it is not part of every routine STI panel.

Is trichomoniasis dangerous in pregnancy?

Trich in pregnancy is associated with preterm birth. Treatment is recommended, and the choice and timing of antibiotic may be discussed with an OB-GYN or midwife.

How soon after treatment can I have sex again?

Clinicians generally advise waiting until both you and your partner have completed treatment. Ask your clinician for specific timing guidance.

Talk to a clinician

Nina Osei, NP — Nurse Practitioner

checkups, refills & skin. Gale can match you with a licensed clinician for a visit.

Find care →

When to seek care promptly

  • —Pelvic or lower abdominal pain combined with discharge or fever — this may indicate the infection has spread or that a separate, more serious infection is present
  • —High fever alongside vaginal or urethral symptoms
  • —Symptoms during pregnancy that are worsening — trich in pregnancy warrants prompt evaluation

This article is general health information and is not a diagnosis. Only a licensed clinician who examines you and orders the appropriate tests can diagnose trichomoniasis or any other condition. If you have symptoms, see a clinician rather than waiting for them to resolve on their own.

References

  1. 1.Workowski KA, Bachmann LH, Chan PA, Johnston CM, Muzny CA, Park I, Reno H, Zenilman JM, Bolan GA (2021). Sexually Transmitted Infections Treatment Guidelines, 2021. MMWR Recommendations and Reports. doi:10.15585/mmwr.rr7004a1 ✓Trichomoniasis symptoms, transmission, testing, and treatment recommendations including simultaneous partner treatment and link to HIV risk
  2. 2.American College of Obstetricians and Gynecologists (2020). Vaginitis in Nonpregnant Patients: ACOG Practice Bulletin, Number 215. Obstetrics & Gynecology. doi:10.1097/AOG.0000000000003604 ✓Differential diagnosis of trichomoniasis versus bacterial vaginosis and yeast infection based on discharge characteristics and clinical findings
  3. 3.US Preventive Services Task Force; Owens DK, Davidson KW, Krist AH, et al. (2019). Screening for HIV Infection: US Preventive Services Task Force Recommendation Statement. JAMA. doi:10.1001/jama.2019.6587 ✓Recommendation for comprehensive STI testing including HIV in sexually active individuals, supporting the guidance to test for HIV when trichomoniasis is diagnosed

3 sources, numbered by first appearance. General health information, not medical advice — synthetic demonstration content.