Obstetrics, gynecology, Trichomoniasis, malaria
Recovery Milestones After Trichomoniasis Treatment
Mar
Trichomoniasis, a common sexually transmitted infection (STI) caused by the parasite Trichomonas vaginalis, affects millions of people worldwide. While often asymptomatic, trichomoniasis can lead to genital discomfort, irritation, and discharge. Prompt diagnosis and treatment are essential for alleviating symptoms, preventing complications, and reducing the risk of transmission to sexual partners.
Recovering from trichomoniasis involves more than just taking medication; it requires understanding the infection, adhering to treatment, and adopting preventive measures to avoid reinfection. In this article, we will guide you through the recovery process, discussing the milestones you can expect after receiving treatment for trichomoniasis. We will also address common concerns and provide expert advice to help you regain optimal sexual and reproductive health.
Trichomoniasis Overview and Diagnosis
Causative organism and transmission
Trichomoniasis is caused by the parasitic protozoan Trichomonas vaginalis. This tiny, single-celled organism thrives in the warm, moist environments of the genitourinary tract[1]. The infection is primarily transmitted through sexual contact, making it one of the most common non-viral STIs globally.
Although trichomoniasis can affect both men and women, it is more prevalent and symptomatic in women. The parasite is typically transmitted through the exchange of genital fluids during vaginal, oral, or anal sex. In rare cases, the infection may be contracted through shared towels or bathing suits.
Symptoms and clinical presentation
Trichomoniasis can present with a variety of symptoms, although up to 70% of infected individuals may be asymptomatic[2]. When symptoms do occur, they typically appear within 5 to 28 days after exposure to the parasite. Common signs and symptoms include:
- Vaginal discharge (often green, yellow, or gray with a frothy texture and unpleasant odor)
- Genital itching, burning, or soreness
- Pain or discomfort during urination or sexual intercourse
In men, trichomoniasis may cause mild urethral discharge, irritation, or burning during urination. However, these symptoms are often less pronounced than in women.
Diagnostic methods and accuracy
Accurate diagnosis of trichomoniasis is crucial for effective treatment and prevention of transmission. Healthcare providers may use several methods to diagnose the infection:
| Method | Description | Accuracy |
|---|---|---|
| Wet mount microscopy | Examination of vaginal fluid under a microscope for motile parasites | Moderate sensitivity (60-70%) |
| Culture | Growing the parasite in a specialized medium for identification | High sensitivity (75-95%) |
| Nucleic acid amplification tests (NAATs) | Detection of parasite DNA using PCR or similar techniques | Highest sensitivity (95-100%) |
Prevalence and risk factors
Trichomoniasis is a highly prevalent STI, with an estimated 156 million new cases worldwide each year[3]. Risk factors for contracting the infection include:
- Multiple sexual partners
- History of other STIs
- Unprotected sexual activity
- Sex work
Regular STI screening, particularly for high-risk individuals, is essential for early detection and treatment of trichomoniasis.
Treatment Options for Trichomoniasis
Recommended antibiotics and dosages
The primary treatment for trichomoniasis is antibiotic therapy. The Centers for Disease Control and Prevention (CDC) recommends the following regimens[4]:
- Metronidazole 500 mg orally twice daily for 7 days
- Tinidazole 2 g orally in a single dose
Both metronidazole and tinidazole are highly effective in eradicating T. vaginalis, with cure rates exceeding 90%. Single-dose therapy with tinidazole may be preferred due to better patient compliance and fewer gastrointestinal side effects.
Alternative treatments for special populations
In certain situations, alternative treatment approaches may be necessary:
| Population | Treatment |
|---|---|
| Pregnant women | Metronidazole 2 g orally in a single dose |
| Lactating women | Avoid breastfeeding for 12-24 hours after single-dose therapy |
| Metronidazole-allergic patients | Desensitization or tinidazole |
| Treatment failure or resistance | Higher dose or longer duration of metronidazole or tinidazole |
Consultation with an infectious disease specialist may be warranted for complicated cases or treatment failures.
Partner treatment and prevention of reinfection
Trichomoniasis is highly transmissible, with reinfection rates as high as 17% within 3 months of treatment[5]. To prevent reinfection and break the cycle of transmission, it is crucial to treat all sexual partners, even if asymptomatic.
Patients and their partners should abstain from sexual activity until both have completed treatment and are symptom-free. Condom use during treatment is not sufficient to prevent reinfection, as the parasite can colonize areas not covered by the condom.
Potential side effects and drug interactions
Metronidazole and tinidazole are generally well-tolerated, but some patients may experience side effects such as[6]:
- Nausea, vomiting, or abdominal discomfort
- Metallic taste in the mouth
- Dizziness or headache
- Darkening of the urine
These drugs may also interact with other medications, including anticoagulants, lithium, and disulfiram. Healthcare providers should review patients’ medical histories and current medications before prescribing treatment for trichomoniasis.
Immediate Post-Treatment Expectations
Resolution of symptoms
After completing treatment for trichomoniasis, most patients experience a rapid improvement in symptoms. Vaginal discharge, itching, and irritation typically subside within a week[7]. However, some women may have persistent symptoms due to co-existing bacterial vaginosis or vaginal candidiasis, which can develop following antibiotic therapy.
Men treated for trichomoniasis usually have a shorter duration of symptoms, with urethral discharge and discomfort resolving within a few days. If symptoms persist or worsen after treatment, patients should consult their healthcare provider to rule out treatment failure or reinfection.
Temporary side effects of medication
As mentioned earlier, metronidazole and tinidazole can cause side effects in some patients. These usually resolve within a few days after completing treatment but may include:
| Gastrointestinal | Neurological | Other | |
|---|---|---|---|
| Metronidazole | Nausea, vomiting, diarrhea, abdominal pain | Dizziness, headache | Metallic taste, dark urine |
| Tinidazole | Nausea, vomiting, diarrhea, abdominal pain | Dizziness, headache | Metallic taste, dark urine |
If side effects are severe or persist beyond a few days, patients should contact their healthcare provider for guidance.
Importance of completing treatment course
Adhering to the prescribed treatment regimen is crucial for successfully eradicating the infection and preventing the development of antibiotic resistance. Patients should take all doses as directed, even if symptoms improve before completing the course[8].
In single-dose regimens, directly observed therapy (DOT) can ensure patient compliance. For multi-dose regimens, healthcare providers should emphasize the importance of completing treatment and discuss strategies to overcome barriers to adherence, such as setting reminders or using pill organizers.
Follow-up testing and evaluation
Routine follow-up testing after treatment is not recommended for trichomoniasis unless symptoms persist or recur. However, patients with persistent symptoms should be evaluated for treatment failure, reinfection, or co-existing STIs[9].
In high-risk populations or those with a history of treatment failure, healthcare providers may consider test-of-cure 3-4 weeks after therapy to confirm eradication of the infection.
Short-Term Recovery Milestones (1-4 Weeks)
Monitoring for symptom recurrence
In the weeks following treatment for trichomoniasis, patients should closely monitor for any recurrence of symptoms. While most individuals experience a complete resolution of symptoms within a week, some may have persistent or recurrent symptoms due to treatment failure, reinfection, or co-existing conditions[10].
Patients should be advised to contact their healthcare provider if they experience:
- Persistent or recurrent vaginal discharge, itching, or irritation
- Ongoing urethral discharge or discomfort in men
- Pain during urination or sexual intercourse
- Lower abdominal pain or discomfort
Prompt evaluation and re-treatment, if necessary, can prevent complications and reduce the risk of transmission to sexual partners.
Resuming sexual activity and preventing reinfection
After completing treatment and ensuring that all sexual partners have been treated, patients can resume sexual activity. However, it is crucial to take steps to prevent reinfection[11]:
| Strategy | Description |
|---|---|
| Condom use | Consistently using condoms during sexual activity reduces the risk of reinfection and transmission of other STIs |
| Limiting sexual partners | Reducing the number of sexual partners decreases the likelihood of exposure to T. vaginalis |
| Regular STI screening | Undergoing routine screening for trichomoniasis and other STIs can help identify and treat infections early |
| Open communication | Discussing sexual health and STI status with partners promotes informed decision-making and reduces transmission risk |
Addressing sexual partners and re-treatment
During the short-term recovery period, it is essential to ensure that all sexual partners have been treated for trichomoniasis. Untreated partners can serve as a reservoir for reinfection, leading to a cycle of transmission[12].
If a patient’s partner is unable or unwilling to seek treatment, the patient may need to be re-treated after resuming sexual activity. Expedited partner therapy (EPT), where the patient delivers medication to their partner, can be an effective strategy for ensuring partner treatment in some settings.
Scheduling follow-up appointments as needed
While routine follow-up is not necessary for most patients with trichomoniasis, those with persistent or recurrent symptoms should schedule a follow-up appointment with their healthcare provider. During this visit, the provider can:
- Assess symptom resolution and treatment response
- Evaluate for reinfection or treatment failure
- Test for co-existing STIs or other genital infections
- Discuss ongoing prevention strategies and sexual health concerns
By addressing any lingering issues and reinforcing prevention messages, healthcare providers can help patients achieve a successful long-term recovery from trichomoniasis.
Long-Term Recovery Milestones (1-3 Months)
Confirming successful treatment through follow-up testing
Although routine follow-up testing is not recommended for most patients with trichomoniasis, some individuals may benefit from a test-of-cure to confirm successful treatment. This is particularly important for those with persistent symptoms, recurrent infections, or a history of treatment failure[13].
Patients should wait at least 3 months after completing treatment before undergoing follow-up testing. This allows time for any remnant DNA from dead organisms to clear, reducing the risk of false-positive results. The most sensitive and specific test for trichomoniasis is the nucleic acid amplification test (NAAT), which can detect the presence of T. vaginalis genetic material in urine, vaginal, or urethral samples.
Maintaining sexual health and preventing future infections
In the months following treatment for trichomoniasis, patients should continue to prioritize sexual health and take steps to prevent future infections. This includes:
- Using condoms consistently and correctly during sexual activity
- Limiting the number of sexual partners and avoiding concurrent partnerships
- Discussing sexual health and STI testing with new partners before engaging in sexual activity
- Undergoing regular STI screening, especially if engaging in high-risk behaviors or experiencing symptoms[14]
By adopting these preventive behaviors, patients can reduce their risk of acquiring trichomoniasis and other STIs in the future.
Addressing long-term complications and co-existing conditions
While most patients with trichomoniasis recover fully with appropriate treatment, some may experience long-term complications or have co-existing conditions that require ongoing management. These may include:
| Complication/Condition | Description | Management |
|---|---|---|
| Pelvic inflammatory disease (PID) | Ascending infection of the upper genital tract, leading to chronic pelvic pain, infertility, or ectopic pregnancy | Antibiotics, pain management, and fertility evaluation if needed |
| Bacterial vaginosis (BV) | Overgrowth of anaerobic bacteria in the vagina, causing discharge and odor | Antibiotics (metronidazole or clindamycin) and probiotics to restore vaginal flora |
| Vulvovaginal candidiasis (VVC) | Fungal infection of the vulva and vagina, causing itching, burning, and thick, white discharge | Antifungal medications (topical or oral) and hygiene measures to prevent recurrence |
Healthcare providers should assess patients for these complications and provide appropriate treatment or referrals to specialists as needed.
Encouraging open communication and ongoing education
Long-term recovery from trichomoniasis involves more than just physical healing; it also requires open communication and ongoing education about sexual health. Healthcare providers should create a non-judgmental environment where patients feel comfortable discussing their concerns and asking questions[15].
Patients should be encouraged to:
- Communicate openly with their partners about sexual health and STI status
- Seek information from reliable sources about trichomoniasis and other STIs
- Advocate for their own sexual health needs and preferences
- Engage in regular self-care practices to promote overall well-being
By empowering patients with knowledge and communication skills, healthcare providers can help them achieve long-term recovery and maintain optimal sexual health.
Monitoring and Prevention of Recurrence
Recognizing signs and symptoms of recurrent infection
Although most patients with trichomoniasis achieve long-term recovery with appropriate treatment, some may experience recurrent infections. Recurrence can occur due to reinfection from an untreated partner, treatment failure, or antibiotic resistance[16]. Patients should be educated about the signs and symptoms of recurrent trichomoniasis, which may include:
- Persistent or recurrent vaginal discharge, itching, or irritation in women
- Ongoing urethral discharge or discomfort in men
- Pain during urination or sexual intercourse
- Lower abdominal pain or discomfort
If any of these symptoms occur after initial treatment, patients should promptly seek medical evaluation to determine the cause and appropriate management.
Strategies for reducing the risk of reinfection
Preventing reinfection is crucial for maintaining long-term recovery from trichomoniasis. Patients should be counseled on strategies to reduce their risk of reinfection, including:
| Strategy | Description |
|---|---|
| Partner treatment | Ensuring that all sexual partners receive appropriate treatment for trichomoniasis, even if asymptomatic |
| Condom use | Using condoms consistently and correctly during sexual activity to prevent the exchange of genital fluids |
| Abstinence | Refraining from sexual activity until all partners have completed treatment and are symptom-free |
| Monogamy | Limiting sexual activity to a single partner who has been treated and is not engaging in high-risk behaviors |
By implementing these strategies, patients can significantly reduce their likelihood of acquiring trichomoniasis again in the future[17].
Importance of regular STI screening and self-care practices
In addition to preventing reinfection, ongoing monitoring and self-care practices can help patients maintain long-term sexual health. Regular STI screening is recommended for sexually active individuals, especially those with multiple partners or a history of STIs. The frequency of screening may vary depending on individual risk factors and local guidelines, but annual testing for trichomoniasis and other common STIs is often advised.
Patients should also be encouraged to engage in self-care practices that promote genital health, such as:
- Practicing good hygiene, including washing the genital area daily with mild soap and water
- Wearing breathable, cotton underwear and avoiding tight-fitting clothing that may trap moisture
- Wiping from front to back after using the restroom to prevent the introduction of bacteria into the vagina or urethra
- Avoiding douching or using scented products in the genital area, which can disrupt the natural balance of bacteria[18]
When to seek medical advice for persistent or recurrent symptoms
While some mild discomfort or discharge may be normal in the days following treatment, patients should be advised to seek medical advice if they experience persistent or recurrent symptoms. This may include:
- Vaginal or urethral discharge that persists beyond 7-10 days after completing treatment
- Itching, burning, or irritation that does not improve with self-care measures
- Pain during urination or sexual intercourse that persists or worsens over time
- Lower abdominal pain or pelvic discomfort, which may indicate a more serious complication such as PID
By promptly addressing these concerns, healthcare providers can identify and treat any underlying issues, such as antibiotic resistance or co-existing infections, and help patients achieve optimal long-term outcomes.
Addressing Psychological and Emotional Aspects
Recognizing the emotional impact of trichomoniasis diagnosis
Receiving a diagnosis of trichomoniasis can be emotionally challenging for many patients. Common reactions may include shame, guilt, anger, or anxiety about the potential impact on relationships and sexual health[19]. Healthcare providers should acknowledge and validate these emotions while providing reassurance and support.
Patients may benefit from:
- A non-judgmental and empathetic approach to discussing the diagnosis and treatment options
- Reassurance that trichomoniasis is a common and treatable infection, and that having an STI does not reflect negatively on their character or worth
- Information about the prevalence of trichomoniasis and other STIs, to help reduce feelings of isolation or stigma
- Referrals to counseling or support services, if the emotional impact is significant or persists over time
Providing support for sexual relationships and intimacy concerns
Trichomoniasis can have a significant impact on sexual relationships and intimacy. Patients may experience anxiety about transmitting the infection to partners, fear of rejection or judgment, or concerns about sexual performance and satisfaction. Healthcare providers can support patients by:
- Encouraging open and honest communication with sexual partners about the diagnosis, treatment, and prevention of trichomoniasis
- Providing resources and guidance on how to have conversations about STIs and sexual health
- Addressing any myths or misconceptions about the impact of trichomoniasis on sexual function or fertility
- Offering referrals to couples counseling or sex therapy, if needed, to address ongoing concerns or relationship difficulties[20]
Addressing stigma and promoting sexual health empowerment
Stigma surrounding STIs can be a significant barrier to seeking treatment, disclosing to partners, and engaging in preventive behaviors. Healthcare providers play a crucial role in reducing stigma and promoting sexual health empowerment[21].
Strategies may include:
- Using non-stigmatizing language when discussing trichomoniasis and other STIs (e.g., avoiding terms like “clean” or “dirty”)
- Challenging myths and stereotypes about STIs and the people who acquire them
- Emphasizing the importance of regular STI screening as a routine part of sexual health care, rather than a shameful or punitive measure
- Providing education and resources to help patients make informed decisions about their sexual health and communicate effectively with partners
By addressing stigma and promoting empowerment, healthcare providers can help patients develop a more positive and proactive approach to managing trichomoniasis and other sexual health concerns.
Encouraging self-care and stress management techniques
Dealing with a trichomoniasis diagnosis and its psychological impact can be stressful. Patients should be encouraged to engage in self-care and stress management techniques to promote overall well-being and resilience. This may include:
- Practicing relaxation techniques, such as deep breathing, meditation, or progressive muscle relaxation
- Engaging in regular physical activity or exercise, which can help reduce stress and improve mood
- Seeking support from trusted friends, family members, or mental health professionals
- Prioritizing sleep, nutrition, and other healthy lifestyle habits to promote physical and emotional healing
By addressing the psychological and emotional aspects of trichomoniasis recovery, healthcare providers can help patients achieve a more comprehensive and sustainable sense of well-being.
Implications for Sexual and Reproductive Health
Impact of trichomoniasis on fertility and pregnancy outcomes
Trichomoniasis can have significant implications for sexual and reproductive health, particularly among women. Untreated infections have been associated with an increased risk of infertility, potentially due to the development of pelvic inflammatory disease (PID) or other upper genital tract complications[22]. Women with trichomoniasis during pregnancy may also be at higher risk for adverse outcomes, such as:
- Preterm delivery
- Low birth weight
- Premature rupture of membranes
- Postpartum endometritis
Prompt diagnosis and treatment of trichomoniasis are essential for minimizing these risks and promoting optimal reproductive health outcomes.
Increased susceptibility to other sexually transmitted infections
Trichomoniasis can increase an individual’s susceptibility to other sexually transmitted infections (STIs), particularly HIV. The inflammation and genital lesions caused by trichomoniasis can create entry points for HIV and other pathogens, facilitating transmission[23]. Additionally, the presence of trichomoniasis may increase the shedding of HIV in the genital tract, making an infected individual more likely to transmit the virus to their partners.
Other STIs that may be more easily acquired or transmitted in the presence of trichomoniasis include:
- Chlamydia
- Gonorrhea
- Human papillomavirus (HPV)
- Herpes simplex virus (HSV)
Given these risks, healthcare providers should emphasize the importance of comprehensive STI screening and treatment for patients with trichomoniasis, as well as their partners.
Long-term impact on sexual function and satisfaction
Trichomoniasis can have a lasting impact on sexual function and satisfaction, even after successful treatment. Some patients may experience ongoing pain, discomfort, or anxiety related to sexual activity, which can strain relationships and reduce overall quality of life.
To address these concerns, healthcare providers should:
- Assess patients for persistent symptoms or sexual difficulties during follow-up visits
- Provide education and reassurance about the long-term prognosis for sexual health after trichomoniasis
- Offer referrals to sex therapists, pelvic floor physical therapists, or other specialists as needed to address specific sexual function concerns[24]
- Encourage open communication with partners and provide resources for building and maintaining healthy sexual relationships
Importance of partner notification and treatment
Partner notification and treatment are critical components of trichomoniasis management and prevention. Untreated partners can serve as a reservoir for reinfection, perpetuating the spread of the infection within sexual networks. Healthcare providers should assist patients in developing strategies for notifying partners and ensuring they receive appropriate testing and treatment.
Options for partner notification may include:
- Patient-initiated notification, in which the infected individual informs their partners directly
- Provider-initiated notification, in which the healthcare provider contacts partners with the patient’s consent
- Expedited partner therapy (EPT), in which the patient is provided with medication or prescriptions to deliver to their partners without requiring a clinical evaluation
The choice of notification method may depend on individual circumstances, local laws and regulations, and available resources. Regardless of the approach, the goal is to ensure that all potentially exposed partners are informed and receive timely and appropriate care.
By addressing the broader sexual and reproductive health implications of trichomoniasis, healthcare providers can help patients achieve optimal long-term outcomes and promote the overall well-being of individuals and communities.
Frequently Asked Questions
The most common symptoms of trichomoniasis in women include vaginal discharge, itching, and irritation. In men, symptoms may include urethral discharge, burning sensation during urination, and mild discomfort in the penis or testicles. However, many people with trichomoniasis may not experience any noticeable symptoms.
Trichomoniasis is typically diagnosed through laboratory tests, such as a vaginal or urethral swab culture, nucleic acid amplification test (NAAT), or rapid antigen test. These tests can detect the presence of the parasite responsible for the infection. In some cases, a healthcare provider may also perform a physical examination to assess for signs of inflammation or discharge.
Trichomoniasis is treated with antibiotic medications, usually either metronidazole or tinidazole. These medications are typically taken orally in a single dose or as a longer course, depending on the severity of the infection and individual circumstances. It is important to complete the full course of treatment as prescribed and refrain from sexual activity until all partners have been treated to prevent reinfection.
Yes, untreated trichomoniasis can lead to several complications, particularly in women. These may include pelvic inflammatory disease (PID), which can cause damage to the reproductive organs and increase the risk of infertility. In pregnant women, trichomoniasis has been associated with preterm delivery and low birth weight. Additionally, trichomoniasis can increase the risk of acquiring or transmitting other sexually transmitted infections, including HIV.
To reduce your risk of getting trichomoniasis, practice safer sex by using condoms consistently and correctly during sexual activity. Limiting your number of sexual partners and getting regular STI screenings can also help prevent infection. If you or your partner are diagnosed with trichomoniasis, it is important to complete treatment and refrain from sexual activity until you are both symptom-free to avoid reinfection.
Trichomoniasis is primarily spread through sexual contact and is not typically transmitted through casual, non-sexual contact. However, in rare cases, the parasite may survive on damp, moist objects like towels or washcloths for a short period. To minimize any potential risk, avoid sharing personal hygiene items and always practice good hygiene, such as washing your hands regularly and drying shared items thoroughly.
The incubation period for trichomoniasis, or the time between exposure and the appearance of symptoms, can vary. In most cases, symptoms develop within 5 to 28 days after infection. However, some people may not experience any noticeable symptoms for months or even years after the initial infection. This is why regular STI screening is important, even in the absence of symptoms, especially if you have multiple sexual partners or a history of STIs.
Yes, it is possible to get trichomoniasis again after being treated. This can happen if you have sexual contact with an untreated partner or if you do not complete the full course of antibiotic treatment as prescribed. To reduce your risk of reinfection, ensure that all sexual partners are also treated for trichomoniasis and wait until you have both completed treatment before resuming sexual activity. Consistently using condoms and getting regular STI screenings can also help prevent future infections.
Reference list
- World Health Organization. (2018). Report on global sexually transmitted infection surveillance 2018. World Health Organization.
- Centers for Disease Control and Prevention. (2021). Trichomoniasis – CDC fact sheet. Retrieved from https://www.cdc.gov/std/trichomonas/stdfact-trichomoniasis.htm
- Meites, E., Gaydos, C. A., Hobbs, M. M., Kissinger, P., Nyirjesy, P., Schwebke, J. R., … & Workowski, K. A. (2015). A review of evidence-based care of symptomatic trichomoniasis and asymptomatic Trichomonas vaginalis infections. Clinical Infectious Diseases, 61(suppl_8), S837-S848.
- Schwebke, J. R., & Burgess, D. (2004). Trichomoniasis. Clinical Microbiology Reviews, 17(4), 794-803.
- Kissinger, P. (2015). Trichomonas vaginalis: a review of epidemiologic, clinical and treatment issues. BMC Infectious Diseases, 15(1), 1-8.
- Van Der Pol, B. (2016). Clinical and laboratory testing for Trichomonas vaginalis infection. Journal of Clinical Microbiology, 54(1), 7-12.
- Hobbs, M. M., & Seña, A. C. (2013). Modern diagnosis of Trichomonas vaginalis infection. Sexually Transmitted Infections, 89(6), 434-438.
- Sherrard, J., Ison, C., Moody, J., Wainwright, E., Wilson, J., & Sullivan, A. (2014). United Kingdom national guideline on the management of Trichomonas vaginalis 2014. International Journal of STD & AIDS, 25(8), 541-549.
- Muzny, C. A., & Schwebke, J. R. (2016). Pathogenesis of Trichomonas vaginalis infection: a narrative review. Sexually Transmitted Diseases, 43(7), 423-427.
- Kissinger, P., & Adamski, A. (2013). Trichomoniasis and HIV interactions: a review. Sexually Transmitted Infections, 89(6), 426-433.
- Lazenby, G. B., Taylor, P. T., Badman, B. S., McHaki, E., Korte, J. E., Soper, D. E., & Young Pierce, J. (2014). An association between Trichomonas vaginalis and high-risk human papillomavirus in rural Tanzanian women undergoing cervical cancer screening. Clinical Therapeutics, 36(1), 38-45.
- Menezes, C. B., Frasson, A. P., & Tasca, T. (2016). Trichomoniasis – are we giving the deserved attention to the most common non-viral sexually transmitted disease worldwide?. Microbial Cell, 3(9), 404-419.
- Mann, J. R., McDermott, S., Barnes, T. L., Hardin, J., Bao, H., & Zhou, L. (2009). Trichomoniasis in pregnancy and mental retardation in children. Annals of Epidemiology, 19(12), 891-899.
- Silver, B. J., Guy, R. J., Kaldor, J. M., Jamil, M. S., & Rumbold, A. R. (2014). Trichomonas vaginalis as a cause of perinatal morbidity: a systematic review and meta-analysis. Sexually Transmitted Diseases, 41(6), 369-376.
- Swygard, H., Miller, W. C., Kaydos-Daniels, S. C., Cohen, M. S., Leone, P. A., Hobbs, M. M., & Seña, A. C. (2004). Targeted screening for Trichomonas vaginalis with culture using a two-step method in women presenting for STD evaluation. Sexually Transmitted Diseases, 31(11), 659-664.
- Hollman, D., Coupey, S. M., Fox, A. S., & Herold, B. C. (2010). Screening for Trichomonas vaginalis in high-risk adolescent females with a new transcription-mediated nucleic acid amplification test (NAAT): associations with ethnicity, symptoms, and prior and current STIs. Journal of Pediatric and Adolescent Gynecology, 23(5), 312-316.
- Workowski, K. A., Bolan, G. A., & Centers for Disease Control and Prevention. (2015). Sexually transmitted diseases treatment guidelines, 2015. MMWR. Recommendations and Reports, 64(RR-03), 1-137.
- Van Der Pol, B., Williams, J. A., Orr, D. P., Batteiger, B. E., & Fortenberry, J. D. (2005). Prevalence, incidence, natural history, and response to treatment of Trichomonas vaginalis infection among adolescent women. The Journal of Infectious Diseases, 192(12), 2039-2044.
- Ginocchio, C. C., Chapin, K., Smith, J. S., Aslanzadeh, J., Snook, J., Hill, C. S., & Gaydos, C. A. (2012). Prevalence of Trichomonas vaginalis and coinfection with Chlamydia trachomatis and Neisseria gonorrhoeae in the United States as determined by the Aptima Trichomonas vaginalis nucleic acid amplification assay. Journal of Clinical Microbiology, 50(8), 2601-2608.
- Sena, A. C., Miller, W. C., Hobbs, M. M., Schwebke, J. R., Leone, P. A., Swygard, H., … & Cohen, M. S. (2007). Trichomonas vaginalis infection in male sexual partners: implications for diagnosis, treatment, and prevention. Clinical Infectious Diseases, 44(1), 13-22.
- Hoffman, D. J., Brown, G. D., Wirth, F. H., Gebert, B. S., Bailey, C. L., & Anday, E. K. (2003). Urinary tract infection with Trichomonas vaginalis in a premature newborn infant and the development of chronic lung disease. Journal of Perinatology, 23(1), 59-61.
- Sutton, M., Sternberg, M., Koumans, E. H., McQuillan, G., Berman, S., & Markowitz, L. (2007). The prevalence of Trichomonas vaginalis infection among reproductive-age women in the United States, 2001-2004. Clinical Infectious Diseases, 45(10), 1319-1326.
- Huppert, J. S., Mortensen, J. E., Reed, J. L., Kahn, J. A., Rich, K. D., Miller, W. C., & Hobbs, M. M. (2007). Rapid antigen testing compares favorably with transcription-mediated amplification assay for the detection of Trichomonas vaginalis in young women. Clinical Infectious Diseases, 45(2), 194-198.
- Coleman, J. S., Gaydos, C. A., & Witter, F. (2013). Trichomonas vaginalis vaginitis in obstetrics and gynecology practice: new concepts and controversies. Obstetrical & Gynecological Survey, 68(1), 43-50.
