What You Need To Know About This "Stealthy" STI

Photographed by Eylul Aslan.
You may feel like you know your vagina well enough to be able to diagnose and treat an infection the second you notice unusual discharge or get a whiff of an odor. But in some cases, the telltale symptoms of a vaginal infection — like discharge, itching, or odor — can be indicative of trichomoniasis, aka "trich," which involves an entirely different treatment.
Trich is a sexually transmitted infection (STI) caused by a parasite that can travel from vagina to penis, vagina to vagina, or vagina to hands, mouth, or anus, during sex. An estimated 3.7 million people in the United States have trich, but only 30% will experience symptoms, according to the Centers for Disease Control. And when people do experience symptoms, they often confuse them with vaginal infections, which is what makes it tricky.
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"Trichomoniasis is the most stealthy of the STIs, because it masquerades as a sort of garden variety vaginal infection like bacterial vaginosis or yeast," says Kate O'Connell White, MD, MPH, director, Fellowship in Family Planning, department of Ob/Gyn at Boston University, Boston Medical Center. For example, a symptom of trich is discomfort with urination, which could make you think you have a UTI. And there might also be itching and burning of the labia, which may make you think you have a yeast infection, she says. Or it's common for people to get vaginal discharge with an odor, which could resemble bacterial vaginosis.
If you have these symptoms, it's natural to try to self-treat to avoid the inconvenience of going to the doctor. But trying to solve your vaginal infection on your own will only delay the treatment process, Dr. White says. Think about it: If you don't know what you have, then how can you expect to treat it? "I know getting to the doctor's office is a complete pain, really I do," Dr. White says. "But in an ideal world, [you should] come see a gynecologist." That said, if you're on the fence about whether or not you need to see a doctor, Dr. White suggests giving it about three days to see if your symptoms go away. If you don't feel better by then, go see a healthcare provider for sure.

it masquerades as a sort of garden variety vaginal infection like bacterial vaginosis or yeast.

Kate O'Connell White, MD, MPH, director, Fellowship in Family Planning, department of Ob/Gyn at Boston University
The only real way to tell that you have trichomoniasis versus a vaginal infection is to get tested, Dr. White says. "Luckily, it's very easy to diagnose," she says. A doctor will swab the walls of your vagina and look for the parasite under a microscope. (Sometimes, trich is diagnosed during a pap smear, but Dr. White suggests getting retested if that's the case. "A pap smear is looking for precancerous cells; that's its main mission in life," she says. "When it picks up on anything else along the way we take it with a grain of salt.") Doctors don't always include trich when testing for STIs, so it's important to bring it up to your doctor if you're concerned, she says.
It's not the end of the world if you have trich, and it's treated with a single dose of antibiotics, Dr. White says. Your sexual partners will also have to get tested and treated, in order to prevent getting reinfected with the parasite. And it's wise to wait 7-10 days after treatment before having sex again to make sure you're in the clear, because about 1 in 5 people get trich again after treatment, she says. As always, using safer sex measures like condoms or dental dams can decrease your risk of contracting or spreading an infection like trich.
While you may know your vagina better than anyone out there, self-diagnosing or self-treating an infection is usually not the way to go. It's better to go get proper testing rather than assume you know what's up — even if you have had, like, dozens of vaginal infections and consider yourself basically an expert. At the end of the day, knowing that trichomoniasis could be hanging out in your vagina under the guise of a vaginal infection is just one reason why it's important to get tested regularly.
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