Trichomoniasis In Pregnancy: How To Treat, And Prevent It

Trichomoniasis referred to as “Trich,” is a sexually transmitted disease caused by the protozoan parasite called Trichomonas vaginalis. The incidence of trichomoniasis in pregnancy varies depending on age and ethnicity. However, a few studies also claim that trichomoniasis affects around 3-3.7% of pregnant women in the US annually (1). The infection is treated, but it could lead to serious fetal complications when left untreated.

Keep reading to know the symptoms, risk factors, complications, diagnosis, and treatment options for trichomoniasis during pregnancy.

Signs Of Trichomoniasis During Pregnancy

According to the Centers for Disease Control and Prevention (CDC), around 70% of infected individuals remain asymptomatic. When present, the symptoms vary from mild to severe and are mostly non-persistent (2). The symptoms of trichomoniasis in pregnancy are similar to those that occur in a non-pregnant state and include the following (3) (4).

• Foul-smelling vaginal discharge
• Frothy, white, yellowish, or greenish vaginal discharge with odor
• Itching and irritation in the genital region (vulvar region)
• Soreness or swelling in the vaginal region
• Frequent, painful, or difficult urination
• Rashes in the skin around the genital area
• Pain during a sexual intercourse

The symptoms may develop within a month of infection or be completely absent. If you feel any of these signs of infection in pregnancy, it is wise to visit your healthcare provider for further evaluations.

Risk Factors For Trichomoniasis In Pregnancy

Research suggests that the infection is more prevalent in the first trimester. The following factors may increase the risk of trichomoniasis in pregnant women (1) (3).

• Prior history of sexually transmitted diseases (STDs)
• Multiple sex partners
• Lack of knowledge of partner’s history of STDs
• Unprotected intercourse
• Poor prenatal care

Diagnosis Of Trichomoniasis In Pregnancy

Diagnostic steps are usually conducted only if the pregnant woman has symptoms of the infection. Below are the common methods used for screening for trichomoniasis (4) (5).

• Microscopy: A vaginal swab is examined under a microscope to check the presence of the mobile flagella of the trichomonas parasite. This method is commonly used due to its low cost but is only 40-60% sensitive.

• Culture study: This method involves microscopic investigations of the vaginal swab culture. This method is recommended to study asymptomatic pregnant women.

• Nucleic acid amplification tests (NAAT): This is the most sensitive molecular testing method to detect trichomonas in a vaginal and urine sample.

Complications Of Trichomoniasis In Pregnancy

Trichomonas may cause significant risks to pregnant women when left untreated. Research suggests that a pregnant woman with trichomonas infection is more likely to contract other sexually transmitted infections and HIV (4). In addition, pregnant women with infection have a higher risk of preterm birth, a baby with low birth weight, premature membrane rupture, and a chance of transmitting the infection to her baby during birth (6).

Treatment For Trichomoniasis In Pregnancy

Trichomoniasis is treated with the antibiotic metronidazole, which is administered as a single-dose oral pill. The duration of the treatment may last for five to seven days or longer, depending on individual cases. The treatment may be considered only in symptomatic women, although this could vary based on your OB-GYN’s recommendation (6).

Research indicates that metronidazole has a cure rate of 90% among pregnant women (1). The drug was usually contraindicated during the first trimester. However, experts indicate that more research is needed to prove the drug’s adverse effects during pregnancy (7) (8). The benefits of metronidazole may outweigh the risks of trichomoniasis in pregnancy. Talk to your doctor to understand the risks and benefits of metronidazole in detail.

It is essential to have your partner treated with metronidazole even if they do not show any symptoms. This is vital to avoid re-infection since not all with trichomoniasis may show symptoms. Avoid intercourse until you and your partner have completed the antibiotic course.

Note: The antibiotic tinidazole is also used for trichomoniasis treatment but is contraindicated in the first trimester and may not be preferred for pregnant women. It is also not recommended for use during the lactation phase (9).

Prevention Of Trichomoniasis In Pregnancy

The following preventive measures may help you avoid trichomoniasis in pregnancy (8).

• Have protected sex by using condoms to avoid sexual transmission of any infection.
• Avoid having multiple sex partners to reduce the risk of STDs.
• Avoid douching, as it may remove some of the useful, protective bacteria from your vagina.
• Maintain good overall hygiene by washing your hands frequently, especially after using the bathroom.
• Have yourself and your partner screened for STDs, including trichomoniasis. It can help in the early detection of the disease and prevent adverse effects during pregnancy. Timely treatment can also prevent the transmission of the infection to the baby during delivery.

Trichomoniasis is a sexually transmitted infection that can also affect women during pregnancy. Not all women may show symptoms. Women who show symptoms must consult a doctor promptly for treatment, which can prevent complications. You must have your partner tested as well and avoid intercourse until you and your partner complete the antibiotic course and no longer have symptoms to avoid re-infection.

References

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