Some other STDs cause genital ulcers that may be mistaken for the ulcers of syphilis or genital herpes. These are chancroid, Lymphogranuloma venereum (LGV) and Donovanosis, which are mainly found in impoverished parts of the world. In the case of Donovanosis, this includes northern Australia.
These three infections are caught by sexual contact with a partner’s lesion. The germs that cause them get into the body, as usual, through a small surface break. They are diagnosed by taking a scraping from the ulcer and identifying the organism in the laboratory. They are all cured by antibiotics.
If chancroid, LGV or Donovanosis is suspected or proved, you will be advised to have tests for other STDs, which are often picked up at the same time.
Trichomoniasis
This infection is caused by Trichomonas vaginalis (TV), a single-cell parasite like an amoeba. It has a tail that it lashes to move itself along, and a wavy membrane along one side of the cell. Trichomonads feed by wrapping themselves around their food, including bacteria, which can sometimes be seen inside them under the microscope. TV infects the vagina, urethra, bladder and sometimes the Bartholin’s glands and the glands near the opening of the urethra.
How do you catch trichomoniasis?
It is transmitted mainly through sexual intercourse. It’s also possible for TV to be passed by a fomite such as a towel recently used by someone infected or from contaminated water splashing out of a toilet, though this sort of transmission is believed to be rare. However, I’ve seen TV infection in virgins so I know it can get into the vagina other than by sexual penetration. It is also the only STD regularly seen in women who only have sex with other women.
Symptoms of TV infection
In women symptoms include increased vaginal discharge, itching or soreness of the vulva and an unpleasant fishy smell. The discharge can vary from thin, greyish and watery to thick, yellow and frothy. Some infected women have no symptoms. Men rarely notice any symptoms.
How is trichomoniasis diagnosed?
The best way to detect this infection is to take a swab of the discharge and examine it straight away in a drop of saline under the microscope. The appearance and movements of TV are unmistakable. If your doctor hasn’t a microscope, the swab can be sent to a laboratory for the same test. If TV is diagnosed, your doctor will usually advise tests for other STDs that could have been picked up at the same time.
Trichomoniasis is usually treated with a single dose of tinidazole or metronidazole. Sometimes longer treatment is recommended. Symptoms usually disappear within a day or two of starting treatment. You must avoid alcohol (including drinks or medicines containing alcohol, such as some cough mixtures – read the list of contents on the label) while taking these drugs: they can make you feel very sick if taken with alcohol. Tinidazole and metronidazole shouldn’t be used during the first three months of pregnancy or during breast-feeding unless recommended by your doctor. Your partner should be treated at the same time, even if he has no symptoms.
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