Most men with trichomonas have no complaints. That is not an exception but the normal course, and it explains why this parasite can spread so quietly. Without complaints there is no reason to test, and without a test the infection stays put.
Those who do notice something usually notice very little: mild irritation in the urethra, some fluid, or a burning feeling when peeing that fades after a few days.
Which complaints can men get?
When there are complaints, they are usually irritation or itching in the urethra, a burning feeling when peeing or ejaculating, and sometimes a small amount of discharge. Those complaints are mild and can disappear by themselves while the infection persists. That last part is what gets missed most often.
| Men | Women | |
|---|---|---|
| Complaints | Usually none | Variable, often present |
| Typical complaint | Urethral irritation | Changed discharge |
| Test material | Urine or urethral swab | Vaginal swab |
| Reason for testing | Often via the partner | Often via own complaints |
| Partner treatment | Standard | Standard |
Look at the "reason for testing" row and you see the problem. Men usually only come into view when somebody else gets a result.
Why do men notice so little?
Because the parasite often persists for less time in men and triggers less inflammation. Van Gerwen and colleagues described the natural course in men in 2021 and discussed how the infection clears spontaneously in a share of them, while others develop persistent urethritis.
Clearing spontaneously sounds reassuring. It is not.
Between infection and clearing sits a period in which you are contagious, and that period feels exactly like being healthy. It is an awkward message, and it is the honest one.
How is trichomonas tested in men?
Usually with a PCR test on urine or on material from the urethra. In men the parasite is harder to detect than in women, which means microscopy is even less suitable here. Molecular techniques are more sensitive, as described in the 2022 evidence summary accompanying the revised US treatment guidelines.
A trichomonas test targets that one parasite. If more is in play, for instance after unprotected sex with a new partner, a chlamydia, gonorrhoea and trichomonas test covers the three most common at once.
Could it be something other than trichomonas?
Yes, and in men that is closer to the rule than the exception. Irritation in the urethra with some discharge is called urethritis, and it has several causes. Chlamydia and gonorrhoea top that list, and trichomonas belongs on it without being the most common.
From the complaint alone they cannot be told apart.
That is exactly why a combined test is often more sensible than a single one. If you are handing in material anyway, separating those three is a question of which assay gets run on it, not of an extra visit.
Imagine someone aged 34 with a burning feeling when peeing for 2 weeks, assuming a bladder infection and waiting it out. Bladder infections are uncommon in men, which makes that assumption statistically the weakest of all the options.
My partner tested positive, what now?
With trichomonas you are usually treated too, even without complaints of your own. The reason is practical: without it, the treated partner gets reinfected. Your GP arranges that, and the Farmacotherapeutisch Kompas describes which agent is usual.
Testing alongside treatment is still worthwhile if you want to know where you stand.
What often plays underneath is the unspoken question of whether this means someone cheated. Because the infection can stay silent so long in men, the moment of diagnosis says little about the moment of transmission. We work that out in trichomonas without sexual contact.
What this means for you
If you have had a risk moment, the absence of complaints is not an argument against testing. With trichomonas that link is simply weak. The RIVM tracks Dutch STI figures, and there too trichomonas only appears when someone looked for it.
Read the full overview in bacterial vaginosis, thrush or trichomonas, and the female side in trichomonas symptoms in women. More about silent infections is in STI without symptoms.
Every blood test result includes a professional assessment from a BIG-registered doctor. For treatment decisions, discuss your results with your GP.
References
- Van Gerwen OT, et al. Epidemiology, Natural History, Diagnosis, and Treatment of Trichomonas vaginalis in Men. Clinical Infectious Diseases, 2021. PMID: 34079999
- Schwebke JR, Burgess D. Trichomoniasis. Clinical Microbiology Reviews, 2004. PMID: 15489349
- Kissinger PJ, et al. Diagnosis and Management of Trichomonas vaginalis: Summary of Evidence Reviewed for the 2021 Sexually Transmitted Infections Treatment Guidelines. Clinical Infectious Diseases, 2022. PMID: 35416973
- Sutton M, et al. The prevalence of Trichomonas vaginalis infection among reproductive-age women in the United States, 2001-2004. Clinical Infectious Diseases, 2007. PMID: 17968828
- RIVM, sexually transmitted infections in the Netherlands, annual surveillance report
- Farmacotherapeutisch Kompas, agents for trichomoniasis
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