Lesbians and Trichomoniasis - Ask the Doc

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I am a social worker in an out patient clinic for women with HIV. One of my nurse practitioners treated a patient for Trichomoniasis recently. The patient is a lesbian, states her and her partner are monogamous and denies they use any sex toys. The nurse practitioner is wondering how this patient got trichomonas...any ideas?

Thank you for any info

Houston, Texas

Answer by Jeanne Marrazzo, MD, MPH

Hello Donna,

Hi, regarding the question about trichomonas and the discussion that ensued regarding transmission between women, toilet seats/water, and Pap smears: there is at least one well-documented report of trich being sexually transmitted between women. Trich is a very hardy bug that can live for along periods in the periurethral glands and epithelial folds/crypts, which is probably why its identification sometimes seems not to be obviously related to recent sexual activity. So, female sex partners always need to be treated too (you can use a single dose of oral metronidazole at 2 grams, or a week of 500 mg twice a day--no alcohol while taking it)

Pap smears are not specific enough for the diagnosis of trich and are NOT RELIABLE for diagnosing it. I don't know if anyone has examined the newer thin Prep methodology for identifying trich, though. Trich is often overcalled on the wet prep too. It's almost the same size as white blood cells, which may be present for other reasons and with which it can be confused. And, just in case you didn't figure this out from my comment above, there are no reports in the literature (or any that I have heard, anecdotally) about trich toilet transmission, via water, seat, paper, or anything else one might encounter in the bathroom.
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