Trichomoniasis in Men: Discharge Characteristics, Diagnosis, and Treatment

Trichomonas vaginalis infection in men is often asymptomatic but can cause urethritis with distinctive discharge.

Typical Discharge

• Appearance: Frothy, thin, whitish‑yellow to greenish‑yellow.
• Volume: Scant to moderate.
• Odor: Often musty or faintly fishy.

Associated Symptoms

• Urethral irritation, pruritus, burning on urination.
• Frequency, urgency.
• Balanitis (uncircumcised): erythema, edema, erosions.
• Prostatitis/epididymitis (less common): perineal pain, obstructive symptoms.

Diagnosis

• NAAT (PCR/TMA) on urethral swab or first‑catch urine — gold standard (sensitivity >95%).
• Microscopy (wet mount) — low sensitivity in men (~30–50%); motile trichomonads if positive.
• Culture — specific but slower.

Treatment

• Metronidazole 2 g PO single dose (or 500 mg BID × 7 days).
• Treat all partners simultaneously to prevent ping‑pong reinfection.
• Abstain until treatment complete + symptoms resolved.
• Test for other STIs (HIV, syphilis, gonorrhea, chlamydia).

Key Point

Frothy, yellow‑green urethral discharge in a sexually active male should prompt NAAT testing for T. vaginalis alongside gonorrhea/chlamydia. Asymptomatic screening is recommended for high‑risk men.