Women who are symptomatic from trichomoniasis complain of vaginal discharge, pruritus, and irritation. Signs of infection include vaginal discharge (42%), odor (50%), and edema or erythema (22 to 37%). The discharge is classically described as frothy, but it is actually frothy in only about 10% of patients. The color of the discharge may vary. Colpitis macularis (strawberry cervix) is a specific clinical sign for this infection but is detected with reliability only by colposcopy and rarely during routine examination.
Other complaints may include dysuria and lower abdominal pain; the etiology of the
latter is unclear. The urethra is also infected in the majority of
women. Nearly half of all women with trichomoniasis vaginalis are
asymptomatic. Therefore, if these women are not
screened, the diagnosis will be missed.
The extent of the inflammatory response to the parasite may determine the severity of the symptoms. Factors that influence the host inflammatory response are not well understood but may include
hormonal levels, the coexisting vaginal flora, and the strain and
relative concentration of the organisms present in the vagina.