A Quick Reference Guide to Common Conditions Related to Sexual Health, Part 3: Parasites and Fungi

Understanding the Importance of Sexual Health

Our sexual health is vital to our well-being and includes our physical, emotional, mental, and social health. It revolves around respecting, safeguarding, and realizing our sexual rights while, ideally, remaining free from infections. Unfortunately, our sexual health can be compromised unexpectedly by a variety of pathogens such as bacteria, viruses, parasites, and fungi. Understanding how these infections impact us is essential for enjoying a satisfying and healthy sex life. To that end, let’s explore the variety of parasitic and fungal infections that may affect sexual health.

What is Trichomoniasis? Symptoms, Diagnosis, and Treatment

Let’s start with trichomoniasis, sometimes called trich (pronounced “trick”) is a sexually transmitted infection (STI) caused by the parasite Trichomonas vaginalis. Parasites are a type of microorganism that need to live on or in a host, like you or me. In the case of trich, it’s passed from one person to another through sexual contact.

Note that this article focuses on reproductive health disorders within the sex binary (female/male), examining conditions that affect the reproductive tract. In biological female bodies, trich typically infects the vagina and urethra. In contrast, in biological male bodies, it affects the urethra and, less commonly, the head of the penis, prostate gland, or sometimes the epididymis.

Asymptomatic Trichomoniasis: Risks and Complications

What makes trich so “tricky,” you might say, is that the majority of those infected never develop any signs or symptoms, which means they can unknowingly pass the infection along to their sexual partner(s) or have a long-standing infection. For those who do experience signs and symptoms, they may have either abnormal vaginal discharge that is thick, frothy, foul-smelling, or yellow-green in color or penile discharge, along with pelvic pain, swelling, or itching; dysuria (pain when urinating); and dyspareunia (pain during sexual intercourse). While a relatively large percentage of individuals don’t have signs and symptoms, patients should make sure to take this parasite seriously.

Complications of Untreated Trichomoniasis

Complications from untreated trich aren’t common, but they can include pelvic inflammatory disease in biological females along with birth complications, like preterm labor, in those who are pregnant. It can also increase the risk of contracting other STIs and developing cervical cancer.

Diagnosing and Treating Trichomoniasis

Since trich can show no outward signs or symptoms, you may assume it’s difficult to diagnose trich, and you’d be right. If trich is suspected, patients will need to get a genital swab and, in some cases, a urine test. And because trich can be asymptomatic, it’s crucial to get routinely screened for STIs, especially before engaging in sexual activity with a new partner, to help identify ongoing, inconspicuous infections.

Treatment includes a course of antibiotics, usually metronidazole. Patients should also notify their sexual partners and ask them to get treatment to prevent the recurrence and spread of the infection. While it’s difficult to share this kind of news with your current sexual partner or a potential new sexual partner that you have an STI, be sure to remain calm and speak directly and honestly about it.

If you need assistance or support sharing information about an STI diagnosis, there are a variety of online resources (see below), or you can chat with your healthcare provider.

Understanding Pubic Lice: Causes, Symptoms, and Treatment

Let’s talk about another parasite. Colloquially referred to as crabs, the scientific name for pubic lice is Pthirus pubis. While they aren’t considered STIs, they’re commonly transmitted through sexual contact or during non-sexual close-body contact. You can even get pubic lice from infected clothes, towels, or bedding.

Identifying and Treating Pubic Lice Infections

Pubic lice typically live on pubic hair, in or around the penis and vagina, but they can also infest chest hair, armpit hair, or eyelashes rather than the hair on your head. While pubic lice are technically large enough to see with the naked eye, they’re very small. More often, signs and symptoms like itching, white/yellow dots on the hair, brown spots on underwear, or sticky eyelashes are better indicators of a pubic lice infection for patients.

Recognizing Signs and Symptoms of Pubic Lice

Using a magnifying glass to identify pubic lice visually is the first diagnostic step for clinicians. Once identified, treatment includes over-the-counter and/or prescription creams and/or shampoos such as Permethrin (Nix). On top of that, it’s important to wash your clothes, bedding, and towels in hot water and/or bag them up for a week or more. And make sure you don’t forget to clean your mattress! These treatments remove any lingering lice and should prevent any reinfection and spread. As always, be sure to notify any sexual partner or other people you’ve had close contact with who may have been exposed.

On to fungi!

Diagnosing and Managing Candida Infections

Some fungi are also considered parasites because they require a host to live. However, not all fungi are parasites. With regard to sexual health, the most common type of fungus is yeast. We’re going to focus on infections of the reproductive tracts caused by a yeast called candida. It’s important to note that candida normally lives on our skin, but under the right conditions, it can get way out of control and overgrow, which causes a yeast infection. Candida infections, also called candidiasis, can occur in the vagina and on the head of the penis, especially in those who are uncircumcised.

Recognizing Signs and Symptoms of Candida Infections

While yeast infections aren’t technically an STI, they can be more common in those who are sexually active. You can also get a yeast infection from using certain medications, like antibiotics, or by being overly stressed with a weakened immune system. And, sometimes, they happen for no identifiable reason!

For biologically female patients, signs and symptoms of a yeast infection typically include irritation, itching, or burning of the vagina and/or vulva; thick, white discharge; and even swelling. For biologically male patients, the head of the penis can become swollen, itchy, sore, and red. There might also be discharge, pain with urination, and difficulty retracting the foreskin in uncircumcised patients.

Diagnosis and Treatment Options for Candida Infections

To diagnose candidiasis, swabs of the affected area are taken. Treatment consists of antifungal medications. To help prevent a recurrence, keep the genital area dry, wear breathable fabrics like cotton underwear, and avoid douching so that your body can re-establish a healthy balance.

Understanding Tinea Cruris: Causes, Symptoms, and Treatment

Our final fungal infection, tinea cruris, is commonly known as jock itch and usually affects the genitals as well as the perineal and perianal areas. Transmitting tinea cruris happens through contact with an infected person or surface. However, you can also spread the infection to a variety of places on your own body. For instance, you might have a tinea infection on your feet, which can spread to your groin if you touch your feet and then subsequently touch your groin, and it’s called autoinoculation! Other ways to transmit tinea cruris include close body contact or sharing towels, clothes, or bedding.

Recognizing Signs and Symptoms of Tinea Cruris

Tinea cruris presents as an itchy, red, and scaly rash. There might also be excoriation (superficial scratches, abrasions, or wounds caused by repetitive picking, scratching, or rubbing the skin) or maceration (prolonged exposure to moisture from itching), which can cause pain and secondary infections when bacteria makes its way through the skin.

Diagnosis and Treatment Options for Tinea Cruris

The rash is distinctive, so diagnosis is typically made clinically, with a patient history and visual inspection of the area. Most cases are treated with a topical antifungal cream or ointment, but an oral antifungal can be used for those with recurrent infections. To prevent a recurrence of candidiasis, wear loose, breathable clothing, keep your skin dry, and avoid sharing towels, clothes, or bedding.

The Importance of Taking Charge of Your Sexual Health

Prioritizing sexual health is important to our overall well-being because it not only impacts our physical health but our mental, emotional, and social lives as well. Being fully informed about potential infections is essential for effective prevention and management, which can help patients take charge of their health as well as safeguard their partners. Regular health screenings, transparent communication with healthcare professionals, and candid conversations with partners about STIs are crucial for maintaining a healthy sexual life and a healthier community.

About the Author

Kelsey LaFayette, DNP, ARNP, FNP-C, Nursing Content Manager at Osmosis from Elsevier, obtained a Bachelor of Arts in Nursing degree from Luther College in 2011. As an RN, she has a clinical background in medical and pulmonary inpatient units, urgent care, and critical care, and she obtained her Doctor of Nursing Practice degree at the University of Illinois at Chicago in 2022. Throughout her career, Kelsey has had many opportunities to function in an education role by being a charge nurse, preceptor to new RNs and nursing students, as well as a Clinical Team Lead in charge of creating orientation programs and policies. Through these opportunities, Kelsey realized her ideal career path should focus on the education of nurses, nursing students, patients, families, and anyone else with a desire to learn. Kelsey serves as a manager on the Nursing Content team and has been able to work on various projects that fulfill her love of perpetual learning.

Contributors

Ian Mannarino, MD, MBA, Osmosis Faculty Reviewer

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