Trichomoniasis in Black Men: Silent, Common and Curable

Yes, men get trich, and most men who have it feel nothing. If a partner tells you she has trichomoniasis, get tested and treated even if you feel fine: in a study of male partners of women with trich at three US public clinics, 71.7% of the men were infected, and 77.3% of those infected men had no symptoms. Trich is a parasite infection, Trichomonas vaginalis, and one dose of an antibiotic cures it in men.

The CDC treatment guidelines put it plainly: 70% to 85% of people with trichomoniasis have minimal or no genital symptoms, and untreated infections might last from months to years. For men, that silence is the whole problem. A man can carry trich, pass it to a partner, get it back from her after she is treated, and never have a reason to walk into a clinic.

In national NHANES urine testing from 2013 and 2014, 4.2% of Black men aged 18 to 59 tested positive, roughly 1 in 24. The same analysis tied infection to living below the poverty line and to having two or more partners in the past year, and its authors concluded the burden in the Black population "warrants intervention." That is a finding about missed testing and uneven access to sexual health care, not about Black men. A lot of Black men are carrying a curable infection that nobody ever tested them for.

When trich does cause symptoms in men, the CDC lists itching or irritation inside the penis, burning after peeing or ejaculating, and discharge from the penis. Some people notice symptoms 5 to 28 days after infection, and symptoms can come and go. That last detail matters: burning that fades on its own does not mean the infection cleared.

In clinical terms, the treatment guidelines say men with trichomoniasis sometimes have symptoms of urethritis, epididymitis, or prostatitis: inflammation of the urethra, of the tube behind the testicle, or of the prostate. None of those symptoms is specific to trich. Chlamydia and gonorrhea cause the same burning and discharge, and the CDC says trich cannot be diagnosed from symptoms alone. If your symptoms match, our guide to chlamydia in Black men covers the other common cause, and a lab test sorts out which one you have.

Trich usually spreads during penis-to-vagina sex, in either direction. For women, an untreated infection carries its own risks, laid out in our companion guide to trichomoniasis in Black women. A man who is never tested is often the reason a woman who was treated and did everything right gets infected again. The CDC estimates reinfection occurs in about 1 in 5 people within 3 months of treatment.

There is also HIV. The CDC guidelines state that trich infection is associated with a 1.5-fold increased risk for HIV acquisition. A meta-analysis of 11 studies found the same figure: people infected with trich were 1.5 times more likely to acquire HIV. All of the studies in that review were done in sub-Saharan Africa, so the size of the effect in US men has not been measured directly. Treating trich is cheap and fast, and it removes one avoidable risk. If HIV prevention is on your mind, ask about PrEP at the same visit.

A NAAT (nucleic acid amplification test) looks for the parasite's genetic material, and it is the kind of test that finds trich in men. The CDC guidelines note that the GeneXpert TV assay has been FDA cleared for male urine specimens. Other trich assays are not FDA cleared for men, though labs can validate them internally, so the practical ask is simple: "Please test my urine for trichomoniasis with a NAAT."

Name it. A urine test for "STIs" usually means chlamydia and gonorrhea, and trich is a separate order. The CDC treatment guidelines do not set a routine trich screening schedule for men the way they do for chlamydia in some groups, so the reasons to ask are concrete: a partner with trich, burning or discharge that a chlamydia and gonorrhea test did not explain, or symptoms that keep coming back. Our STD testing guide lists where to get tested at low or no cost.

The CDC 2021 STI Treatment Guidelines recommend this for men: metronidazole 2 g by mouth in a single dose. The alternative is tinidazole 2 g by mouth in a single dose. Women are now treated with a 7-day course, so do not be thrown if you and your partner get different prescriptions. That difference is in the guidelines.

Partner treatment is where cures fail. The guidelines call concurrent treatment of all sex partners vital for preventing reinfections: current partners should be referred for treatment, and both of you should abstain from sex until you have both been treated and any symptoms have resolved. The CDC patient page says the same in plain words: no sex until you and your partners complete treatment.

Retesting is different for men. The CDC recommends that women retest about 3 months after treatment, and states that data are insufficient to support retesting men after treatment. That is not a pass. If symptoms return, or a partner tests positive again, go back and get tested.

Expedited partner therapy (EPT) means your clinician gives you a prescription or the medication to pass to your partner without the partner needing a visit first. For trich, the CDC guidelines say EPT might have a role in partner management and can be used in states where permissible by law. Whether it is allowed depends on your state. Ask your clinician directly: "Can you give me EPT for my partner, or does she need her own visit?"

Any primary care office, urgent care, or sexual health clinic can run a trich NAAT and write the prescription. If you want a clinician you feel comfortable saying all of this to, search our provider directory or find a community health clinic near you. Bring one sentence: "Please test my urine for trichomoniasis with a NAAT, and tell me how my partner gets treated too."