Strawberry cervix – Erm, what?

Happened upon the strawberry cervix tag? You might well wonder what on earth it means – and whether it’s something you need to worry about. Trich too, to be honest. There’s a big knowledge gap re these terms, so let’s get into it. 

A strawberry cervix is a term used to describe a cervix that appears red and has tiny pinpoint spots, giving it a strawberry-like appearance. It is classically associated with trichomoniasis, a common sexually transmitted infection (STI) caused by the parasite Trichomonas vaginalis.

But a strawberry cervix isn’t something you can diagnose yourself, and having vaginal symptoms doesn’t necessarily mean you have trichomoniasis. Here’s what to know.

What is trichomoniasis?

Trichomoniasis, often shortened to “trich”, is an STI caused by the parasite Trichomonas vaginalis. It is usually passed through vaginal sex or by sharing sex toys. 

One of the tricky things about trichomoniasis (sorry for the pun) is that many people have no symptoms. When symptoms do occur, they can include:

• itching, soreness, redness or swelling around the vagina
• pain or discomfort when peeing
• pain during sex
• yellow-green vaginal discharge, which may be frothy or have a fishy smell
• tummy pain

In men, symptoms can include discharge from the penis, pain when peeing, needing to pee more often and soreness around the penis, testicles or bottom. 

A strawberry-appearing cervix can be seen with trichomoniasis, although it is more commonly observed during colposcopy than during a routine physical examination.

Can trichomoniasis be dormant?

Yes, trichomoniasis can be present without causing obvious symptoms. Around 70-85% of people with trichomoniasis have minimal or no genital symptoms, according to the CDC. Untreated infections can persist for months or even years. 

This means you can’t necessarily tell when an infection was acquired based on when symptoms appear. Some people develop symptoms within a few weeks, while others don’t notice anything until much later. Plus, symptoms can come and go. 

Importantly, a diagnosis of trich doesn’t by itself tell you when the infection was acquired.

BV or trichomoniasis – what’s the difference?

Bacterial vaginosis (BV) and trichomoniasis can have some similar symptoms, which can make them difficult to distinguish based on symptoms alone.

BV is caused by an imbalance in the bacteria normally found in the vagina. Trich, on the other hand, is an STI caused by a parasite.

Both can cause changes to vaginal discharge and an unpleasant or fishy smell. Trichomoniasis can also cause itching, soreness and irritation, while these symptoms are less typical of BV.

There is also a connection between the two: having BV can increase the risk of acquiring trichomoniasis.

So, BV can’t “turn into” trichomoniasis – they’re two different conditions – but they can occur at the same time.

Because symptoms overlap, testing is the best way to tell the difference.

What STI causes itching?

Several STIs can cause genital itching or irritation, including trichomoniasis. However, itching isn’t specific to an STI.

Thrush, BV, skin irritation and other vaginal or vulval conditions can also cause itching, so it’s important not to self-diagnose based on this symptom alone.

If you’ve developed new vaginal symptoms, particularly after sex with a new partner or without a condom, a sexual health clinic can test for STIs and other possible causes.

Can trichomoniasis go away on its own?

It’s not something you should rely on going away without treatment.

Although symptoms can disappear or fluctuate, the infection itself can remain. Untreated trichomoniasis can last for months or years, so if you think you may have it, get tested rather than waiting for symptoms to settle. 

Trichomoniasis is treatable with antibiotics – usually metronidazole. In the UK, the NHS advises that treatment is generally either taken twice a day for seven days or as a one-off dose, depending on the circumstances. 

 Can you catch trichomoniasis from something else, like a toilet seat?

No – a toilet seat isn’t considered a typical way to catch trichomoniasis.

Trichomoniasis is primarily passed through sexual contact, including vaginal sex and sharing sex toys.

So while STI worries after using a public toilet can be understandable, this isn’t a realistic route of transmission.

How is trichomoniasis tested and treated?

You can’t reliably diagnose trichomoniasis from symptoms or by looking at the cervix. A healthcare professional can take a vaginal or penile swab and/or a urine sample, depending on the circumstances, and laboratory testing can confirm whether T. vaginalis is present.

Treatment is with medication taken by mouth, usually metronidazole. And, it’s important to complete the prescribed course even if symptoms improve.

If you’re diagnosed with trichomoniasis, current and recent sexual partners need to be treated too to reduce the risk of passing the infection back and forth. The NHS advises avoiding sex until at least one week after you and your partners have completed treatment. 

The CDC also recommends that sexually active women are retested around three months after treatment because reinfection is relatively common. 

About that strawberry

A ‘strawberry cervix’ can be a sign of trichomoniasis, but vaginal itching, discharge or changes in smell don’t automatically mean you have an STI. BV, thrush and other conditions can cause similar symptoms.

If you’re concerned about trichomoniasis – particularly if you’ve had unprotected sex or a new sexual partner – the safest approach is to get tested. And remember: having no symptoms doesn’t necessarily mean you don’t have trichomoniasis. 

On your reading list

All caught up? These reads might be a handy bookmark: 

• The NHS is rolling out home HPV tests in the UK – Here are 3 key things to know
• What does a healthy vagina smell like? The facts (& our notes on the Vaginamaxxing trend)
• Pain during sex? Here’s why, and what you can do about it 
• Check your gynecologist-recommended lubricant for these 9 no-nos