The vaginal walls and surface of the cervix frequently are normal but may show punctate, red strawberry spots, or a small amount of discharge may be present in the vaginal fornices. Men are generally asymptomatic. Epididymitis and prostatitis are rare complications. In women, an immediate diagnosis can usually be made with an unstained saline suspension of vaginal secretion from the posterior fornix examined under ordinary light microscopy. The lashing movements of the flagella and striking motility of the oval-shaped organisms are readily observed.
Cultures are more sensitive than direct examination.
Trichomoniasis is also commonly diagnosed on a Papanicolaou smear. Tests should be done to exclude gonorrhea, chlamydia, and other STDs. In men, if examination is done early in the morning before urinating, a slight mucoid discharge may be present, and some fine mucous threads may be found in the 2-glass urine test. A wet film of the urethral secretions in men should be examined microscopically for trichomonads and cultures inoculated. Examining the centrifuged sediment of urine and prostatic secretions may also be helpful.