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Objective: To establish clinical features, course of illness, and treatment outcome of cats with diarrhea and concurrent infection with Trichomonas organisms. Prevalence of fecal trichomonads in a geographically comparable population of healthy indoor and feral cats also was assessed., Design: Longitudinal study and a cohort study., Animals: 32 cats with diarrhea and naturally acquired trichomonosis that were native to North Carolina, Virginia, Connecticut, and Tennessee; 20 healthy indoor cats; and 100 feral cats., Procedure: Trichomonosis was diagnosed in 32 cats by identification of organisms in fresh feces or by protozoal culture of feces., Results: Diarrhea associated with the large intestine and trichomonosis were diagnosed in 32 cats. Median age of the cats was 9 months; 23 cats were < or = 1 year old at the time of diagnosis. Two cats developed diarrhea accompanied by infection with Trichomonas organisms after the addition of an infected kitten into the home. Duration of diarrhea ranged from 2 days to 3 years. Six cats had a coexisting enteric infection. Treatment with antimicrobials improved fecal consistency and reduced the number of flagellates in the feces, but did not eliminate infection. Diarrhea (with microscopically detectable flagellates) was observed shortly after antibiotics were discontinued. Trichomonads were not recovered from feces of any healthy indoor or feral cats., Conclusions and Clinical Relevance: Our findings suggest that trichomonosis may be a cofactor in development of diarrhea in young cats. Trichomonas organisms were not identified as part of the indiginous fauna of healthy indoor or feral cats.