From the Guidelines
If trichomoniasis is found at the time of labor, you should receive immediate treatment with metronidazole 2 grams as a single oral dose, as recommended by the most recent guidelines 1. This medication is safe during labor and effectively treats the infection. Your sexual partner should also be treated with the same regimen to prevent reinfection. Trichomoniasis is a common sexually transmitted infection caused by the parasite Trichomonas vaginalis, which can lead to preterm birth, low birth weight, and postpartum infections if left untreated. The single-dose treatment is highly effective and works quickly to eliminate the parasite. After delivery, you should abstain from alcohol for 24 hours after taking metronidazole to avoid a disulfiram-like reaction (nausea, vomiting, headache). Breastfeeding can be continued during treatment, but you may want to wait 12-24 hours after taking the medication before nursing. Follow-up testing is recommended 3-4 weeks after treatment to ensure the infection has cleared.
Key Points to Consider
- Metronidazole is the only recommended treatment for trichomoniasis, with a cure rate of approximately 90%-95% 1.
- Treatment of the patient and sex partner results in relief of symptoms, microbiologic cure, and reduction of transmission 1.
- Vaginal trichomoniasis might be associated with adverse pregnancy outcomes, particularly premature rupture of the membranes and preterm delivery 1.
- The use of metronidazole during pregnancy has not been shown to have a consistent association with teratogenic or mutagenic effects in the infant 1.
Treatment Options
- Metronidazole 2 grams as a single oral dose is the recommended treatment for trichomoniasis 1.
- Alternative treatment options include metronidazole 500 mg orally twice a day for 7 days, or tinidazole 2 grams as a single oral dose 1.
From the FDA Drug Label
Metronidazole tablets are indicated for the treatment of symptomatic trichomoniasis in females and males when the presence of the trichomonad has been confirmed by appropriate laboratory procedures (wet smears and/or cultures)
- Treatment of Trichomoniasis: The patient should be treated with metronidazole tablets, as it is indicated for the treatment of symptomatic trichomoniasis in females and males when the presence of the trichomonad has been confirmed by appropriate laboratory procedures (wet smears and/or cultures) 2.
- Partner Treatment: Asymptomatic sexual partners of treated patients should be treated simultaneously if the organism has been found to be present, in order to prevent reinfection of the partner 2.
- Key Considerations:
- The patient's partner should be treated to prevent reinfection.
- Treatment should be initiated as soon as possible to prevent complications.
- The decision to treat should be made on a case-by-case basis, taking into account the individual patient's circumstances.
From the Research
Diagnosis and Treatment of Trichomoniasis
- Trichomoniasis is a sexually transmitted infection that can be asymptomatic or cause vaginitis and urethritis 3.
- The recommended treatment for trichomoniasis is a 2g metronidazole oral single dose, which is effective against Trichomonas and safe to use during pregnancy 4.
- In cases where the patient is allergic to nitroimidazole antibiotics, alternative treatments may be considered, such as high-dose tinidazole or intravaginal metronidazole/miconazole 5, 6.
Management of Resistant Trichomoniasis
- Metronidazole-resistant trichomoniasis is an emerging problem, and alternative treatment options are being studied 7.
- High-dose regimens of metronidazole or tinidazole, as well as combination therapies, may be effective in treating resistant trichomoniasis 5, 7.
- Intravaginal metronidazole/miconazole has been shown to be a well-tolerated and effective treatment for trichomoniasis, with cure rates comparable to oral metronidazole 6.
Considerations for Pregnant Women
- Trichomoniasis can be vertically transmitted at birth, and treatment during pregnancy is important to prevent adverse outcomes 4.
- Metronidazole is safe to use during pregnancy, and its use is recommended even for asymptomatic patients 4.
- In cases where the patient is allergic to nitroimidazole antibiotics, alternative treatments should be considered, and the patient should be closely monitored for adverse outcomes 4.