What is the recommended treatment for trichomoniasis?

Treatment for Trichomonas

The first-line treatment for trichomoniasis is metronidazole 2g orally in a single dose, which has a cure rate of 90-95%. 1

First-line Treatment Options

• Metronidazole 2g orally in a single dose (preferred regimen) 1, 2
• Alternative regimen: Metronidazole 500mg twice daily for 7 days 1

Both regimens are equally effective, but the single-dose option offers better compliance. The FDA has approved metronidazole for both symptomatic and asymptomatic trichomoniasis in males and females 2.

Important Treatment Considerations

1. Partner treatment is essential

   • Sexual partners must be treated simultaneously to prevent reinfection 1, 2
   • This applies even to asymptomatic partners 2

2. Sexual activity precautions

   • Patients should avoid sexual activity until both they and their partners complete treatment and are asymptomatic 1

3. Follow-up

   • Routine test-of-cure is not necessary for patients who become asymptomatic after treatment 1
   • Patients should be retested 3 months after treatment regardless of partner treatment status 1

Treatment in Special Populations

• HIV-positive patients: Same treatment regimen as HIV-negative patients 1
• Pregnant women: Metronidazole 2g orally in a single dose is safe after the first trimester 1
  • Pregnant women should be retested 3-4 weeks after treatment 1
  • Treatment is particularly important as trichomoniasis has been associated with adverse pregnancy outcomes including premature rupture of membranes, preterm delivery, and low birthweight 1

Management of Treatment Failure

If initial treatment fails:

1. First step: Retreatment with metronidazole 500mg twice daily for 7 days 1
2. For persistent infection: Metronidazole 2g once daily for 3-5 days 1
3. For resistant cases: Consider consulting a specialist for susceptibility testing 1, 3

Important Caveats and Pitfalls

• Avoid metronidazole gel for trichomoniasis as it has <50% efficacy compared to oral preparations 1
• Alternative medication: Tinidazole is FDA-approved for trichomoniasis 4 and may be effective in some metronidazole-resistant cases 3
• Resistance concerns: Some T. vaginalis strains have diminished susceptibility to metronidazole but usually respond to higher doses 1
• Diagnostic confirmation: Diagnosis should be confirmed through wet mount microscopy (60-70% sensitivity) or culture (most sensitive commercially available method) 1

By following these evidence-based guidelines, clinicians can effectively treat trichomoniasis and prevent complications and reinfection.