What is the recommended treatment for trichomoniasis, an infection requiring sexual partner treatment?

Treatment of Trichomoniasis with Sexual Partner Treatment

The recommended first-line treatment for trichomoniasis is metronidazole 500 mg orally twice daily for 7 days, with simultaneous treatment of all sexual partners to prevent reinfection. 1

Treatment Regimens

First-line Treatment

• Metronidazole 500 mg orally twice daily for 7 days 1
  • Take with food to minimize gastrointestinal side effects 2
  • Avoid alcohol during treatment and for 24 hours afterward to prevent disulfiram-like reactions 1

Alternative Regimens

• Tinidazole 2 g orally in a single dose 1, 3
  • Indicated for patients with metronidazole allergy
  • Should be taken with food 3
  • Avoid alcohol during treatment and for 3 days afterward 3
• Metronidazole 2 g orally in a single dose 2
  • While convenient, the 7-day regimen has shown higher cure rates than single-dose therapy 4

Partner Management

Partner treatment is critical for trichomoniasis management:

• All sexual partners should be treated simultaneously with the same regimen as the index case 1
• Partners should be treated if the last sexual contact was within 30 days of symptom onset 1
• Concurrent treatment prevents reinfection and breaks the transmission cycle 1, 3

Diagnostic Considerations

Before initiating treatment, confirm diagnosis through:

• Wet mount microscopy (60-70% sensitivity) 1
• Culture (most sensitive commercially available method) 1
• Nucleic Acid Amplification Tests (NAATs) - preferred when available 1

Special Populations

Pregnancy

• Metronidazole is contraindicated in the first trimester of pregnancy 1
• After first trimester, recommended dosage is 500 mg three times daily for 7 days 2
• Single-dose treatment should be avoided in pregnancy due to higher serum levels reaching fetal circulation 1

HIV-Positive Patients

• Same treatment regimen as HIV-negative patients 1

Follow-up and Retreatment

• Routine follow-up is unnecessary for asymptomatic patients after treatment 1
• Patients should return for evaluation if symptoms persist or recur 1
• Test-of-cure is recommended for persistent symptoms, suspected reinfection, or questionable compliance 1
• Patients should be retested 3 months after treatment 1

Concurrent Infections

• Always evaluate for concurrent sexually transmitted infections, including Chlamydia trachomatis and Neisseria gonorrhoeae 1
• Testing for both gonorrhea and chlamydia is encouraged to facilitate partner referral and treatment 1

Clinical Pearls and Pitfalls

• The 7-day regimen of metronidazole has demonstrated superior efficacy compared to single-dose therapy (11% vs 19% treatment failure) 4
• While single-dose therapy offers better compliance, the higher cure rates with the 7-day regimen make it the preferred option 1, 4
• Patients should be counseled about the importance of completing the full treatment course even if symptoms resolve earlier
• Alcohol must be strictly avoided during treatment with nitroimidazoles to prevent severe reactions 1, 3, 2
• Treatment failure may result from reinfection from untreated partners rather than drug resistance, emphasizing the importance of partner treatment 1