What is the treatment for trichomoniasis?

Treatment for Trichomoniasis

Metronidazole 500 mg orally twice daily for 7 days is the first-line treatment for trichomoniasis, as recommended by the CDC. 1

First-Line Treatment Options

• Metronidazole regimen: 500 mg orally twice daily for 7 days 1, 2

  • This is the preferred treatment regimen due to higher efficacy compared to single-dose therapy
  • FDA-approved for both symptomatic and asymptomatic trichomoniasis 2

• Alternative regimen: Tinidazole 2 g orally in a single dose 1, 3

  • Recommended for patients with metronidazole allergy
  • FDA-approved specifically for trichomoniasis caused by Trichomonas vaginalis 3

Evidence Supporting 7-Day Treatment

Recent evidence strongly favors the 7-day metronidazole regimen over single-dose therapy. A randomized controlled trial found that patients treated with the 7-day regimen were significantly less likely to test positive for T. vaginalis at follow-up compared to those receiving single-dose treatment (11% vs 19%, p<0.0001) 4.

Diagnostic Considerations

Before initiating treatment, diagnosis should be confirmed through one of these methods:

• Nucleic acid amplification tests (NAATs) - preferred method due to high sensitivity 1
• Culture - most sensitive commercially available method 1
• Wet mount microscopy - limited sensitivity (60-70%) 1

Partner Treatment

• All recent sexual partners (within 60 days) should be evaluated, tested, and treated 1
• Sexual partners should be treated simultaneously to prevent reinfection 3, 2
• Patients should abstain from sexual intercourse until both they and their partners have completed treatment 1

Important Precautions

• Alcohol interaction: Patients should avoid alcohol during treatment and for 24-48 hours afterward to prevent disulfiram-like reactions 1
• Monitoring: Improvement in symptoms should be seen within 72 hours of starting treatment 1
• Follow-up: Consider retesting 3 months after treatment due to high rates of reinfection 1
• Neurotoxicity risk: Avoid prolonged courses of metronidazole to prevent cumulative and potentially irreversible neurotoxicity 1

Special Populations

• Pregnancy: Metronidazole is contraindicated in the first trimester but may be used after the first trimester in a 2 g single dose 1
• HIV patients: Should receive the same treatment regimen as patients without HIV 1

Treatment Failures

If no improvement is observed within 72 hours:

1. Reassess the diagnosis
2. Consider alternative regimen
3. Rule out reinfection from untreated partner

Common Pitfalls to Avoid

• Single-dose therapy: While historically used and still sometimes practiced, the 7-day regimen has demonstrated superior efficacy 4
• Inadequate partner treatment: Failure to treat partners simultaneously is a major cause of recurrent infection 1, 3, 2
• Alcohol consumption: Not warning patients about alcohol interaction can lead to severe adverse reactions
• Incomplete treatment course: Poor adherence to the 7-day regimen can result in treatment failure