What is the treatment for trichomoniasis?

Treatment for Trichomoniasis

Metronidazole 500mg 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:

  • 500mg orally twice daily for 7 days 1, 2
  • This regimen has been shown to be more effective than single-dose therapy

• Alternative treatment (for metronidazole allergy):

  • Tinidazole 2g orally in a single dose 1, 3
  • FDA-approved specifically for trichomoniasis caused by Trichomonas vaginalis 3

Evidence Supporting 7-Day Treatment

Recent high-quality evidence demonstrates that the 7-day metronidazole regimen is more effective than the single-dose approach. A randomized controlled trial showed that patients in the 7-day-dose group were less likely to be T. vaginalis positive at follow-up compared to those in the single-dose group (11% vs 19%, relative risk 0.55) 4.

Important Clinical Considerations

• Partner treatment:

  • All recent sexual partners (within 60 days) should be evaluated, tested, and treated 1
  • Partners should be treated simultaneously to prevent reinfection 3, 2

• Sexual activity:

  • Patients should abstain from sexual intercourse until they and their partners have completed treatment 1

• Alcohol avoidance:

  • Patients should avoid alcohol during treatment and for 24-48 hours afterward to prevent disulfiram-like reactions 1

• Monitoring:

  • No routine test-of-cure is recommended if symptoms resolve
  • Consider retesting 3 months after treatment due to high rates of reinfection 1

Diagnostic Testing

• Preferred testing methods:
  • Nucleic acid amplification tests (NAATs) - highest sensitivity 1
  • Culture - most sensitive commercially available method 1
  • Wet mount microscopy - limited sensitivity (60-70%) 1

Special Populations

• Pregnancy:

  • Metronidazole is contraindicated in the first trimester but may be used after the first trimester in a 2g single dose 1

• HIV patients:

  • Should receive the same treatment regimen as patients without HIV 1

Caution

• Avoid prolonged courses of metronidazole to minimize the risk of cumulative and potentially irreversible neurotoxicity 1
• For patients who cannot tolerate oral metronidazole due to gastrointestinal side effects, high-dose intravaginal metronidazole combined with miconazole may be considered, though this is not the first-line approach 5