Does a partner of a patient with trichomoniasis need treatment?

Treatment of Partners for Trichomoniasis

Yes, partners of patients with trichomoniasis should always be treated simultaneously to prevent reinfection, even if they are asymptomatic. 1

Rationale for Partner Treatment

• Trichomoniasis is a sexually transmitted disease that can easily lead to reinfection if partners are not treated
• The CDC recommends that all sexual partners be treated simultaneously to prevent reinfection 1
• Partner treatment significantly increases cure rates, which are typically 90-95% with appropriate treatment 2
• Most men infected with Trichomonas vaginalis are asymptomatic carriers, making them silent reservoirs for reinfection if left untreated 2

Treatment Protocol

1. First-line treatment for partners:

   • Metronidazole 2g orally in a single dose 1
   • Alternative: Metronidazole 500mg orally twice daily for 7 days 1

2. For partners with metronidazole allergy:

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

3. Patient and partner management:

   • Both patient and partner(s) should be treated simultaneously 2, 1
   • Sexual abstinence until both parties complete treatment and are asymptomatic 1
   • All recent sexual partners (within 60 days) should be evaluated and treated 1

Important Clinical Considerations

• Partner treatment is essential regardless of whether the partner is symptomatic or not 2, 1
• Without partner treatment, reinfection is common, leading to treatment failure and persistent infection 4
• In a study of HIV-infected women with trichomoniasis, patient-delivered partner treatment showed high adherence rates (75.4% provided treatment to all partners) 4
• The FDA label for tinidazole explicitly states: "Because trichomoniasis is a sexually transmitted disease with potentially serious sequelae, partners of infected patients should be treated simultaneously in order to prevent re-infection" 3

Potential Barriers to Partner Treatment

• Multiple sex partners
• Partners unaware of patient's infection status
• Single relationship status 4

Follow-up Recommendations

• Routine follow-up is unnecessary for patients who become asymptomatic after treatment 2
• Consider retesting all patients 3 months after treatment due to high rates of reinfection 1
• If symptoms persist, consider treatment failure and re-treat with metronidazole 500mg twice daily for 7 days 1

Cautions

• Both patient and partner should avoid alcohol during treatment and for 3 days afterward due to potential disulfiram-like reaction 3
• Topical metronidazole preparations are not effective for trichomoniasis (less than 50% efficacy) and should not be used 1
• If treatment failure occurs despite partner treatment, consider metronidazole resistance and consult with an expert 1

Partner treatment is a critical component of trichomoniasis management, as it breaks the cycle of reinfection and increases overall cure rates. Without treating partners, the 90-95% cure rate with appropriate treatment will be significantly compromised.