What is the recommended treatment for trichomoniasis (trichomonas infection)?

Treatment of Trichomoniasis Infection

The recommended first-line treatment for trichomoniasis is metronidazole 500 mg orally twice daily for 7 days, which provides cure rates of approximately 90-95%. 1

First-Line Treatment Options

• Metronidazole 500 mg orally twice daily for 7 days is the preferred regimen for treating trichomoniasis according to the Centers for Disease Control and Prevention 1
• An alternative regimen is metronidazole 2 g orally in a single dose, which may be preferred when medication adherence is a concern 1, 2
• Tinidazole is also FDA-approved for trichomoniasis treatment, though it's typically considered an alternative option 3
• The most recent evidence suggests that the 7-day regimen of metronidazole is more effective than the single-dose treatment (11% vs 19% positive at test-of-cure) 4

Management of Sex Partners

• All sexual partners should be treated simultaneously to prevent reinfection, as trichomoniasis is a sexually transmitted disease 1, 2
• Patients and their partners should abstain from sexual activity until both have completed treatment and are asymptomatic 1
• Treating asymptomatic partners is essential even if their test results are negative, as the organism can be difficult to detect in males 2

Important Clinical Considerations

• Topical metronidazole gel is NOT effective for trichomoniasis (efficacy <50%) and should not be used despite its approval for bacterial vaginosis 1, 2
• Metronidazole can cause a disulfiram-like reaction when combined with alcohol, resulting in nausea, vomiting, flushing, headache, and abdominal cramps 5
• Patients should be advised to avoid alcohol during treatment and for at least 24-48 hours after completing metronidazole therapy 5
• Metronidazole is indicated for both symptomatic and asymptomatic trichomoniasis 6

Treatment in Special Populations

Pregnancy

• Pregnant women can be treated with metronidazole 2 g orally in a single dose 1
• Treatment is particularly important as trichomoniasis has been associated with adverse pregnancy outcomes, including premature rupture of membranes and preterm delivery 1, 2

HIV Infection

• Patients with HIV infection should receive the same treatment regimen as HIV-negative individuals 1, 5

Metronidazole Allergy

• For patients with true metronidazole allergy, desensitization may be required as effective alternatives are limited 1, 5

Management of Treatment Failure

• If symptoms persist after initial treatment, re-treat with metronidazole 500 mg twice daily for 7 days 1, 2
• For repeated treatment failures, consider metronidazole 2 g once daily for 3-5 days 1, 2
• Treatment failures may be due to reinfection from untreated partners, non-adherence to treatment, or rarely, metronidazole-resistant T. vaginalis 1
• For persistent cases despite appropriate therapy, consultation with infectious disease specialists is recommended 7

Follow-Up

• Routine follow-up is unnecessary for patients who become asymptomatic after treatment 1, 2
• Test of cure is not routinely recommended following treatment of trichomoniasis with oral metronidazole 8

By following these evidence-based recommendations, clinicians can effectively treat trichomoniasis and reduce associated morbidity, while preventing transmission and recurrence of infection.