Treatment of Trichomoniasis
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 according to the Centers for Disease Control and Prevention (CDC) 2, 1
- An alternative regimen is metronidazole 2 g orally in a single dose, which may be preferred when medication adherence is a concern 3, 1
- Tinidazole is also FDA-approved for trichomoniasis treatment and can be considered as an alternative option 4
Management of Sex Partners
- All sexual partners should be treated simultaneously to prevent reinfection 2, 1
- Patients should avoid sexual intercourse until both they and their partners have completed treatment and are asymptomatic 1
- Trichomoniasis is a sexually transmitted disease, and treating asymptomatic partners is essential to prevent reinfection 5
Special Populations
Pregnancy
- Metronidazole is contraindicated during the first trimester of pregnancy 2, 6
- After the first trimester, pregnant women can be safely treated with metronidazole 2 g orally in a single dose 6
- Treatment is important as trichomoniasis has been associated with adverse pregnancy outcomes, including premature rupture of membranes and preterm delivery 6, 1
HIV Infection
- Patients with HIV infection should receive the same treatment regimen as HIV-negative individuals 3, 1
Follow-Up Recommendations
- Routine follow-up is unnecessary for patients who become asymptomatic after treatment 3, 1
- If symptoms persist, patients should be re-evaluated 2
Treatment Failure Management
- For first treatment failure, re-treat with metronidazole 500 mg twice daily for 7 days 3, 1
- For repeated failure, administer metronidazole 2 g once daily for 3-5 days 3, 1
- Resistant trichomoniasis is an emerging concern and may require consultation with an infectious disease specialist 7
Important Clinical Considerations
- Metronidazole gel is NOT recommended for trichomoniasis treatment despite its approval for bacterial vaginosis, as its efficacy is considerably lower (<50%) compared to oral metronidazole 3, 1
- Recent research suggests that the 7-day regimen of metronidazole is more effective than the single-dose regimen, with treatment failure rates of 11% versus 19% respectively 8
- Common side effects of metronidazole include nausea (23%), headache (7%), and vomiting (4%) 8
Diagnostic Approach
- Accurate diagnosis is important before treatment initiation, with diagnostic methods including wet mount microscopy, culture, or nucleic acid amplification tests 1, 9
- Nucleic acid amplification tests (NAATs) offer improved sensitivity and specificity compared to traditional methods 7
By following these evidence-based recommendations, clinicians can effectively treat trichomoniasis and prevent complications and transmission of this common sexually transmitted infection.