What is the treatment for trichomoniasis?

Treatment for Trichomoniasis

The recommended first-line treatment for trichomoniasis is metronidazole 2g orally in a single dose, which has cure rates of approximately 90-95%. 1, 2

First-Line Treatment Options

• Metronidazole 2g orally in a single dose is the recommended first-line treatment for trichomoniasis 3
• Alternative regimen: Metronidazole 500mg orally twice daily for 7 days 3
• Recent research suggests the 7-day regimen may be more effective than the single-dose treatment (11% vs 19% treatment failure rates) 4
• The FDA has approved Flagyl 375mg twice daily for 7 days for treatment of trichomoniasis based on pharmacokinetic equivalency 3

Management of Sexual Partners

• All sexual partners should be treated simultaneously to prevent reinfection 3, 1
• Patients should abstain from sexual activity until both they and their partners complete treatment and are asymptomatic 3, 5
• Trichomoniasis is a sexually transmitted disease, so treating asymptomatic partners is essential to prevent reinfection 2

Treatment Considerations and Precautions

• Metronidazole can cause a disulfiram-like reaction when combined with alcohol, resulting in nausea, vomiting, flushing, headache, and abdominal cramps 5
• Patients should avoid alcohol during treatment and for at least 24 hours after completing metronidazole therapy 5
• Topical metronidazole gel is NOT effective for trichomoniasis (efficacy <50%) and should not be used 1, 6
• Tinidazole is an alternative medication approved by the FDA for trichomoniasis treatment 7, 8

Special Populations

Pregnancy

• Metronidazole 2g orally in a single dose can be used after the first trimester of pregnancy 3
• Metronidazole is contraindicated during the first trimester of pregnancy 3, 9
• Treatment is important as trichomoniasis has been associated with adverse pregnancy outcomes, including premature rupture of membranes and preterm delivery 3, 9

HIV Infection

• Patients with HIV infection should receive the same treatment regimen as HIV-negative individuals 3, 9

Follow-Up and Treatment Failure Management

• Routine follow-up is unnecessary for patients who become asymptomatic after treatment 3, 1
• If symptoms persist after initial treatment:
  • Re-treat with metronidazole 500mg twice daily for 7 days 3
  • For repeated failure, administer metronidazole 2g once daily for 3-5 days 3, 1
  • Consider consultation with an infectious disease specialist for persistent cases 1, 9

Common Pitfalls to Avoid

• Failing to treat sexual partners is a common cause of recurrent infection 1, 5
• Using topical metronidazole gel instead of oral therapy (topical treatment has poor efficacy) 1, 6
• Not advising patients about alcohol interactions with metronidazole 5
• Not considering resistant T. vaginalis strains in cases of treatment failure 5