Treatment of Trichomoniasis in Pregnancy
Metronidazole 2g orally in a single dose is the recommended treatment for trichomoniasis in pregnant women after the first trimester. 1, 2
First Trimester Considerations
- Metronidazole is contraindicated during the first trimester of pregnancy due to potential concerns about fetal organogenesis 2, 3
- Treatment should be delayed until after the first trimester whenever possible 2
Treatment Regimens After First Trimester
- Recommended regimen: Metronidazole 2g orally in a single dose 1, 2
- This regimen has cure rates of approximately 90-95% in non-pregnant populations 1
Important Clinical Considerations
- Trichomoniasis during pregnancy has been associated with adverse pregnancy outcomes, including:
- Despite these associations, a randomized controlled trial found that treatment of asymptomatic trichomoniasis with metronidazole during pregnancy did not prevent preterm delivery and was actually associated with increased risk of preterm birth 4
- Therefore, routine screening and treatment of asymptomatic pregnant women for trichomoniasis is not recommended 4, 5
- Treatment should focus on symptomatic pregnant women after the first trimester 2
Alternative Approaches
- Topical treatments such as intravaginal metronidazole or clotrimazole are significantly less effective than oral metronidazole for trichomoniasis (50% vs 90-95% cure rates) and are not recommended 1, 6, 7
- There are no effective alternatives to metronidazole for patients with true metronidazole allergy during pregnancy 1, 2
Management of Sexual Partners
- All sexual partners should be treated simultaneously to prevent reinfection 2, 8
- Patients should abstain from sexual activity until both they and their partners complete treatment and are asymptomatic 2, 8
Follow-Up Recommendations
- Follow-up is unnecessary for women who become asymptomatic after treatment 1
- If symptoms persist, consider reinfection or resistant infection 1
- For treatment failure, re-treat with metronidazole 500mg twice daily for 7 days 1
- For repeated failure, administer metronidazole 2g once daily for 3-5 days 1
Important Precautions
- Advise patients to avoid alcohol during treatment and for at least 24 hours after completing metronidazole therapy due to potential disulfiram-like reactions 8
- Metronidazole crosses the placental barrier rapidly, which is why treatment is contraindicated in the first trimester 3
HIV Considerations
- Pregnant women with HIV infection should receive the same treatment regimen as HIV-negative individuals 2
Remember that while treating symptomatic trichomoniasis is important for maternal comfort and potentially reducing complications, the evidence does not support routine screening and treatment of asymptomatic trichomoniasis during pregnancy.