Treatment of Trichomoniasis in Males
The recommended first-line treatment for trichomoniasis in males is metronidazole 2g orally in a single dose, which has cure rates of approximately 90-95%. 1
Treatment Regimens
- Metronidazole 2g orally in a single dose is the preferred first-line treatment for males with trichomoniasis 1, 2
- An alternative regimen is metronidazole 500mg orally twice daily for 7 days, which may be considered when medication adherence is not a concern 1, 3
- Tinidazole 2g orally in a single dose is also effective for trichomoniasis treatment and is FDA-approved for this indication 4
Management of Sexual Partners
- All sexual partners should be treated simultaneously to prevent reinfection, as trichomoniasis is a sexually transmitted disease 1, 5
- Patients and their partners should abstain from sexual activity until both complete treatment and are asymptomatic 1, 6
- Even asymptomatic partners should receive treatment to prevent reinfection, as the majority of men infected with T. vaginalis are asymptomatic 6, 7
Follow-Up Recommendations
- Routine follow-up is unnecessary for men who become asymptomatic after treatment 1, 6
- If symptoms persist after treatment, consider reinfection or resistant infection 1, 3
Treatment Failure Management
- For first treatment failure, re-treat with metronidazole 500mg twice daily for 7 days 1, 3
- For repeated failure, administer metronidazole 2g once daily for 3-5 days 1, 6
- If treatment continues to fail and reinfection has been excluded, consultation with an infectious disease specialist is recommended 1
- Tinidazole may be effective in cases of metronidazole-resistant trichomoniasis, typically at higher doses (2g twice daily for up to 14 days) 8, 9
Important Clinical Considerations
- Patients should avoid alcohol during treatment with metronidazole and for at least 24 hours afterward due to potential disulfiram-like reactions (nausea, vomiting, flushing, headache) 1, 3
- For tinidazole, alcohol should be avoided during treatment and for 3 days afterward 4
- Topical metronidazole gel is NOT effective for trichomoniasis and should not be used (efficacy <50%) 1, 6
- Taking metronidazole or tinidazole with food helps minimize gastrointestinal side effects 3, 4
Special Situations
- For patients with HIV infection, the same treatment regimen applies as for HIV-negative individuals 1, 6
- For patients with true metronidazole allergy, options are limited and desensitization may be required; tinidazole may be considered but cross-reactivity is possible 1, 3
Trichomoniasis is a common sexually transmitted infection that requires appropriate treatment to prevent complications and transmission. While many infected males are asymptomatic, proper treatment is essential to prevent reinfection of partners and potential complications.