Treatment of Trichomonas 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
First-Line Treatment Options
- Metronidazole 2g orally in a single dose is the standard treatment recommended by the Centers for Disease Control and Prevention for males with trichomoniasis 1
- An alternative regimen is metronidazole 500mg orally twice daily for 7 days, which may be considered when medication adherence is not a concern 1
- Tinidazole 2g orally in a single dose is also an effective alternative treatment option 2
Management of Sexual Partners
- All sexual partners should be treated simultaneously to prevent reinfection 1, 3
- Patients should abstain from sexual activity until both they and their partners complete treatment and are asymptomatic 1, 3
- Treatment of asymptomatic partners is essential as trichomoniasis is a sexually transmitted disease that can lead to reinfection if partners are not treated 4, 5
Important Clinical Considerations
- Patients should take metronidazole with food to minimize gastrointestinal side effects 4
- Alcohol should be avoided during treatment and for at least 24 hours after completing metronidazole therapy due to potential disulfiram-like reactions (nausea, vomiting, flushing, headache, and abdominal cramps) 1, 4
- For tinidazole, alcohol should be avoided during treatment and for 3 days afterward 2
- Topical metronidazole gel is NOT effective for trichomoniasis (efficacy <50%) and should not be used 1, 3
Follow-Up Recommendations
- Routine follow-up is unnecessary for men who become asymptomatic after treatment 1
- If symptoms persist after treatment, consider reinfection or resistant infection 1
Treatment Failure Management
- For first 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
- If treatment continues to fail and reinfection has been excluded, consultation with an infectious disease specialist is recommended 1
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, desensitization may be required as effective alternatives are limited 1, 6
- Patients with azole allergies may have cross-reactivity with metronidazole despite it being from a different drug class (nitroimidazole vs. azole) 3
Clinical Pearls
- Asymptomatic infection is common in men, making screening important in high-risk populations or partners of infected women 5
- Single-dose therapy offers advantages in terms of convenience and compliance, particularly important for sexually transmitted infections 7
- Metronidazole resistance is an emerging problem, though its clinical significance is still being determined 5
- Secnidazole, a newer FDA-approved treatment for trichomoniasis, may be considered as an alternative with its favorable pharmacokinetic profile and single-dose administration 8