Treatment for Trichomoniasis Infection
The recommended first-line treatment for trichomoniasis is metronidazole 2g orally in a single dose, which achieves cure rates of approximately 90-95%. 1
First-Line Treatment Options
- Metronidazole 2g orally in a single dose is the recommended first-line treatment for trichomoniasis infection 2, 1
- An alternative regimen is metronidazole 500mg orally twice daily for 7 days, which may be preferred in certain situations 2, 1
- The 7-day regimen may be more effective than the single-dose treatment, with one study showing reduced positivity at test-of-cure (11% vs 19%) 3
Treatment Considerations
- Metronidazole is the only oral medication available in the United States that has been traditionally used for treating trichomoniasis 2
- Tinidazole is also FDA-approved for trichomoniasis treatment, with similar efficacy to metronidazole 4, 5
- Topical metronidazole gel is NOT effective for trichomoniasis and should not be used (efficacy <50%) 2, 1
- Metronidazole can cause a disulfiram-like reaction when combined with alcohol, including nausea, vomiting, flushing, and headache 6
- Patients should avoid alcohol during treatment and for at least 24 hours after completing metronidazole therapy 6
Management of Sexual Partners
- All sexual partners should be treated simultaneously to prevent reinfection 2, 1
- Patients should abstain from sexual activity until both they and their partners complete treatment and are asymptomatic 2, 1
- Failure to treat sexual partners is a common cause of recurrent infection 6
Follow-Up Recommendations
- Routine follow-up is unnecessary for patients who become asymptomatic after treatment 2, 1
- If symptoms persist after treatment, consider reinfection or resistant infection 2, 1
Treatment Failure Management
- For first treatment failure, re-treat with metronidazole 500mg twice daily for 7 days 2, 1
- For repeated failure, administer metronidazole 2g once daily for 3-5 days 2, 1
- If treatment continues to fail and reinfection has been excluded, consultation with an infectious disease specialist is recommended 2, 1
- Evaluation of such cases should include determination of the susceptibility of T. vaginalis to metronidazole 2
Special Populations
Pregnancy
- Metronidazole can be used after the first trimester of pregnancy 7
- Trichomoniasis has been associated with adverse pregnancy outcomes, including premature rupture of membranes and preterm delivery 2, 7
HIV Infection
- Patients with HIV infection should receive the same treatment regimen as HIV-negative individuals 2, 1
Metronidazole Allergy
- For patients with allergy to metronidazole, options are limited as effective alternatives are not readily available 2
- Patients with true metronidazole allergy may require desensitization 2, 1
Clinical Pitfalls to Avoid
- Failing to treat sexual partners, which commonly leads to reinfection 1, 6
- Using topical metronidazole gel instead of oral therapy, which is ineffective for trichomoniasis 2, 1
- Not warning patients about alcohol interactions with metronidazole 6
- Overlooking asymptomatic infections, which are common in both men and women 8