Treatment of Trichomonas vaginalis in Partners
Sex partners of patients with Trichomonas vaginalis infection should be treated simultaneously with metronidazole 2g orally in a single dose to prevent reinfection. 1, 2
First-Line Treatment Options for Partners
- Metronidazole 2g orally in a single dose is the recommended first-line treatment for partners, with cure rates of approximately 90-95% 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 2
- Tinidazole 2g as a single oral dose is an FDA-approved alternative, particularly useful in cases where metronidazole treatment has failed 3
Importance of Partner Treatment
- Treatment of both the patient and sex partners results in relief of symptoms, microbiologic cure, and reduction of transmission 4
- Since trichomoniasis is a sexually transmitted disease, treating partners simultaneously is essential to prevent reinfection 2, 3
- Failure to treat sexual partners significantly increases the risk of reinfection 5
Post-Treatment Recommendations
- Patients should be instructed to avoid sex until both they and their partner(s) are cured 4, 2
- In the absence of microbiologic test-of-cure, this means when therapy has been completed and both patient and partner(s) are asymptomatic 4
- Routine follow-up is unnecessary for men who become asymptomatic after treatment 1, 2
Management of Treatment Failure
- If treatment fails with either regimen, retreat with metronidazole 500mg twice daily for 7 days 4, 2
- For repeated failure, administer metronidazole 2g once daily for 3-5 days 4, 5
- If treatment continues to fail and reinfection has been excluded, consider tinidazole as an alternative treatment option 6
- Consultation with an infectious disease specialist is recommended for persistent infections 5
Important Clinical Considerations
- Metronidazole gel is NOT effective for trichomoniasis (efficacy <50%) and should not be used 1, 2
- Patients should avoid alcohol during treatment with metronidazole and for at least 24 hours after completing therapy due to potential disulfiram-like reactions 1
- For tinidazole, alcoholic beverages should be avoided during treatment and for 3 days afterward 3
Special Situations
- For partners with HIV infection, the same treatment regimen applies as for HIV-negative individuals 2, 5
- For partners with true metronidazole allergy, desensitization may be required as effective alternatives are limited 4, 2
- Tinidazole may be considered for patients who fail metronidazole therapy, as suggested by recent research showing effectiveness in metronidazole-resistant cases 6
Michigan-Specific Considerations
- Michigan follows the CDC guidelines for treatment of trichomoniasis in partners
- The same treatment regimens and partner management strategies apply throughout the state
- Expedited partner therapy may be considered to ensure partners receive treatment, especially when partners are unlikely to seek medical care 7