Are men treated for trichomoniasis?

Treatment of Trichomoniasis in Men

Direct Answer

Yes, men with trichomoniasis must be treated, even if asymptomatic, using the same metronidazole regimens as women. 1, 2, 3

First-Line Treatment Regimen

The CDC recommends metronidazole 2g orally as a single dose for men with trichomoniasis, achieving cure rates of 90-95%. 1, 2, 4 This single-dose regimen remains the preferred treatment specifically for males according to the most recent evidence. 4

Alternative Regimen

• Metronidazole 500mg orally twice daily for 7 days can be used as an alternative, particularly when adherence is not a concern. 1, 2
• Recent data suggest the 7-day regimen may reduce treatment failure rates in women, but the single-dose remains preferred in men. 4

Critical Management Principles

Partner Treatment is Mandatory

• All sexual partners must be treated simultaneously, regardless of symptom status, to prevent reinfection. 1, 2, 5, 6
• The FDA label explicitly states that asymptomatic male partners should be treated when the organism is found, as men often serve as asymptomatic carriers who reinfect their partners. 3
• Patients must abstain from sexual activity until both partners complete treatment and are asymptomatic. 1, 2, 5, 6

Why Men Must Be Treated

• Most men infected with T. vaginalis are asymptomatic but can develop urethritis or prostatitis. 1, 7
• Male partners are a major reservoir for reinfection—women frequently become reinfected if their male partners remain untreated. 3
• Isolating the organism from asymptomatic male carriers is difficult, so negative cultures cannot be relied upon to rule out infection. 1

Treatment Failure Algorithm

If initial treatment fails, follow this stepwise approach:

1. First failure: Re-treat with metronidazole 500mg twice daily for 7 days 1, 2, 5, 6
2. Second failure: Administer metronidazole 2g once daily for 3-5 days 1, 2, 5, 6
3. Persistent failure: Consult infectious disease specialist for susceptibility testing (available through CDC at 770-488-4115) 1

Follow-Up Recommendations

• Routine follow-up is unnecessary for men who become asymptomatic after treatment. 1, 2, 6
• Re-evaluate only if symptoms persist, considering reinfection or resistant infection. 2, 6

Critical Pitfall to Avoid

Never use topical metronidazole gel for trichomoniasis—it has <50% efficacy because it cannot achieve therapeutic levels in the urethra or perivaginal glands. 1, 5, 6 This is a common error that leads to treatment failure.

Special Populations

HIV-Infected Men

• Use the same treatment regimens as HIV-negative patients. 1, 6

Metronidazole Allergy

• Desensitization may be required, as effective alternatives are extremely limited. 2, 6
• Tinidazole 2g single dose is an alternative nitroimidazole with similar efficacy (95% cure rate), though it shares cross-reactivity concerns. 8, 9, 10

Patient Counseling

• Patients must avoid alcohol during treatment and for at least 24 hours (up to 3 days with tinidazole) after completion due to disulfiram-like reaction causing nausea, vomiting, flushing, headache, and abdominal cramps. 2, 5, 8
• Take medication with food to minimize gastrointestinal side effects. 3, 8

Resistance Considerations

• In vitro antibiotic resistance to 5-nitroimidazoles remains low at 4.3%, but should be monitored. 4
• Most strains with diminished susceptibility respond to higher doses of metronidazole. 1