Treatment of Sexual Partners with Trichomoniasis
Yes, you should treat the patient for trichomoniasis even if only their sexual partner tested positive, as concurrent partner treatment is essential to prevent reinfection and achieve cure. 1, 2, 3
Rationale for Treating Asymptomatic Partners
The FDA-approved metronidazole labeling explicitly states that "asymptomatic sexual partners of treated patients should be treated simultaneously if the organism has been found to be present, in order to prevent reinfection of the partner." 3 This recommendation is based on several critical factors:
Trichomoniasis is a sexually transmitted infection where the majority of infected men are asymptomatic, making detection difficult and reinfection of treated partners highly likely without concurrent treatment 1
Diagnostic limitations in male partners mean that negative cultures or smears cannot be relied upon to rule out infection, as isolating the organism from asymptomatic male carriers is considerably difficult 3
Treatment of both partners results in relief of symptoms, microbiologic cure, and reduction of transmission, with cure rates reaching approximately 95% when both are treated 1
Recommended Treatment Regimen
Treat the patient with one of these metronidazole regimens:
- Metronidazole 2g orally as a single dose (preferred) 1, 2
- Alternative: Metronidazole 500mg twice daily for 7 days 1, 2
Both regimens demonstrate approximately 95% cure rates in clinical trials. 1, 2
Critical Management Points
Sexual abstinence is mandatory until both the patient and all partners complete treatment and are asymptomatic, as this prevents reinfection during the treatment period. 1, 2
In cases of reinfection, the patient should be retreated even if the partner's treatment status is uncertain, as there is evidence that women may become reinfected if their partners are not treated. 3
Common Pitfalls to Avoid
Failure to treat sexual partners significantly increases the risk of reinfection, which is the most common cause of treatment failure aside from drug resistance 2, 4
Do not use topical metronidazole gel, as it has poor efficacy (<50%) against T. vaginalis and is not recommended for trichomoniasis treatment 1, 2
Do not assume negative testing in male partners rules out infection, as diagnostic sensitivity is poor in asymptomatic men 3
Special Considerations
If the patient is pregnant, metronidazole is contraindicated in the first trimester but can be administered as a 2g single dose after the first trimester for symptomatic cases. 1, 5
For patients with metronidazole allergy or intolerance, tinidazole 2g orally as a single dose is an alternative option. 6