Trichomoniasis medical therapy
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Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1], Associate Editor(s)-in-Chief: Aysha Anwar, M.B.B.S[2]
Overview
Antimicrobial therapy is indicated in trichomoniasis among both genders when the diagnosis is confirmed. The symptoms of trichomoniasis among infected men may disappear within a few weeks even without treatment, but asymptomatic men may continue to be infectious and should therefore be treated. Antimicrobial therapy generally includes either metronidazole or tinidazole 2 g PO in a single dose. Prolonged therapy for 7 days is indicated among patients who fail the initial course of therapy. Following successful treatment, individuals may still be susceptible to re-infection.
Medical Therapy
- Antimicrobial therapy is indicated in trichomoniasis among both genders when the diagnosis is confirmed.[1][2][3]
- The symptoms of trichomoniasis among infected men may disappear within a few weeks even without treatment, but asymptomatic men may continue to be infectious and should therefore be treated.
Antimicrobial Regimen
- 1. T. vaginalis infection in adults[4]
- Preferred regimen (1): Metronidazole 2 g PO in a single dose
- Preferred regimen (2): Tinidazole 2 g PO in a single dose
- Alternative regimen: Metronidazole 500 mg PO bid for 7 days
- Note: Patients should avoid sexual contact until they are fully cured of trichomoniasis
- 2. T. vaginalis infection in pregnant and lactating Women
- 2.1 Pregnant women
- Preferred regimen: Metronidazole 2 g PO in a single dose
- 2.2 Post-partum and Breastfeeding
- Preferred regimen (1): Metronidazole 2 g PO in a single dose
- Preferred regimen (2): Tinidazole 2 g PO in a single dose
- Note (1): Do not breastfeed for 12-24 hrs following Metronidazole and 72 hrs following Tinidazole
- Note (2): Symptomatic pregnant women, regardless of pregnancy stage, should be tested and considered for treatment. Pregnant women should be advised of the risk and benefits to treatment as infection (definitely) and treatment (possibly)
- Note (3): Pregnant women with HIV who are treated for T. vaginalis infection should be retested 3 months after treatment.
- 3. T. vaginalis infection in patients with HIV
- Preferred regimen: Metronidazole 500 mg PO bid for 7 days
- 4. Persistent or recurrent trichomoniasis
- 4.1 Treatment failure, first-time
- Preferred regimen: Metronidazole 500 mg PO bid for 7 days
- 4.2 Treatment failure, second-time
- Preferred regimen (1): Metronidazole 2 g PO for 7 days
- Preferred regimen (2): Tinidazole 2 g PO for 7 days
- 4.3 Nitroimidazole-resistant T. vaginalis
- Preferred regimen: Tinidazole 2-3 g PO for 14 days
Treatment of Sexual Partners
- Sexual partners of patients with trichomoniasis should also be evaluated and treated.
- Patients and their sexual partners should avoid sexual contact until they are fully cured of trichomoniasis.
Follow-up
- Patients should be re-evaluated at the end of the antimicrobial therapy regimen to evaluate for cure vs. failure of therapy.
- Patients should be instructed that they are still susceptible to re-infection.
- Restesting is recommended for sexually active women within 3 months of treatment for initial infection.[5]
References
- ↑ Cudmore SL, Delgaty KL, Hayward-McClelland SF, Petrin DP, Garber GE (2004). "Treatment of infections caused by metronidazole-resistant Trichomonas vaginalis". Clin Microbiol Rev. 17 (4): 783–93, table of contents. doi:10.1128/CMR.17.4.783-793.2004. PMC 523556. PMID 15489348.
- ↑ Coleman JS, Gaydos CA, Witter F (2013). "Trichomonas vaginalis vaginitis in obstetrics and gynecology practice: new concepts and controversies". Obstet Gynecol Surv. 68 (1): 43–50. doi:10.1097/OGX.0b013e318279fb7d. PMC 3586271. PMID 23322080.
- ↑ http://www.cdc.gov/std/tg2015/trichomoniasis.htm, Accessed on September 13, 2016
- ↑ "trichomoniasis".
- ↑ Van Der Pol, Barbara, et al. "Prevalence, incidence, natural history, and response to treatment of Trichomonas vaginalis infection among adolescent women." Journal of Infectious Diseases 192.12 (2005): 2039-2044.