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 the standard of care for trichomoniasis in both genders once the diagnosis has been 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 to respond to the initial course of therapy. Following successful treatment, individuals may still be susceptible to re-infection.
Medical Therapy
Antimicrobial therapy is the standard of care for trichomoniasis in both genders once the diagnosis has been confirmed.[1][2][3] The symptoms of trichomoniasis in 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 women
- Preferred regimen: Metronidazole 500 mg PO bid for 7 days
- Alternative regimen: Tinidazole 2 g PO in a single dose
- Note: Patients should avoid sexual contact until they are fully cured of trichomoniasis
- Note: Testing for other STIs, including HIV, syphilis, gonorrhea, and chlamydia, should be performed for persons with T. vaginalis.
- 2. T. vaginalis infection in men
- Preferred regimen: Metronidazole 2 g PO in a single dose
- Alternative regimen: Tinidazole 2 g PO in a single dose
- Note: Patients should avoid sexual contact until they are fully cured of trichomoniasis
- Note: Testing for other STIs, including HIV, syphilis, gonorrhea, and chlamydia, should be performed for persons with T. vaginalis.
- 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 500 mg PO bid for 7 days
- 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.[4] 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[5]
- 4.1 Treatment failure:
- 4.1.1 In a woman after completing a regimen and has been re-exposed to an untreated partner
- Preferred regimen: Metronidazole 500 mg PO bid for 7 days
- 4.1.2 In a woman after completing a regimen and no re-exposure has occurred:
- Preferred regimen (1): Metronidazole 2 g PO for 7 days
- Preferred regimen (2): Tinidazole 2 g PO for 7 days
- 4.1.3 In men after completing a regimen and has been re-exposed to an untreated partner
- Preferred regimen: Metronidazole single 2-g dose.
- 4.1.4 In men after completing a regimen and no re-exposure has occurred:
- Preferred regimen (1): Metronidazole 500 mg PO BID for 7 days.
- 4.1.1 In a woman after completing a regimen and has been re-exposed to an untreated partner
- 4.2 Nitroimidazole-resistant T. vaginalis
- Antibiotic susceptibility testing recommended
- Preferred regimen: Tinidazole or metronidazole 2 g daily for 7 days
- Alternative regimen (1): high-dose oral tinidazole 2 g daily plus tinidazole 500 mg BID intravaginal for 14 days
- Alternative regimen (2): If the first failed, high-dose oral tinidazole 1 g TID plus paromomycin 4 g of 6.25% intravaginal paromomycin cream nightly for 14 days.
- 4.1 Treatment failure:
Treatment of Sexual Partners
- Sexual partners of patients with trichomoniasis should be treated.[3][6]
- 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 determine whether therapy has been successful.
- Patients should be instructed that they are still susceptible to re-infection.
- Retesting is recommended for sexually active women within 3 months of treatment for initial infection. If retesting at 3 months is not possible, clinicians should retest whenever persons next seek medical care <12 months after initial treatment. [7]
- Data are insufficient to support retesting men after treatment.
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.
- ↑ 3.0 3.1 http://www.cdc.gov/std/tg2015/trichomoniasis.htm, Accessed on September 13, 2016
- ↑ Trintis, J., et al. "Neonatal Trichomonas vaginalis infection: a case report and review of literature." International journal of STD & AIDS 21.8 (2010): 606-607.
- ↑ "www.cdc.gov" (PDF).
- ↑ Kissinger, Patricia, et al. "Patient-delivered partner treatment for Trichomonas vaginalis infection: a randomized controlled trial." Sexually transmitted diseases 33.7 (2006): 445-450.
- ↑ 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.