Criteria & Principles
DUHS Management of Adult and Adolescent (≥13 yrs) Trichomonas vaginalis infection
- Asymptomatic screening should be avoided in general populations.
- Treatment of asymptomatic T. vaginalis is recommended for sex partners of known positive contacts
- Treatment of asymptomatic T. vaginalis may be considered for specific at-risk populations (e.g., vaginal screening in patients living with HIV, multiple sex partners, transactional sex)
- T. vaginalis more commonly causes vaginitis, but can occasionally cause urethritis or cystitis in individuals with a vagina. Evaluation and treatment for Trichomonas as a cause of urethritis is generally limited to cases where contact with an infected partner occurred or symptoms have persisted/recurred despite initial evaluation/treatment.
- The role of T. vaginalis in urethritis among individuals with a penis is less clear: infection tends to be asymptomatic in >75% of cases and may sometimes spontaneously clear. Untreated infection can serve as a reservoir for re-infection of sex partners with a vagina. Evaluation and treatment for Trichomonas as a cause of urethritis is generally limited to cases where contact with an infected partner occurred or symptoms have persisted/recurred despite initial evaluation/treatment.
- Advise individuals with T. vaginalis infections to abstain from sex until they and their sex partners are treated. Screening for other STIs, including HIV, syphilis, gonorrhea, and chlamydia, should be performed for individuals with T. vaginalis.
- Retesting for clearance of T. vaginalis is recommended for sexually active individuals with a vagina approximately 3 months after initial treatment (regardless of whether they believe their sex partners were treated).
- Allergy to metronidazole may require desensitization.
Treatment
Severity
All Severity
Asymptomatic detection in at-risk population: Treat with options below based on anatomy
Sex partner of known case (symptomatic or asymptomatic): Treat with options below based on anatomy
Symptomatic urethritis among individuals with a penis: Metronidazole 2g orally in a single dose
Symptomatic vaginitis or cystitis/urethritis among individuals with a vagina: Metronidazole 500mg Q12 hours orally for 7 days
Alternative (for refractory disease): tinidazole 1g orally in a single dose
References
https://www.cdc.gov/std/treatment-guidelines/trichomoniasis.htm