Treatment of trichonomiasis in females

Metronidazole is the usual treatment. Alternatives include tinidazole. Both are administered orally (1,2).

• metronidazole 400 mg twice a day for 5-7 days or 2 g as a stat dose if compliance is a problem

Note: Stat doses should be avoided if pregnant or breast feeding (1,2,5).

The male partner should also be treated; especially if there is a recurrence. During treatment, a condom should be used during intercourse. It is advisable to treat an asymptomatic woman in whom trichomonas has been found, before it becomes an established infection.

If pregnant woman does not wish treatment with metronidazole (5)

• pregnancy to treat symptoms:
  • clotrimazole 100mg pessary at night for 6 nights

Note that when one sexually transmitted disease is found, others frequently co-exist and should be looked for (Gonorrhoea often co-exists with trichomoniasis). GUM clinic review is recommended.

Alcohol abstinence is advised during the course of the treatment and at least for 2 days afterwards because of the possibility of a disulfiram-like reaction (1).

Current sexual partners of women diagnosed with TV should be offered a full sexual health screen and should be treated for TV irrespective of the results of their tests (3)

Recurrent TV is usually due to re-infection, but consideration should be given to the possibility of drug resistance (3)

Key points (4):

• oral treatment needed as extravaginal infection common
• treat partners, and refer to GUM for other STIs.
• pregnant/breastfeeding:
  • avoid 2g single dose metronidazole;
  • clotrimazole for symptom relief (not cure) if metronidazole declined

Reference:

• (1) BASHH (2007) United Kingdom national guideline on the management of Trichomonas vaginalis. British Association of Sexual Health and HIV
• (2) RCGP and BASHH (2006) Sexually transmitted infections in primary care. Royal College of General Practitioners.
• (3) FSRH and BASHH Guidance (February 2012) Management of Vaginal Discharge in Non-Genitourinary Medicine Settings.
• (4) Public Health England (June 2021). Managing common infections: guidance for primary care