Trichomoniasis Treatment in Singapore: Trichomoniasis symptoms in men/women, screening/diagnosis, testing/check, treatment clinic, Singapore. Private and confidential service. Definitions, references, and latest news.
Both symptomatic and asymptomatic patients should be treated.
Metronidazole 400mg orally bid x 7 days [Ib, A]
Metronidazole 2g orally single dose [Ib, A]
Tinidazole 2g orally single dose
Metronidazole gel is not recommended because it is less efficacious. (<50%)
Trichomoniasis may be acquired perinatally and occurs in ~ 5% of babies born to infected mothers. Infection beyond the first year of life should suggest sexual contact and the child should be appropriately evaluated.
Metronidazole 15mg/kg orally tid x 7 days
Treatment in pregnancy
Trichomoniasis has been associated with adverse pregnancy outcomes (premature rupture of membranes, preterm delivery, low birth weight). Metronidazole in pregnancy has not been shown to be teratogenic or mutagenic and can be used during all stages of pregnancy or breastfeeding. Imidazole and metronidazole pessaries may be used to provide symptomatic relief, but systemic metronidazole is needed for eradication of infection.
Metronidazole and Tinidazole may provoke a disulfiram – like reaction when taken with alcohol. Patients should be advised to abstain from alcohol use for 24 hours after completion of metronidazole and 72 hours after completion of tinidazole.
Allergy to Metronidazole
Clotrimazole pessaries 100mg od intravaginally x 6 days [IV, C]
TV in HIV infection
T. vaginalis infection in HIV-infected women has been shown to enhance HIV transmission by increasing genital shedding of the virus and treatment for T. vaginalis has been shown to reduce HIV shedding. Rescreening at 3 months after completion of therapy should be considered in HIV-positive women. Single dose metronidazole is not as effective as 400-500mg twice daily for 7 days in HIV-positive women.
Follow-up is unnecessary for asymptomatic patients. Patients with persistent symptoms treated with either regimen should be retreated with metronidazole 400mg bid for 7 days. If treatment failure occurs repeatedly, the patient should be treated with a single 2g dose of metronidazole once a day for 3-5 days. Such cases should have determination of susceptibility of T. vaginalis to metronidazole.