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For further information, see CMDT Part 37-12: Trichomoniasis
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Vaginitis with copious vaginal discharge in women
Nongonococcal urethritis in men
Motile trichomonads on wet mounts
Caused by the protozoan Trichomonas vaginalis
Among the most common sexually transmitted diseases; can be isolated from about 10% of men with nongonococcal urethritis
Occasionally can be acquired by non-sexual means, since it can survive in moist environments for several hours
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Often asymptomatic
For women with symptomatic disease
Vaginal discharge develops after an incubation period of 5 days to 4 weeks
Vulvovaginal discomfort, pruritus, dysuria, dyspareunia, or abdominal pain may be present
Inflammation of the vaginal walls and cervix with punctate hemorrhages are common
For men with symptomatic disease, the urethral discharge is generally more scanty than with other causes of urethritis
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Traditionally made by identifying the organism in vaginal or urethral secretions
Examination of wet mounts will show motile organisms
Tests for bacterial vaginosis are often positive
Point-of-care antigen tests, nucleic acid probe hybridization tests, and nucleic acid amplification assays have improved sensitivity compared to wet mount microscopy and excellent specificity
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The treatment of choice is metronidazole, 500 mg orally twice daily for 7 days in women, and as a single 2 g dose in men
An alternative is tinidazole, 2 g single oral dose in men and women
All persons with infection should be treated, even if asymptomatic, to prevent subsequent symptomatic disease and limit spread
Treatment failure suggests reinfection
However, metronidazole-resistant organisms have been reported and may be treated with