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For further information, see CMDT Part 37-12: Trichomoniasis

KEY FEATURES

  • 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

CLINICAL FINDINGS

  • Often asymptomatic

  • For women with symptomatic disease

    • Vaginal discharge develops after an incubation period of 5 days to 4 weeks

      • May be copious

      • Usually not foul-smelling

      • Often frothy and yellow or green in color

    • 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

DIAGNOSIS

  • 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

    • pH > 4.5

    • Fishy odor after addition of potassium hydroxide

  • 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

TREATMENT

  • 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

    • Tinidazole

    • Longer courses of metronidazole

    • Intravaginal paromomycin

    • Other experimental therapies

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