Trichomoniasis

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Trichomoniasis is one of the most common STIs, caused by a parasitic protozoan Trichomonas vaginalis. Women are mostly symptomatic while men are asymptomatic carriers.

Causes

  • T. vaginalis

Symptoms

In women

-          Vulvo-vaginal itching, burning or soreness

-          Pain during sex (major complaint)

-          Post-coital bleeding, lower abdominal pain

 

In men

-          Urethritis, urethral pruritus, dysuria,            testicular pain, lower abdominal pain

Signs

In women

-          Purulent, bloody or frothy-yellow-green discharge

-          Vulval inflammation

-          Pelvic inflammatory disease

 

In men

Urethral discharge

Differential diagnosis

  • Gonorrhoea
  • Trichomoniasis
    • May cause cervicitis or vaginitis

Complications

  • Acute salpingitis
  • Adverse pregnancy outcomes, particularly premature rupture of membranes, pre-term delivery and low birth weight

Investigations

  • Microscopy (this is the gold standard for diagnosis)
  • Histology

Treatment objectives

  • Eliminate the causative organism in the patient and sexual partner(s)
  • Prevent re-infection
  • Consistent and correct use of condoms(Male and Female condoms)
  • Manage symptoms
  • Prevent transmission of the infection
  • Prevent complications

Non-pharmacological treatment

  • Advice on avoidance of alcohol consumption during treatment
  • Advise patient on personal hygiene

Pharmacological treatment

Adult:

Metronidazole oral

2 g as a single dose

OR

400 mg or 500 mg every 12 hours for 7 days

OR

Tinidazole oral

2 g orally in a single dose

OR

500 mg orally every 12 hours for 5 days

Note: Patients should not consume alcohol during the course of treatment or during the 24 hours after the completion of the medication.

Pregnancy

Metronidazole

2g in a single doseNote: Metronidazole is not recommended for pregnant women in the first trimester

Lactation

In lactating women, breastfeeding must be withheld during treatment and until 12-24 hours after the last dose to reduce exposure to the infant.

Note: Patients on tinidazole therapy should not consume alcohol during therapy or for 72 hours after completion of medication.

Neonatal infections

Metronidazole oral

5 mg/kg 3 times daily for 5 days

Prevention

  • Advise patient and partner(s) to abstain from sex while on treatment
  • Re-screen at 3 months post-therapy for sexually active women, as they have a high risk of re-infection
  • Limit number of sexual partners
  • Advice on the correct and consistent use of male or female condoms

Referral

  • Patients with conditions not responding to the above treatment should be referred for specialized management.