United Kingdom National Guideline on the Management of Trichomonas vaginalis 2014

Abstract

The main objective is to assist practitioners in managing men and women diagnosed with Trichomonas vaginalis (TV) infection. This guideline offers recommendations on the diagnostic tests, treatment regimens and health promotion principles needed for the effective management of TV, covering the management of the initial presentation, as well as how to prevent transmission and future infection.

Sexually Transmitted Diseases of the Vulva

“…Speculum examination may reveal the classic 'strawberry cervix' seen in about 2% of women (Sherrard 2007), which is due to punctate haemorrhages on the ectocervix.…”

“…The recommended treatment for trichomoniasis is with oral metronidazole 2 g as a single dose or 400-500 mg twice daily for 5-7 days (Sherrard 2007). Tinidazole 2 g orally as a single dose may also be used.…”

“…Metronidazole and tinidazole have a cure rate of approximately 95% (Gülmezoglu & Garner 1998). Spontaneous cure occurs in 20-25% (Sherrard 2007). It is important to ensure that the male partners of women with trichomoniasis are treated.…”

“…Repeating a standard course of treatment will usually result in a response in the first three situations. When resistance is suspected, higher doses or longer courses of metronidazole or tinidazole may be considered, as may the following treatments for which there is only anecdotal evidence: nonoxynol-9 pessaries nightly for 2 weeks and then once weekly for up to 7 months; acetarsol pessaries 2 × 250 mg nightly for 2 weeks; paromomycin sulphate 250 mg pessaries once or twice daily for 2 weeks (Sherrard 2007).…”

Trichomonas vaginalis: Clinical relevance, pathogenicity and diagnosis

“…The most commonly administered drug in the UK is metronidazole, in part due to the low associated cost (Sherrard et al, 2014). These antibiotics from the 5-nitroimidazole family exert their antimicrobial activity by disrupting the redox system of the parasite, with metabolic products of the drug binding to proteins in the thioredoxin mediated redox network and inhibiting thioredoxin reductase (Leitsch et al, 2009).…”