Etiology
- Trichomonas vaginalis
Epidemiology
- More common in older women relative to other STIs
- Black Caribbean and black “other” ethnic groups
Testing indications
- Vaginal discharge
- When is it appropriate to screen asymptomatic women for TV?
- Controversial. Depends on local prevalence
- Black population have higher prevalence - consider testing
Diagnóstico
- Microscopy - low sensitivity
- NAAT - gold standard
- Point of care in low risk population will have false positives
- No validated test for men! Low sensitivity/specificity. Urethral or meatal swab can be used
- Rectal and oral testing is not recommended
Treatment
- Metronidazole 400-500mg orally 2x/d for 7 days
- Single dose (used before) is no longer recommended
- Systemic antibiotics are required because periurethral gland affection
- Don’t give topical treatment alone
- Allergy - no real treatment alternative. Well document cases of desensitization. True allergy to metronidazole is rare - confirm history.
- Alcoholics may have disulfiram effect - consider single dose
- Recurrent infection
- Untreated partner
- Treatment failure (resistance)
- Lack of adherence
- If NAAT is used to confirm, should be done 3 weeks after the end of treatment due to the risk of detection of uninfectious particles
- Metronidazole 800mg 3x/d for 7 days
- Metronidazole 2g daily for 5-7 days
- Repeat metronidazole 2g 2x/d for 14 days with metronidazole vaginal cream 5g twice daily for 14 days
- Dequalinium chloride 10mg vaginal tablets for 18weeks
- Boric acid pessaries 600mg alternate nights to 600mg 2 times daily for between 1-5 months
- Intravaginal paromomucin alone
- Nitroimidazol - 2nd line treatment that is usually effective. Higher effecicacy but higher risk of resistance
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