Trichomoniasis

Overview

  • In Australia, trichomonas is more common in older women and women from regional and remote areas, especially Aboriginal & Torres Strait Islander women
  • Uncommon cause of vaginal discharge or male urethritis in urban settings
  • Long natural history (years) if not treated in women
  • Without treatment, the infection is cleared more quickly in men than women.

Cause

Trichomonas vaginalis, a protozoan which infects the vagina, urethra and paraurethral glands.

Clinical presentation

Male Female
Symptoms
Usually asymptomatic. See chlamydia for more information Malodourous vaginal discharge - typically profuse and frothy
Urethral discharge (uncommon) Vulval itch/soreness
Dysuria (uncommon) Cervicitis
Complications
Associated with prostatitis Associated with premature rupture of membranes, pre-term delivery and low birth weight
  Post-partum sepsis

Special considerations

  • Up to 50% of infected women are asymptomatic, men are usually asymptomatic.
  • May enhance HIV transmission.

Diagnosis

Diagnosis in males
TestSite/SpecimenConsideration
NAAT

FPU Available in major laboratories in each state
NAAT – Nucleic Acid Amplification Test
FPU – First pass urine
Diagnosis in females
TestSite/SpecimenConsideration
NAAT

High vaginal swab or FPU

High vaginal swab should ideally be clinician collected during pelvic examination but can be self-collected if client declines examination.
Other

High vaginal swab (wet prep)

TV can be found on a high vaginal swab (wet prep) by the laboratory if TV is requested. However this test has poor sensitivity compared to NAAT testing.

NAAT – Nucleic Acid Amplification Test
FPU – First pass urine

Specimen collection

Clinician collected |
Self-collection

Investigations

Management

Principal Treatment Options
SituationRecommendedAlternative
Uncomplicated infection

Metronidazole 2g PO with food, stat.
OR
Tinidazole 2g PO stat. 

Metronidazole 400mg PO with food, BD for 5 days.

Treatment advice

Other immediate management

Special treatment situations

Special considerations

  • Single-dose treatments are advised.
  • Consider seeking specialist advice before treating any complicated presentation.
SituationRecommended
Pregnant women 
pregnancy
Due to conflicting outcomes of treating in pregnancy, seek specialist advice
Breastfeeding Consider intravaginal treatment. Metronidazole may affect taste of breast milk; avoid high doses in breastfeeding.
Allergy to principal treatment choice There is no effective alternative to 5 nitroimidazole compounds.
Metronidazole desensitisation has been described
People who are HIV positive Reports indicate single-dose metronidazole is less effective than extended metronidazole.

Contact tracing

See Australasian Contact Tracing Manual - Trichomoniasis for more information.

Follow up

Review in 1 week provides an opportunity to:

Test of Cure (TOC)

Not recommended.

Retesting

Auditable outcomes

100% of women diagnosed are treated with recommended principle treatment option.

References

Last Updated: Thursday, 29 March 2018