eMedicine Specialties > Infectious Diseases > Parasitic Infections

Trichomoniasis: Follow-up

Author: Darvin Scott Smith, MD, MSc, DTM&H,, Adjunct Assistant Professor, Department of Microbiology and Immunology, Stanford University; Chief of Infectious Diseases and Geographic Medicine, Department of Internal Medicine, Kaiser Redwood City Hospital
Coauthor(s): Natalia Ramos,, Stanford University, Keck School of Medicine of the University of Southern California
Contributor Information and Disclosures

Updated: Aug 20, 2008

Follow-up

Further Outpatient Care

  • Sexual partners of patients infected with trichomoniasis must be treated to prevent reinfection.
  • Consider empiric treatment of other sexually transmitted infections that frequently coexist with trichomoniasis.
  • Advise the patient to abstain from sexual intercourse until both the patient and partner have completed therapy and are asymptomatic.2
  • Persistent treatment failures may require metronidazole susceptibility testing through the Centers for Disease Control and Prevention (CDC).

Deterrence/Prevention

  • Abstinence from sexual intercourse prevents trichomoniasis.
  • Limiting the number of sexual partners decreases the risk of trichomoniasis.
  • Male condoms can protect against the transmission of trichomoniasis. Although the efficacy of female condoms is undefined, they may also provide some protection.2
  • Diaphragms have been shown to protect against trichomoniasis but should not be used as the primary source of protection against HIV.2
  • Spermicides that contain nonoxynol-9 are not recommended for the prevention of sexually transmitted diseases. Frequent use is associated with disruption of the genital epithelium, which may be associated with an increased risk of HIV infection and other sexually transmissible agents.2

Complications

Patient Education

  • Persons with trichomoniasis who notify their partner of their infection help disrupt the transmission of trichomoniasis and other sexually transmitted diseases.2
  • Discuss the side effects and interactions encountered with metronidazole and other nitroimidazole drugs.
  • Education concerning sexually transmitted disease treatment and sexually transmitted infection prevention should be provided (see Deterrence/Prevention). For excellent patient education resources, visit eMedicine's Parasites and Worms Center and Pregnancy and Reproduction Center. Also, see eMedicine's patient education article Trichomoniasis.

Miscellaneous

Medicolegal Pitfalls

  • Trichomoniasis is not a nationally mandated reported sexually transmitted disease, although other sexually transmitted disease reporting requirements vary by state.2
  • Failure to treat trichomoniasis during pregnancy may result in preterm birth or other adverse fetal outcomes.1 The mother should seek treatment during pregnancy. Transmission of trichomoniasis from an infected mother during delivery is rare but possible. An infected infant may present with fever. Young girls may present with vaginal discharge.
  • Screen for sexually transmitted diseases in pregnant patients and treat appropriately.

Special Concerns

The use of metronidazole in the first trimester of pregnancy is traditionally avoided. Although the mechanism of action is unclear, parasite death due to large doses of the drug may lead to a release of toxic substances.2 Consider the benefits and risks in treating trichomoniasis in pregnant patients.

 
Acknowledgments

Thanks to Amy Cai, MD, for sharing patient samples and insights.



More on Trichomoniasis

Overview: Trichomoniasis
Differential Diagnoses & Workup: Trichomoniasis
Treatment & Medication: Trichomoniasis
Follow-up: Trichomoniasis
Multimedia: Trichomoniasis
References
Further Reading
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References

  1. Forna F, Gülmezoglu AM. Interventions for treating trichomoniasis in women. Cochrane Database Syst Rev. 2003;CD000218. [Medline].

  2. Centers for Disease Control and Prevention (CDC), Workowski KA, Berman SM. Sexually transmitted diseases treatment guidelines, 2006. MMWR Recomm Rep. Aug 4 2006;55:1-94. [Medline].

  3. Soper D. Trichomoniasis: under control or undercontrolled?. Am J Obstet Gynecol. Jan 2004;190(1):281-90. [Medline].

  4. Gerbase AC, Rowley JT, Mertens TE. Global epidemiology of sexually transmitted diseases. Lancet. 1998;351 Suppl 3:2-4. [Medline].

  5. Sobel JD. What's new in bacterial vaginosis and trichomoniasis?. Infect Dis Clin North Am. Jun 2005;19(2):387-406. [Medline].

  6. Patel SR, Wiese W, Patel SC, Ohl C, Byrd JC, Estrada CA. Systematic review of diagnostic tests for vaginal trichomoniasis. Infect Dis Obstet Gynecol. 2000;8(5-6):248-57. [Medline].

  7. Laga M, Manoka A, Kivuvu M, et al. Non-ulcerative sexually transmitted diseases as risk factors for HIV-1 transmission in women: results from a cohort study. AIDS. Jan 1993;7(1):95-102. [Medline].

  8. Moodley P, Wilkinson D, Connolly C, et al. Trichomonas vaginalis is associated with pelvic inflammatory disease in women infected with human immunodeficiency virus. Clin Infect Dis. Feb 15 2002;34(4):519-22. [Medline].

  9. Grodstein F, Goldman MB, Ryan L, et al. Relation of female infertility to consumption of caffeinated beverages. Am J Epidemiol. Jun 15 1993;137(12):1353-60. [Medline].

  10. ACOG Practice Bulletin. Clinical management guidelines for obstetrician-gynecologists, Number 72, May 2006: Vaginitis. Obstet Gynecol. May 2006;107(5):1195-1206. [Medline].

  11. Burtin P, Taddio A, Ariburnu O, et al. Safety of metronidazole in pregnancy: a meta-analysis. Am J Obstet Gynecol. Feb 1995;172(2 Pt 1):525-9. [Medline].

  12. Guenthner PC, Secor WE, Dezzutti CS. Trichomonas vaginalis-induced epithelial monolayer disruption and human immunodeficiency virus type 1 (HIV-1) replication: implications for the sexual transmission of HIV-1. Infect Immun. Jul 2005;73(7):4155-60. [Medline]. [Full Text].

  13. Nanda N, Michel RG, Kurdgelashvili G, et al. Trichomoniasis and its treatment. Expert Rev Anti Infect Ther. Feb 2006;4(1):125-35. [Medline].

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Further Reading

ACOG Committee on Practice Bulletins--Gynecology. ACOG Practice Bulletin. Clinical management guidelines for obstetrician-gynecologists, Number 72, May 2006: Vaginitis. Obstet Gynecol. May 2006;107(5):1195-1206.
 
Abramowicz M (ed.). Drugs for Parasitic Infections. The Medical Letter. Aug 2004.
 
Burtin P, Taddio A, Ariburnu O. Safety of metronidazole in pregnancy: a meta-analysis. ALYSIS. Feb 1995;172(2 Pt 1):525-9. 
 
Guenthner PC, Secor WE, Dezzutti CS. Trichomonas vaginalis-induced epithelial monolayer disruption and human immunodeficiency virus type 1 (HIV-1) replication: implications for the sexual transmission of HIV-1. Infect Immun. Jul 2005;73(7):4155-60. [Full Text].
 
Nanda N, Michel RG, Kurdgelashvili G, Wendel KA. Trichomoniasis and its treatment. Expert Rev Anti Infect Ther. Feb 2006;4(1):125-35.

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Keywords

trichomoniasis, vaginal trichomoniasis, trichomonads, nongonococcal nonchlamydial urethritis, prostatitis, epididymitis, urethral stricture disease, pelvic inflammatory disease, colpitis macularis, vaginal discharge, vaginitis, cervicitis, dyspareunia, dysuria

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Contributor Information and Disclosures

Author

Darvin Scott Smith, MD, MSc, DTM&H,, Adjunct Assistant Professor, Department of Microbiology and Immunology, Stanford University; Chief of Infectious Diseases and Geographic Medicine, Department of Internal Medicine, Kaiser Redwood City Hospital
Darvin Scott Smith, MD, MSc, DTM&H, is a member of the following medical societies: American Medical Association, American Society of Tropical Medicine and Hygiene, Infectious Diseases Society of America, and International Society of Travel Medicine
Disclosure: Nothing to disclose.

Coauthor(s)

Natalia Ramos,, Stanford University, Keck School of Medicine of the University of Southern California
Natalia Ramos, is a member of the following medical societies: American Medical Student Association/Foundation and American Medical Women's Association
Disclosure: Nothing to disclose.

Medical Editor

Jeffrey M Zaks, MD, Clinical Associate Professor of Medicine, Wayne State University School of Medicine; Vice President, Medical Affairs, Chief Medical Officer, Department of Internal Medicine, Providence Hospital
Jeffrey M Zaks, MD is a member of the following medical societies: American College of Cardiology, American College of Healthcare Executives, American College of Physician Executives, and American Medical Association
Disclosure: Nothing to disclose.

Pharmacy Editor

Francisco Talavera, PharmD, PhD, Senior Pharmacy Editor, eMedicine
Disclosure: eMedicine Salary Employment

Managing Editor

John L Brusch, MD, FACP, Assistant Professor of Medicine, Harvard Medical School; Consulting Staff, Department of Medicine and Infectious Disease Service, Cambridge Health Alliance
John L Brusch, MD, FACP is a member of the following medical societies: American College of Physicians and Infectious Diseases Society of America
Disclosure: Nothing to disclose.

CME Editor

Eleftherios Mylonakis, MD, Clinical and Research Fellow, Department of Internal Medicine, Division of Infectious Diseases, Massachusetts General Hospital
Eleftherios Mylonakis, MD is a member of the following medical societies: American Association for the Advancement of Science, American College of Physicians, American Society for Microbiology, and Infectious Diseases Society of America
Disclosure: Nothing to disclose.

Chief Editor

Burke A Cunha, MD, Professor of Medicine, State University of New York School of Medicine at Stony Brook; Chief, Infectious Disease Division, Winthrop-University Hospital
Burke A Cunha, MD is a member of the following medical societies: American College of Chest Physicians, American College of Physicians, and Infectious Diseases Society of America
Disclosure: Nothing to disclose.

 
 
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