How is Trichomoniasis Treated?

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Question: How is Trichomoniasis Treated?

Answer: Treatment for trichomoniasis is with oral medication.

Trichomoniasis is treated with a specific group of drugs known as the nitroimidazoles.

When you are being treated for trichomoniasis it is important that your sexual partners are treated as well. If they are not, you could end up passing the infection back and forth between you. That's not the only behavior you need to change in order to avoid infecting your sexual partners.

You should also abstain from sex until treatment is finished and your symptoms clear up. If abstaining is not possible, make certain to use condoms for all sexual encounters.

The drug regimens below are taken from the the Centers for Disease Control 2015 STD treatment guidelines. Remember that only your doctor can say which treatment is right for you.

Recommended Regimens for Non-Pregnant Patients

Metronidazole 2 g orally in a single dose
OR
Tinidazole 2 g orally in a single dose

Alternative Regimen for Non-Pregnant Patients

Metronidazole 500 mg orally twice a day for 7 days

Trichomoniasis Treatment and Alcohol Use - A Bad Combination

Both recommended trichomoniasis treatments interact badly with alcohol. They may become less effective if you drink. Therefore, you should avoid drinking any alcohol beverages during trichomoniasis treatment. You should also avoid drinking alcohol for 24 hours after treatment with metronidazole.

For tinadazole, you will need to wait a whole 72 hours.

Failure to wait to drink alcoholcould cause a disulfiram-like reaction. This reaction can cause significant discomfort. In very serious cases it has the potential to lead to death. One such death has been reported during metronidazole treatment.

Although such reactions are far from common, it's probably best to avoid the risk. That's why people are cautioned off alcohol during treatment with these medications

Trichomoniasis and Pregnancy

Trichomoniasis can negatively affect the outcome of a pregnancy. However, opinions are mixed about the benefits of treatment during pregnancy. If you are diagnosed with trichomoniasis during pregnancy, talk to your doctor. You will want to discuss the potential risks and benefits of having, or avoiding, treatment. If treatment is chosen, it is normally done with a single oral dose of 2g of metronidazole. No adverse outcomes of using metronidazole during pregnancy have been reported. However, it has not been well studied in humans. These drugs also can show up in breast milk. Therefore, women who are breastfeeding during treatment may be advised to stop for 12-72 hours, depending on what drug is used.

Trichomoniasis and HIV

Coinfection with trichomoniasis and HIV may be particularly problematic for women and their sexual partners.

Such coinfection has been linked to an increased amount of viral shedding from the genitals. Therefore, it is important for all HIV-positive women to be screened for trichomoniasis. The recommended treatment in these women is 500 mg orally, twice daily, for 7 days.

Sources:

Andersson KE. Pharmacokinetics of nitroimidazoles. Spectrum of adverse reactions. Scand J Infect Dis Suppl. 1981;26:60-7.

CDC (2015) "Sexually Transmitted Diseases Treatment Guidelines, 2015" Accessed (2/25/16) from http://www.cdc.gov/std/tg2015/vaginal-discharge.htm

Cina SJ, Russell RA, Conradi SE. Sudden death due to metronidazole/ethanol interaction. Am J Forensic Med Pathol. 1996 Dec;17(4):343-6.

Karamanakos PN, Pappas P, Boumba VA, Thomas C, Malamas M, Vougiouklakis T, Marselos M. Pharmaceutical agents known to produce disulfiram-like reaction: effects on hepatic ethanol metabolism and brain monoamines. Int J Toxicol. 2007 Sep-Oct;26(5):423-32

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