Trichomoniasis Treatment: Oral Metronidazole, Tinidazole, and the Importance of Contact Tracing to Prevent Reinfection

Trichomoniasis is one of the most common sexually transmitted infections (STIs) worldwide, caused by the protozoan Trichomonas vaginalis. Despite its high prevalence, it often does not receive adequate attention compared to other STIs. The standard treatment for this infection is oral metronidazole, a nitroimidazole that has proven effective in most cases. However, reinfection is a frequent issue, highlighting the importance of contact tracing and treating sexual partners.

Metronidazole is typically administered in a single dose of 2 g, although recent studies suggest that a regimen of 500 mg twice daily for 7 days may be more effective in women, reducing the rate of reinfection [1]. The consideration of sexual partners is crucial, as up to 70% of men may be infected without showing symptoms, contributing to the spread of the infection [2]. Expedited partner therapy (EPT) is a recommended strategy for treating sexual partners without the need for prior medical evaluation, which has been shown to reduce reinfection rates [3].

The use of tinidazole is an alternative to metronidazole, especially in cases of resistance or hypersensitivity to the latter. Although resistance to metronidazole is low, it should be considered in cases of persistent infections [4]. Additionally, the implementation of nucleic acid amplification tests (NAAT) has improved diagnostic accuracy, allowing for more timely and effective treatment [5].

In conclusion, the treatment of trichomoniasis with metronidazole remains the standard of care, but the consideration of sexual partners and the implementation of strategies such as EPT are essential to reduce reinfection and control the spread of the disease. Continuous education and surveillance are necessary to improve the management of this common STI.

Referencias

• [1] Diagnosis and Management of Trichomonas vaginalis: Summary of Evidence Reviewed for the 2021 Centers for Disease Control and Prevention Sexually Transmitted Infections Treatment Guidelines
• [2] Updates in trichomonas treatment including persistent infection and 5-nitroimidazole hypersensitivity
• [3] Patient-delivered partner treatment and Trichomonas vaginalis repeat infection among human immunodeficiency virus-infected women
• [4] Optimal Timing for Trichomonas vaginalis Test of Cure Using Nucleic Acid Amplification Testing
• [5] Diagnosis and Treatment of Sexually Transmitted Infections: A Review

Created 6/1/2025