Diagnostic Tests, Management & Therapy

Diagnostic Tests

• Microscopic examination of discharge from vagina or urethra (wet mounts)
• Pelvic/vaginal internal exam to check for discharge and inflammation
• Urine test
• Cervical smear test
• Fluorescent antibody assay (staining)
• Polymerase Chain Reaction (PCR)
• In mounts, look for highly motile organisms; darting motion
  

Management

• Antibiotic treatment
• Avoid vaginal, oral, and anal sex until antibiotic treatment has eliminated the parasite
• Treat all sexual partners to avoid re-infection
• Avoid unprotected sex
• Prioritize sexual safety:
  • Talk about protection methods with all partners
  • Use condoms and other protective measures consistently and properly
  • Seek medical advice upon first signs of infection

Therapy

Trichomoniasis is usually treated with Metronidazole, an antibiotic and antiparasitic drug. Metronidazole eliminates T. vaginalis by inhibiting nucleic acid synthesis. It is classified as a nitroimidazole.

The structure of Metronidazole:

http://en.wikipedia.org/wiki/Metronidazole

Brand names of Metronidazole include: Flagyl, Metryl, Protostat, Satric, Neo-Tric

Dosing: Metronidazole 2 grams by mouth (usually 4, 500 mg tabs) or 500 mg twice a day by mouth for 7 days. The single dose has a high success rate (90%+) and good compliance.

Resistance: Intravagical application of nonoxynol-9, a spermicide, may be somewhat effective against metronidazole-resistant strains. Mebendazole and furazolidone may also be effective. Topical metronidazole is not absorbed sufficiently well to eliminate T. vaginalis.