Trichomoniasis

Trichomoniasis

  • Caused by Trichomonas Vaginalis (flagellated protozoan that can exist for a brief period in a warm moist environment–wet sponge 90min, urine 3 hours, wet cloth for up to 24 hours)
  • 2nd most common STD, ~3 million cases/year
  • Commonly occurs in pts w/ gonorrhea
  • Symptoms:
    • Women:  bad smelling, watery, greenish-yellow foamy vaginal discharge, itchy/inflamed vag, burning or uncomfortable peeing
    • Men:  usually asymptomatic but may have an urethral discharge
  • Diagnosis:  noted by seeing the flagella on the wet mount exam of vaginal discharge
  • Treatment:
    • Metronidazole (Flagyl–think flagella) 2 g PO once
      • Preferred for pregos
      • Pts who have GI intolerance to Flagyl or fail on this 2 g trxt may take 500 mg PO BID x 7 days
        • The one time dose is as effective as the 7 day course (but short course increases compliance)
        • If the patient vomits w/in 30 min of dose, the dose should be repeated
      • SE:  metallic taste, disulfiram reaction (avoid EtOH), red/dark brown urine discoloration, irreversible peripheral neuropathy in high doses for longer than a few days
    • Alternative trxt:  Tinidazole (tindamax) 2 g po once, more expensive than flagyl & if breast feeding you need to stop doing so for 3 days

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