Trichomoniasis

Question 1

Describe trichomoniasis.

Answer 1

STD that can infect:

• Women’s:
  
  • Vagina
  • Skene’s gland
  • Lower GU tract
• Men’s:
  
  • Lower GU tract

Question 2

Is trichomoniasis reportable?

Answer 2

No

Question 3

What are expected assessment findings for women with trichomoniasis?

Answer 3

• Asymptomatic (sometimes for decades)
• Cervical petechiae (AKA strawberry cervix)
• Vulvar irritation
• Dysuria
• Vaginal discharge:
  - Frothy
  - Yellow-green (variable)

Question 4

What are expected assessment findings for men with trichomoniasis?

Answer 4

• Asymptomatic
• Urethral discharge
• Dysuria
• Epididymitis
• Prostatitis

Question 5

What tests may be preformed for trichomoniasis?

Answer 5

• Wet prep (60% - 70% sensitive)
  - visualization of trichomonads as flagellated, motile cells slightly larger than WBC’s
  - Polymorphonuclear cells
• Vaginal pH > 4.6
• Pap: UNRELIABLE
• FDA-cleared POC tests for women:
  - Affirm
  - Osom
• PCR testing of urine for men (not widely available)

Question 6

What is the treatment for trichomoniasis?

Answer 6

Women (NOT pregnant or breast-feeding):
- Metronidazole 500 mg PO BID x 7 days
(retest in 3 months with NAAT if HIV+)

Men and Women who are pregnant or breast-feeding:
- Metronidazole 2 g PO x 1 dose

Alternate treatment (if above fails*):
- Tinidazole 2 g PO QD x 14 days –AND–
- Tinidazole intravaginal 500 mg BID x 14 days
–OR–
- Tinidazole 1 g PO TID x 14 days –AND–
- Paromomycin 6.25% intravaginal 4 g qHS x 14 days

*NOTE: Drug resistance tests available from CDC