Trichomoniasis

• Infects vagina, urethra and para-urethral glands
• Co-infection with other STIs is common
• 60-80% of trichomoniasis cases have co-existent bacterial vaginosis
• Transmission can occur between men and women and between women in same sex relationships through:
  • Sexual contact with infected genital secretions
  • Sexual practices such as fingering which allow inoculation of infected secretions onto mucous membranes
  • From mother to baby at vaginal delivery (usually no adverse consequences)
  • Fomite transmission has been documented but is rare
• Trichomoniasis is most commonly diagnosed in
  • Women who test positive for other STIs
  • Māori and Pacific women
  • Women experiencing social deprivation
  • Women with a history of incarceration
• Trichomoniasis is less commonly diagnosed in males; tests are less sensitive, infection is usually asymptomatic, and of shorter duration

• Asymptomatic men do not need testing unless identified as a sexual contact of trichomoniasis
• Symptoms of vaginal discharge, odour, vulval irritation, dysuria or dyspareunia
• Symptoms or signs of vulvitis (vulval rash) or vaginitis
• Sexual contacts of trichomoniasis
• Women who test positive for other STIs
• Men with persistent urethritis who have not responded to standard empirical treatment for non-gonococcal urethritis
• Māori and Pacific women, as part of a sexual health check
• Women experiencing social deprivation, as part of a sexual health check
• Women with a history of incarceration

Note: If patient is asymptomatic and is concerned about a specific recent sexual event the recommended testing interval is 2 weeks from time of last unprotected sexual intercourse

If the patient is unlikely to return and has not been previously tested, then test opportunistically at the time of presentation and offer a re-test after the appropriate window period

Testing for trichomoniasis should occur as part of a complete sexual health check

• Nucleic acid amplification tests (NAAT) for T.vaginalis are the gold standard test for the diagnosis of trichomoniasis (vaginal swab for women, first void urine for men)
• Some laboratories in Aotearoa New Zealand do not offer NAAT for T.vaginalis. Non-molecular tests for trichomonas, such as wet microscopy and culture, have lower sensitivity
• Be familiar with the T.vaginalis test offered by your local laboratory

• Trichomonas type organisms are sometimes reported on cervical cytology specimens but due to lack of specificity, these results must be confirmed by specific NAAT testing or culture as per your local laboratory before initiating treatment

Treatment options

• Any nitroimidazole drug given as a single dose or over 7 days results in parasitological cure in 90% of cases. Single-dose therapy increases side-effects and is less effective, but improves adherence
• Ornidazole may be better tolerated than metronidazole but should NOT be used if pregnant or breastfeeding

Special Situations

• Advise to abstain from sex or use condoms for 1 week from the start of treatment and until 1 week after sexual contact/s have been treated
• If a patient has an intrauterine device (IUD), leave it in place and treat as recommended. Seek specialist advice as needed

• Contact tracing is important to prevent re-infection and reduce transmission
• All sexual contacts in the last 3 months should be notified
• Most patients choose to tell contacts themselves; giving written information can be helpful
• Notifying all contacts may not be possible e.g. if there is insufficient information or a threat of violence

Management of sexual contacts

• Contacts should have a full sexual health check, and should be treated for trichomoniasis without waiting for test results
• Advise contacts to abstain from sex or use condoms until results are available, and for 1 week from the start of treatment
• If contacts test positive for an STI refer to specific guideline
• Patient-delivered partner therapy is not legal in Aotearoa New Zealand

Referral to or discussion with a sexual health specialist is recommended for:

• Screening and treatment of sexual contacts if clinician wishes
• Allergy to standard treatment options
• Suspected antibiotic resistance
• Males with recurrent or persisting urethritis that has not responded to empirical treatment
• Complicated clinical situations for further management

• 100% of patients diagnosed with trichomoniasis are treated with an appropriate antibiotic regimen

Just the facts

Healthy Sex