Initial treatment of trichomoniasis in immunocompetent adults

NAAT: nucleic acid amplification test.

* If testing has not been done, preferred tests include NAAT, nucleic acid probe, or rapid antigen tests. Trichomonads on wet mount, cervical cytology, or culture also warrant treatment.

¶ Metronidazole is preferred in pregnancy and lactation. Safety data for tinidazole and secnidazole are insufficient.

Δ Metronidazole oral suspension 250 mg (2.5 mL) orally three times daily for seven days.

◊ Treatment option per World Health Organization but to be avoided in first trimester if possible.

§ While metronidazole is secreted in breastmilk, the dose received through breastmilk is lower than the dosage used to treat infections in infants.

¥ The concentration of metronidazole in breast milk is lower with the 400 mg dose given three times a day compared with 500 mg given twice a day. However, 400 mg tablets are not universally available and more frequent dosing may be more challenging.

‡ For individuals who wish to avoid any metronidazole exposure to their infants, we advise pumping and discarding breast milk for 12 hours after the 2 gm single oral dose. Some clinicians advise deferring lactation for 12 to 24 hours after single-dose metronidazole treatment because the relative infant dose of metronidazole is higher with the 2 gm single dose compared with multi-day dosing.