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Section 7  Syndromic Approach to the Management of STDs
Section 7 Objectives
Section 7.1  Mucopurulent Cervicitis
Section 7.2 Urethritis
Section 7.3 Genital Ulcerative Disease
Section 7.4 Pelvic Inflammatory Disease
Section 7.5 Vaginitis
5.0  Etiology and Epidemiology
5.1  Pathogenesis
5.2  Clinical Manifestations
5.3.0  Diagnosis
5.4  Laboratory Diagnosis
5.5  Treatment
5.5.1  Bacterial Vaginosis
5.5.2  Vulvovaginal Candidiasis (VVC)
5.5.3  Trichomonas Vaginalis
5.6  Partner Management
5.7  Follow-Up
7.5.8 Interactive Web-Based Case
6.0  Review Questions
7.6.1 CME Credit Questions
7.6.2  References
1.0  Pathophysiology and Definition
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Anatomical Figures
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Clinical Images
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5.5 Treatment

5.5.3 Trichomonas vaginalis

Centers for Disease Control Homepage Recommended Treatment

All patients with T. vaginalis should be treated.

Metronidazole is the only treatment available for T. vaginalis in the USA. The recommended treatment achieves a 95% cure rate. Sexual partners should always be treated. Resistance is rare and can usually be overwhelmed by using higher doses. (Metronidazole gel is ineffective for T. vaginalis and should not be used).

Recommended regimen

2 g orally in a single dose

Alternative Regimen

Metronidazole 500 mg twice a day for 7 days.

Treatment failures- Treatment should be repeated with the 7 day regimen. If treatment fails again, patient should be given a 2 gram daily dose for 3-5 days. Patients not responding to the high-dose multiday regimen should have a subspecialist evaluation including determination of the susceptibility of the T. vaginalis to metronidazole. Centers for Disease Control Homepage has a special hotline for clinical consultation (770-488-4115). Increasing dose and duration of metronidazole or IV administration may be of use. Published regimens are available. Options in the setting of metronidazole allergy include the use of an alternative drug (paromomycin) or desensitization.

Prior to the approval of tinidazole in the US, the Food and Drug Administration has requested that Presutti Laboratories make Tinidazole available to physicians for treating metronidazole resistant trichomoniasis.  Tinidazole is available for metronidazole resistant TV through a compassionate use protocol which was developed by the CDC, IDSOG and Presutti Laboratories.

For more information, call the CDC at (770) 488-4115 or Dawn Flynn (of Presutti laboratories) at (847) 359-7802.

Pregnancy: no evidence of teratogenicity. Treatment may be administrated during the first trimester of pregnancy.


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