Painful single or multiple vesicular or ulcerative lesions present in the genitals, buttocks or groin area of men or women, also:
- Diffuse, malodorous, green-yellow, frothy discharge
- Vulvar irritation/vulvovaginal erythema and/or severe vaginal itching
- Strawberry cervix (cervical petechiae)
- A pH of vaginal fluid greater than 4.5
- Urethral irritation, itching, or "tingling"
- Urethral discharge
Demonstration of motile trichomonads on saline mount of vaginal exudates, or a positive test from the listing below (a pap test positive for trich may require confirmation through a different type of test)
Recommended for: women seeking care for vaginal discharge, persons with partners who have trichomonas.
Consider for: women at high risk (new/multiple partners, commercial sex, history of STDs, injection drug use).
- Polymerase Chain Reaction (PCR) assay - specimens can be urine, or vaginal or endocervical swab
- Nucleic Acid Amplification Test (NAAT) - specimens can be vaginal swabs, urine, or those collected in PreservCyt Solution (ThinPrep)
- APTIMA Assay - specimens can be vaginal, endocervical, or urine in women.
- The BD Probe Tec TV Qx Amplified DNA Assay has recently been cleared to test for Trichomonas in women using vaginal, endocervical, or urine specimens.
Recommended, with reservations:
- Microscopy of vaginal secretions (wet preparation slide) - insensitive
- Rapid test - specimen has to be vaginal swab; more sensitive than microscopy, but possibility of false positives
- Nucleic Acid Probe Test - specimen has to be vaginal swab; more sensitive than microscopy, but possibility of false positives
- Culture - specimens may be urine, vaginal swab in females, or urethral swab or semen in males; highly specific, but not as sensitive as other tests
- Pap test (conventional or liquid based) - poor sensitivity, possibility of false positives
Because of the high rate of reinfection among patients in whom trichomoniasis was diagnosed, consider rescreening sexually active women who test positive for trich three months after initial infection.
For more information on tests, see Advances in Laboratory Detection of Trichomonas Vaginalis.
First Line Treatment
Metronidazole - 2 grams orally in a single dose
Tinidazole 2 grams orally in a single dose
Metronidazole - 500 mg orally twice a day for 7 days