TRICHOMONIASIS - Michigan
TRICHOMONIASISINTRODUCTIONTrichomoniasis (“Trich”) is the most prevalent nonviral sexually transmitted disease that affects both women and men, although symptoms are more common in women. Trichomoniasis is caused by a protozoan parasite Trichomonas vaginalis. Among persons who are sexually active, the best way to prevent trichomoniasis is through consistent and correct use of condoms during all penile-vaginal sexual encounters.T. vaginalis infection is associated with 2-3 fold increased risk for HIV acquisition, preterm birth, and other adverse pregnancy outcomes among pregnant women. Routine screening for T. vaginalis in asymptomatic women with HIV is recommended because of the increased viral shedding and adverse events associated with asymptomatic trichomoniasis and HIV infection. SUBJECTIVE DATAHistory may include:New or multiple partners &/or partner with multiple partnersHistory of STDsUse of illicit drug usePartner symptoms of STDsSexual activity (last exposure, exposure sites)Lack of STD protection (condom use) Report of dyspareuniaSymptoms may include:Yellow-green vaginal discharge (can be diffuse, and malodorous)Vulvar/vaginal pruritus, burning, irritationUrinary frequency/dysuriaPostcoital spotting Penile discharge, dysuria, scrotal painOBJECTIVE DATAPhysical exam: Inspection of the vulva, vagina, and cervix to assess for:Erythema, swellingDiffuse, malodorous or yellow-green, frothy vaginal discharge Petechiae on ectocervix (“strawberry cervix”)Urethral dischargeASSESSMENTDiagnosis of Trichomoniasis:Culture testing-NAAT Positive APTIMAPositive Amplicor (vaginal swab or urine)ORPoint of Care DiagnosticsPositive OSOM Trich Rapid Test (vaginal swab)Positive Affirm (vaginal swab)ORWet Prep Microscopy to identify Trichomonas vaginalisPLAN Treatment:Recommended Regimens* Metronidazole 2 g orally in a single dose OR * Tinidazole 2 g orally in a single doseAlternative Regimen* Metronidazole 500 mg orally twice a day for 7 daysAvoid consuming alcohol during treatment with metronidazole or tinidazole. Abstinence from alcohol use should continue for 24 hours after completion of metronidazole or 72 hours after completion of tinidazoleRecommend client be tested for additional STDs (Chlamydia, Gonorrhea, and HIV)Recommend concurrent partner treatmentSPECIAL CONSIDERATIONSInfection in Pregnancy: Pregnant clients need to seek prenatal provider for treatment.Lactating women who are administered Metronidazole should withhold breastfeeding during treatment and for 12-24 hours after last dose. For women treated with Tinidazole, withhold breastfeeding during treatment and for 3 days after the last dose.Infection in HIV Positive Clients: Metronidazole 500 mg twice daily for seven days is most effective. Rescreening three months following treatment should be considered.CLIENT EDUCATION/COUNSELINGAvoid alcohol during treatment with metronidazole or tinidazole(and for 24 hours after completion of metronidazole or 72 hours after completion of tinidazole)Abstain from sexual intercourse until therapy is completed and any symptoms rm client Trichomonas is a sexually transmitted infectionEducate client that sex partner should be treatedProvide Medication Information Sheet Provide STD educational informationOffer other STD testingProvide current educational information on trichomoniasis Provide contraceptive information, if requestedEncourage condom use to reduce STD exposureFOLLOW-UPRetesting is recommended for sexually active women within 3 months following treatmentIf treatment failure occurs, retreat with metronidazole 500mg twice a day for 7 days or tinidazole 2 g single doseIf treatment failure occurs repeatedly, treat with a single 2 g dose of metronidazole or tinidazole orally once a day for 5 daysREFERRALClients with persistent infectionsClients who are pregnant (refer to prenatal care)REPORTINGMandated state reporting is NOT requiredREFERENCESCDC: Sexually Transmitted Disease, 2015 Reportable Diseases in Michigan: A Guide for Physicians, Health Care Providers and Laboratories, 2018Reviewed/Revised 2020 ................
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