How Trichomoniasis Is Treated

Trichomoniasis is a sexually transmitted disease (STD) that is usually uncomplicated. It can persist and, in rare instances, may cause complications. Trichomoniasis is treated with prescription medications. Treatment is considered safe and one dose of treatment is usually effective. There are also ways to prevent yourself from getting the infection and from infecting others.

Lifestyle

Lifestyle strategies are the key to preventing trichomoniasis as there are no medications or vaccines that can prevent the infection.  

Watch for Symptoms

If you experience itching or sores of the vagina or penis, do not ignore it as this could be the sign of trichomoniasis, another infection, or another STD. Similarly, if you have urinary urgency, urinary frequency, or burning with urination, you should seek medical attention. These are symptoms of a pelvic or urinary infection.

Do Not Scratch

Scratching an itch or a sore on the vagina or penis can cause bleeding, additional irritation, and pain. Excessive scratching can potentially cause ulceration that could lead to bacterial skin infections in the area. This could prolong your recovery when you are medically treated. 

Communicate With Partners

If there is a chance that you or your sexual partner could have trichomoniasis or another STD, it is important to inform one another and to take proper measures to prevent spreading the infection to each other.

 

Use Condoms 

Using condoms can substantially reduce the risk of spreading trichomoniasis. If you or your partner has or might have trichomoniasis, you should discontinue unprotected sexual activity until treatment of each infected person is complete and the infection is resolved

HIV

If you are in a relationship in which one partner has HIV and the other does not, it should not be presumed that HIV prevention or HIV therapy will prevent the spread of STDs such as trichomoniasis.

 

Over-the-Counter Therapies

You can use over-the-counter therapies for comfort if you have itching or pain caused by trichomoniasis. When it comes to over-the-counter products, however, make sure that you do not insert materials into the vagina or penis as this can cause irritation and may worsen your condition.  

Lotions and Creams 

Lotions and creams can provide relief of itching and irritation when used on the surface of the skin. Make sure that you use products that do not cause additional irritation.

There are many different brands of lotions and creams with a variety of ingredients, so it is best to check with your doctor or pharmacist to make sure that any lotion or cream that you use is ok to use with trichomoniasis. A good guideline would be to stick with products that are recommended for use on the genital area, that are hypoallergenic, and that do not have added scents or colors. 

Douching

Douching is not recommended if you have trichomoniasis. It can change the fluids in the vaginal area, making you more susceptible to trichomoniasis.

One of the reasons that women may douche is to improve the scent of the vagina and surrounding area. Because trichomoniasis causes a bad odor for many women, you might consider douching for the first time specifically because of this odor.

However, if you develop a bad odor in the vaginal area, be sure to see a healthcare provider because this could be the first sign of an infection that requires prescription medical treatment; do not douch.

Prescriptions

It is not clear why some people develop symptoms of trichomoniasis and others do not. Treatment is recommended for all people with the infection because you can spread the infection to your sexual partners even if you don't have symptoms yourself. If you are a woman, you will need definitive treatment before you get pregnant because the infection can cause adverse effects on your baby.

 

Trichomoniasis is treated with a specific group of medications known as nitroimidazoles which are used orally (by mouth). The cream or lotion formulations of these medications cannot adequately treat trichomoniasis infections when they are applied to the infected area, even though they can be useful in treating other genital infections.  

Recommended Regimens for Non-Pregnant Patients

  • Flagyl (metronidazole) 2 g orally in a single dose OR
  • Tindamax (tinidazole) 2 g orally in a single dose OR
  • Flagyl (metronidazole) 500 mg orally twice a day for 7 days is generally recommended for repeat treatment if the infection has not resolved. 

Alcohol Use

Both of the recommended trichomoniasis treatments are considered safe and effective but are known to have harmful effects when taken with alcohol. They may also become less effective if you drink alcohol.

Additionally, they can cause a reaction which is described as a disulfiram-like reaction, characterized by flushing (red blotches on the face), dizziness, nausea, rapid heartbeat, trouble breathing, and chest pain. This is a very serious reaction that may require hospitalization and can even cause death. 

You should avoid drinking any alcoholic beverages during your trichomoniasis treatment. You should also avoid drinking alcohol for 24 hours after treatment with metronidazole and for 72 hours after treatment with tinidazole. 

Medical Treatment of Sexual Partners

When you are being treated for trichomoniasis it is important that your sexual partners are treated as well. If they are not, you could end up passing the infection back and forth to each other. 

Specialist-Driven Procedures

If you develop one of the rare complications of trichomoniasis, such as an infected cyst, an abscess or a fistula, you may need a procedure to drain an abscess or to surgically repair a fistula. This is not common as major complications are not typical with trichomoniasis. 

If you become pregnant and have untreated trichomoniasis, your doctor will need to carefully consider the situation and the risks and benefits of treatment for you and your baby. 

Pregnancy and Breastfeeding

Trichomoniasis can negatively affect the outcome of a pregnancy. It can be associated with low birth weight and premature delivery. These risks require close prenatal care and careful monitoring of your pregnancy.

There are potential risks and benefits of treatment for trichomoniasis while pregnant. If treatment is chosen, it is normally a single oral dose of 2 g of metronidazole. The outcomes of using metronidazole during pregnancy have not been well studied. 

Generally, delivery is not complicated by trichomoniasis infection, although there have been few reports of babies contracting the infection during delivery. If your baby is delivered early or has a low birth weight, he or she may need special attention in a neonatal care unit, depending on how small and premature your baby is at birth.

The medications used for the treatment of trichomoniasis can also be present in breast milk. Therefore, women who are breastfeeding during treatment may be advised to stop breastfeeding for 12 to 72 hours.

Complementary Medicine (CAM)

There are a number of alternative therapies that have been studied for the treatment of trichomoniasis, but most of these have been studied in a laboratory setting and are not currently available. These include:

  • Mentha crispa: This plant extract has been studied in a research experiment for the treatment of trichomoniasis in women. A single dose of 2 g of plant extract was compared to secnidazole, which is a nitroimidazole that is not formally approved for treatment of trichomoniasis. The researchers reported good tolerance of Mentha crispa and an improvement of "vaginal discharge, malodorous vaginal secretion, dyspareunia, dysuria, pelvic pain, and burning and itching in the genital area" after treatment in 90 percent of the women who received the plant extract and in 96 percent of the women who received prescription medication.
  • Ginger: Ginger extract has been shown to destroy Trichomonas Vaginalis, the parasite responsible for trichomoniasis when used on a sample of the parasite obtained from mice. It is not currently approved or available as a treatment for the infection in humans. 
  • Phaseolus vulgaris lectin: An extract obtained from kidney beans, this material has been shown to paralyze and destroy the Trichomonas Vaginalis parasite when it was studied in a laboratory setting. 
  • Nigella sativa alcoholic extract and oil: An extract obtained from a seed of the plant, the oil form has been shown to be highly toxic to Trichomonas Vaginalis in the laboratory setting, while the extract form was found to be only moderately toxic to the parasite.

Sources:

Aminou HA, Alam-Eldin YH, Hashem HA. Effect of Nigella sativa alcoholic extract and oil, as well as Phaseolus vulgaris (kidney bean) lectin on the ultrastructure of Trichomonas vaginalis trophozoites. J Parasit Dis. 2016 Sep;40(3):707-13. doi: 10.1007/s12639-014-0564-x. Epub 2014 Sep 11.

Moraes ME, Cunha GH, Bezerra MM et al. Efficacy of the Mentha crispa in the treatment of women with Trichomonas vaginalis infection. Arch Gynecol Obstet. 2012 Jul;286(1):125-30. doi: 10.1007/s00404-012-2251-4. Epub 2012 Feb 21.

Rezk M, Sayyed T, Masood A, Dawood R. Risk of bacterial vaginosis, Trichomonas vaginalis and Candida albicans infection among new users of combined hormonal contraception vs LNG-IUS. Eur J Contracept Reprod Health Care. 2017 Oct;22(5):344-348. doi: 10.1080/13625187.2017.1365835. Epub 2017 Aug 29.

Tsai CS, Shepherd BE, Vermund SH. Does douching increase risk for sexually transmitted infections? A prospective study in high-risk adolescents. Am J Obstet Gynecol. 2009 Jan;200(1):38.e1-8. doi: 10.1016/j.ajog.2008.06.026. Epub 2008 Jul 30.