Trichomoniasis, Antibiotic Prescribing

Comments from Expert Advisory Committee

1. Trichomoniasis is caused by the flagellated protozoan, Trichomonas vaginalis. It can infect the vagina, urethra and para urethral glands. Infection is much more common in women than in men
2. In women it usually presents with a vaginal discharge which may be offensive with an associated vulvitis/vaginitis.
3. Men usually present as sexual contacts of women with infection. They may present with symptoms of urethritis including dysuria and urethral discharge. Infection in men is uncommon.
4. Diagnosis can be made on a wet prep of vaginal secretions (in GUM clinics), culture or PCR. Trichomonas testing can be performed on the same platform (Hologic Aptima) as the chlamydia and gonorrhoea testing, and can be performed on the same sample. Trichomonas should be specifically requested on the testing form. The Aptima specimen collection kits are available through the NVRL 'swab shop' on the NVRL website.
5. Testing in men on a first void urine specimen is indicated in contacts of women with trichomoniasis and in cases of persistent urethritis. Men with persistent urethritis should be referred to a dedicated GUM clinic.
6. Individuals diagnosed with trichomoniasis should be offered testing for other STIs including HIV, Hepatitis B, chlamydia, gonorrhoea and syphilis.
7. Hepatitis C testing should be considered part of routine sexual health screening in the following circumstances: MSM, People living with HIV; Commercial sex workers; PWID people who inject drugs (PWID). Partners of the above should also be considered for HCV testing.
8. Testing and treatment of sexual partners within the four weeks prior to presentation is important to prevent reinfection and onward transmission and patients should be encouraged to inform their sexual partners. Sexual partners in the two week window period after last sexual contact may have a false negative result and should be empirically treated for trichomoniasis.
9. Advise patients to avoid sexual contact with their partner until they and their partner have completed treatment and follow-up. Further information on partner notification is available in the useful resources section.
10. Test of cure should be undertaken post completion of treatment. A positive test of cure with no risk of re-infection requires a referral to a specialist.
11. Trichomoniasis is a notifiable disease. Notification process is usually initiated by the testing laboratory

Treatment 

Patient Information

• Patient information on STIs and genital conditions is available at the HSE Sexual Health and Crisis Pregnancy website
• Trichomonas Vaginalis PIL

Safe Prescribing (visit the safe prescribing page)

• Doses are oral and for adults unless otherwise stated
• Renal impairment dosing table
• Safety in Pregnancy and Lactation
• Drug interactions table. Extensive drug interactions for clarithromycin, fluoroquinolones, azole antifungals and rifampicin. Many antibiotics increase the risk of bleeding with anticoagulants.
• Visit the Health Products Regulatory Authority (HPRA) website for detailed drug information (summary of product characteristics and patient information leaflets). Dosing details, contraindications and drug interactions can also be found in the Irish Medicines Formulary (IMF) or other reference sources such as British National Formulary (BNF) / BNF for children (BNFC).

Reviewed June 2021