# Trichomoniasis (Trichomonas vaginalis Infection) - Category: infectious - Review status: reviewed (every claim checked against a document named on this page) - Sources: British Association for Sexual Health and HIV (BASHH) United Kingdom national guideline on the management of Trichomonas vaginalis 2021 (Sherrard J, Pitt R, Russell Hobbs K, Maynard M, Cochrane E, Wilson J, Tipple C. Int J STD AIDS 2022; DOI 10.1177/09564624221103035; bashh-trichomonas-vaginalis-2021.pdf) · CDC Sexually Transmitted Infections Treatment Guidelines, 2021 (MMWR Recomm Rep 2021;70(4):1-187; PMC8344968), Trichomoniasis - Alternative Regimen for Women and Men (2 g single dose); TINDAMAX (tinidazole) US prescribing information, sections 2.1 Dosing Instructions and 2.4 (DailyMed SetID a0d01539-8413-4703-94cc-d221918630a1) for administration with food and the 50 mg/kg paediatric figure · CDC Sexually Transmitted Infections Treatment Guidelines, 2021 (MMWR Recomm Rep 2021;70(4):1-187; PMC8344968), Trichomoniasis - Recommended Regimens for Women and for Men; daily ceiling from Egyptian National Drug Formulary - Antimicrobial 2023 (metronidazole: adult trichomoniasis 500 mg twice daily) · DailyMed SetID a0d01539-8413-4703-94cc-d221918630a1 sections 1 and 2, https://dailymed.nlm.nih.gov/dailymed/drugInfo.cfm?setid=a0d01539-8413-4703-94cc-d221918630a1 · Egyptian National Drug Formulary 2023 — Antimicrobial, Metronidazole monograph, Trichomoniasis (antimicrobial-2023.pdf, page index 306, printed p297) · Trichomoniasis - disease-level clinical article (trichomoniasis-clinical.txt) · CDC Sexually Transmitted Infections Treatment Guidelines, 2021 (MMWR Recomm Rep 2021;70(4):1-187; PMC8344968), Bacterial Vaginosis - Treatment, the review of alcohol during metronidazole treatment (cdc-sti-2021-bacterial-vaginosis-extract.txt). The Trichomoniasis chapter of the same guideline does not mention alcohol; the position is stated in this chapter. - Verified date: 2026-08 ## Verified against - DailyMed SetID a0d01539-8413-4703-94cc-d221918630a1 sections 1 and 2, https://dailymed.nlm.nih.gov/dailymed/drugInfo.cfm?setid=a0d01539-8413-4703-94cc-d221918630a1 - Egyptian National Drug Formulary 2023 — Antimicrobial, Metronidazole monograph, Trichomoniasis (antimicrobial-2023.pdf, page index 306, printed p297) - Trichomoniasis - disease-level clinical article (trichomoniasis-clinical.txt) - Egyptian National Drug Formulary - Antimicrobial 2023 - British Association for Sexual Health and HIV (BASHH) United Kingdom national guideline on the management of Trichomonas vaginalis 2021 (Sherrard J, Pitt R, Russell Hobbs K, Maynard M, Cochrane E, Wilson J, Tipple C. Int J STD AIDS 2022; DOI 10.1177/09564624221103035; bashh-trichomonas-vaginalis-2021.pdf) - CDC Sexually Transmitted Infections Treatment Guidelines, 2021 (MMWR Recomm Rep 2021;70(4):1-187; PMC8344968), Trichomoniasis - Special Considerations: Pregnancy (cdc-sti-2021-trichomoniasis-extract.txt) - CDC Sexually Transmitted Infections Treatment Guidelines, 2021 (MMWR Recomm Rep 2021;70(4):1-187; PMC8344968), Bacterial Vaginosis - Treatment, the review of alcohol during metronidazole treatment (cdc-sti-2021-bacterial-vaginosis-extract.txt). The Trichomoniasis chapter of the same guideline does not mention alcohol; the position is stated in this chapter. ## Treatment metadata - Metronidazole — 500 mg — oral.solid - Referral & safety-netting (no drug therapy) - Tinidazole — 500 mg — oral.solid - Secnidazole — 500 mg — oral.solid ## Complete treatment card ```text TRICHOMONIASIS (TRICHOMONAS VAGINALIS INFECTION) Sources: British Association for Sexual Health and HIV (BASHH) United Kingdom national guideline on the management of Trichomonas vaginalis 2021 (Sherrard J, Pitt R, Russell Hobbs K, Maynard M, Cochrane E, Wilson J, Tipple C. Int J STD AIDS 2022; DOI 10.1177/09564624221103035; bashh-trichomonas-vaginalis-2021.pdf) · CDC Sexually Transmitted Infections Treatment Guidelines, 2021 (MMWR Recomm Rep 2021;70(4):1-187; PMC8344968), Trichomoniasis - Alternative Regimen for Women and Men (2 g single dose); TINDAMAX (tinidazole) US prescribing information, sections 2.1 Dosing Instructions and 2.4 (DailyMed SetID a0d01539-8413-4703-94cc-d221918630a1) for administration with food and the 50 mg/kg paediatric figure · CDC Sexually Transmitted Infections Treatment Guidelines, 2021 (MMWR Recomm Rep 2021;70(4):1-187; PMC8344968), Trichomoniasis - Recommended Regimens for Women and for Men; daily ceiling from Egyptian National Drug Formulary - Antimicrobial 2023 (metronidazole: adult trichomoniasis 500 mg twice daily) · DailyMed SetID a0d01539-8413-4703-94cc-d221918630a1 sections 1 and 2, https://dailymed.nlm.nih.gov/dailyme d/drugInfo.cfm?setid=a0d01539-8413-4703-94cc-d221918630a1 · Egyptian National Drug Formulary 2023 — Antimicrobial, Metronidazole monograph, Trichomoniasis (antimicrobial-2023.pdf, page index 306, printed p297) · Trichomoniasis - disease-level clinical article (trichomoniasis-clinical.txt) · CDC Sexually Transmitted Infections Treatment Guidelines, 2021 (MMWR Recomm Rep 2021;70(4):1-187; PMC8344968), Bacterial Vaginosis - Treatment, the review of alcohol during metronidazole treatment (cdc- sti-2021-bacterial-vaginosis-extract.txt). The Trichomoniasis chapter of the same guideline does not mention alcohol; the position is stated in this chapter. Review status: REVIEWED against DailyMed SetID a0d01539-8413-4703-94cc-d221918630a1 sections 1 and 2, https://dailymed.nlm.nih.gov/dailymed/drugInfo.cfm?setid=a0d01539 -8413-4703-94cc-d221918630a1, Egyptian National Drug Formulary 2023 — Antimicrobial, Metronidazole monograph, Trichomoniasis (antimicrobial-2023.pdf, page index 306, printed p297), Trichomoniasis - disease-level clinical article (trichomoniasis- clinical.txt), Egyptian National Drug Formulary - Antimicrobial 2023, British Association for Sexual Health and HIV (BASHH) United Kingdom national guideline on the management of Trichomonas vaginalis 2021 (Sherrard J, Pitt R, Russell Hobbs K, Maynard M, Cochrane E, Wilson J, Tipple C. Int J STD AIDS 2022; DOI 10.1177/09564624221103035; bashh-trichomonas-vaginalis-2021.pdf), CDC Sexually Transmitted Infections Treatment Guidelines, 2021 (MMWR Recomm Rep 2021;70(4):1-187; PMC8344968), Trichomoniasis - Special Considerations: Pregnancy (cdc-sti-2021-trichomoniasis-extract.txt), CDC Sexually Transmitted Infections Treatment Guidelines, 2021 (MMWR Recomm Rep 2021;70(4):1-187; PMC8344968), Bacterial Vaginosis - Treatment, the review of alcohol during metronidazole treatment (cdc-sti-2021-bacterial-vaginosis-extract.txt). The Trichomoniasis chapter of the same guideline does not mention alcohol; the position is stated in this chapter. (2026-08) IS IT THIS? - reference only, to read alongside your own examination SYMPTOMS - what the patient reports (5) - Women may report a thin, frothy, foul-smelling vaginal discharge [vaginal discharge] - Pain with intercourse, urinary symptoms like dysuria and frequency, or pelvic pain can also occur in women [abdominal pain · burning on passing urine · pelvic pain] - Bleeding after sex can occur [abnormal uterine bleeding] - Only around 15% of infected women actually have symptoms - About 20% of infected men have symptoms SIGNS - what you find (2) - Vulvar redness and a frothy, foul-smelling yellow-green discharge may be seen on exam [redness] - Pinpoint hemorrhages on the cervix - a strawberry cervix - is a classic but uncommon finding, seen in only about 2% of women TESTS (6) - Motile trichomonads on a wet mount confirm infection, but they stay mobile only about 15 minutes so sensitivity drops with time - A vaginal pH above 4.5 is typical of this infection - Wet mount runs about 60% sensitive but over 99% specific once trichomonads are actually seen - Nucleic acid amplification testing is preferred, running about 99% sensitive and 100% specific - NAAT sensitivity is higher from vaginal swabs (98%) than from urine (95%) - Rapid antigen point-of-care testing runs about 87% sensitive and 98% specific, lower than NAAT IF NOT THIS - what else fits (7) - Chlamydia trachomatis infection is on the differential - Gonorrhea is on the differential - Bacterial vaginosis is on the differential (women) - Vulvovaginal candidiasis is on the differential (women) - Vaginal atrophy is on the differential (women) - Desquamative inflammatory vaginitis is on the differential (women) - Mycoplasma genitalium infection is on the differential (men) Source StatPearls "Trichomoniasis" - disease-level clinical article Status traced to the source above 1. METRONIDAZOLE [1st line] Adult Women: 500 mg orally twice daily for 7 days. Men: 2 g orally as a single dose. Treat the index case and the sexual partner together. x 7 days in women; single dose in men Peds 15-30 mg/kg/day [child max 1000 mg] (The formulary gives no trichomoniasis-specific paediatric dose. Its only paediatric metronidazole line is general dosing for susceptible infection: 15 to 50 mg/kg/day orally in three divided doses, maximum 2,250 mg/day — a daily total and a ceiling, not a per-dose figure. Trichomoniasis in a child needs evaluation for sexual abuse and specialist input before treatment.) 3kg -> 45-90 mg/day 4kg -> 60-120 mg/day 5kg -> 75-150 mg/day 6kg -> 90-180 mg/day 7kg -> 105-210 mg/day 8kg -> 120-240 mg/day 9kg -> 135-270 mg/day 10kg -> 150-300 mg/day 11kg -> 165-330 mg/day 12kg -> 180-360 mg/day 13kg -> 195-390 mg/day 14kg -> 210-420 mg/day 15kg -> 225-450 mg/day 16kg -> 240-480 mg/day 17kg -> 255-510 mg/day 18kg -> 270-540 mg/day 19kg -> 285-570 mg/day 20kg -> 300-600 mg/day 21kg -> 315-630 mg/day 22kg -> 330-660 mg/day 23kg -> 345-690 mg/day 24kg -> 360-720 mg/day 25kg -> 375-750 mg/day 26kg -> 390-780 mg/day 27kg -> 405-810 mg/day 28kg -> 420-840 mg/day 29kg -> 435-870 mg/day 30kg -> 450-900 mg/day 31kg -> 465-930 mg/day 32kg -> 480-960 mg/day 33kg -> 495-990 mg/day 34kg -> 510-1000 mg/day (upper capped) 35kg -> 525-1000 mg/day (upper capped) 36kg -> 540-1000 mg/day (upper capped) 37kg -> 555-1000 mg/day (upper capped) 38kg -> 570-1000 mg/day (upper capped) 39kg -> 585-1000 mg/day (upper capped) 40kg -> 600-1000 mg/day (upper capped) 41kg -> 615-1000 mg/day (upper capped) 42kg -> 630-1000 mg/day (upper capped) 43kg -> 645-1000 mg/day (upper capped) 44kg -> 660-1000 mg/day (upper capped) 45kg -> 675-1000 mg/day (upper capped) 46kg -> 690-1000 mg/day (upper capped) 47kg -> 705-1000 mg/day (upper capped) 48kg -> 720-1000 mg/day (upper capped) 49kg -> 735-1000 mg/day (upper capped) 50kg -> 750-1000 mg/day (upper capped) Source Trichomoniasis - disease-level clinical article (trichomoniasis-clinical.txt) Why The disease article states both regimens and the card carried only one of them: for women it recommends metronidazole 500 mg by mouth twice a day for 7 days, on the grounds that it usually costs less and is easier to obtain than the other 5-nitroimidazoles, tinidazole and secnidazole; for men it recommends a single oral 2 g dose of metronidazole. The Egyptian formulary carries only the 7-day course, so the international figure leads for men and the formulary's is noted on the row. Caution FIRST TRIMESTER: the Egyptian formulary contraindicates metronidazole in the first trimester, and that is the position taken here. BASHH 2021 takes the opposite view and says so plainly - metronidazole is usable at every stage of pregnancy and while breast- feeding. It does add that a single high-dose regimen is not recommended in pregnancy, so the 7-day course is the one it means. Both are current guidance; the disagreement is real and is stated here rather than hidden, so that deferring treatment is a choice and not an oversight. In the first trimester, treat symptoms with clotrimazole pessaries and defer metronidazole to the second, or take the BASHH position deliberately. If a single-dose regimen is needed, the formulary's single-dose trichomoniasis option is secnidazole 2 g orally once, with sexual partners treated at the same time (antimicrobial-2023.pdf page index 316, printed p307). ALCOHOL - the CDC 2021 guideline reviewed the evidence and found abstinence unnecessary. It found "no in vitro studies, animal models, reports of adverse effects, or clinical studies providing convincing evidence of a disulfiram-like interaction between alcohol and metronidazole", notes that "Metronidazole does not inhibit acetaldehyde dehydrogenase, as occurs with disulfiram", and concludes: "Thus, refraining from alcohol use while taking metronidazole (or tinidazole) is unnecessary." The review is in that guideline's Bacterial Vaginosis chapter; its Trichomoniasis chapter does not mention alcohol. Treat all sexual partners concurrently; abstain from intercourse until both partners complete therapy. May cause metallic taste, nausea, dark urine, and peripheral neuropathy with prolonged use. 1,000 mg/day is the paediatric ceiling used here, against the formulary's 15-50 mg/kg/day band. The lower figure is the safer read for trichomoniasis. Do not give metronidazole to anyone who has taken disulfiram within the past 2 weeks. This is a contraindication in its own right and is not affected by the alcohol position above - Egyptian National Drug Formulary, Antimicrobial 2023, metronidazole contraindications. The Egyptian formulary states only one metronidazole regimen for this infection - oral, 500 mg twice a day over 7 days, for the index case and the sexual partner alike - and no single-dose option. The 2 g single dose for men is the disease article's figure. The 7-day course, not the single dose, is what the article recommends for women: it does not offer the 2 g single dose to women, and cure rates are lower with it. Egypt DUMOZOL 500MG 20 F.C. TABS. MINA PHARM > ... 7.00 EGP (0.35/unit) ZOLGUARD 500MG 20 TAB. UNIPHARMA CO.... 9.00 EGP (0.45/unit) NITROFECTAZOLE 500 MG 20 F.C. TABS. GYPTO PHARMA 10.50 EGP (0.53/unit) FLAGICURE FORTE 500 MG 20 F.C. TAB KAHIRA 23.00 EGP (1.15/unit) TRICHOGYL 500MG 12 F.C.TAB. EL NASR 15.00 EGP (1.25/unit) FLAGELLAT FORTE 500MG 20 F.C.TABS. MUP 30.00 EGP (1.50/unit) GEDAZOLE 500MG 20 TAB. JEDCO INT. CO... 34.00 EGP (1.70/unit) METROGYPTON 500 MG 20 F.C. TABS. GYPTO PHARMA 34.00 EGP (1.70/unit) DUMOZOL 125MG/5ML SUSP. 125ML MINA PHARM > ... 5.75 EGP -> ? strength differs, ? different route - not oral solid METROZOLE 125MG/5ML SUSP. 120 ML MEMPHIS 19.50 EGP -> ? strength differs, ? different route - not oral solid 2. REFERRAL & SAFETY-NETTING (NO DRUG THERAPY) [1st line] Adult Source Trichomoniasis - disease-level clinical article (trichomoniasis-clinical.txt) Why Carries the referral criteria and warning signs for this condition, which apply whichever treatment is chosen. Caution RED FLAG - Women should be retested within 12 weeks of treatment given high rates of persistent infection and reinfection. 3. TINIDAZOLE [2nd line] Adult 2 g by mouth as a single dose, taken with food - Single dose Peds Age >3y: Giardiasis 50 mg/kg single dose (max 2 g); Amebiasis 50 mg/kg/day x 3 days (intestinal) or 3-5 days (hepatic abscess) with food (max 2 g/day). Choice Tinidazole is the first choice here; secnidazole is an alternative. Source DailyMed SetID a0d01539-8413-4703-94cc-d221918630a1 sections 1 and 2, https://dailymed.n lm.nih.gov/dailymed/drugInfo.cfm?setid=a0d01539-8413-4703-94cc-d221918630a1 Why Tinidazole 2 g single dose is an effective alternative with longer half-life and better tolerability, particularly for male partners or when single-dose compliance is needed. Caution The label also carries tinidazole regimens for other infections - amoebiasis 2 g daily for 3 days (intestinal) or 3-5 days (hepatic abscess), and bacterial vaginosis 2 g daily for 2 days or 1 g daily for 5 days. Only the trichomoniasis regimen is shown here, because a reader scanning four regimens can take the wrong disease's line. Avoid alcohol during treatment and for 72 hours post-dose. Take with food to minimize gastrointestinal upset. PREGNANCY - the US label and the CDC differ on how far the restriction goes, and both are given here. The label: "Since tinidazole crosses the placental barrier and enters fetal circulation it should not be administered to pregnant patients in the first trimester", which is also BASHH 2021's reading of the manufacturer's position. The CDC 2021 guideline goes further: "Data from studies involving human subjects are limited regarding tinidazole use during pregnancy; however, animal data indicate this drug poses moderate risk. Thus, tinidazole should be avoided for pregnant women, and breastfeeding should be deferred for 72 hours after a single 2-g oral dose of tinidazole." Other than for use in the treatment of giardiasis and amebiasis in pediatric patients older than three years of age, safety and effectiveness of tinidazole in pediatric patients have not been established. Egypt FASIGYN 500 MG 4 TABS. PFIZER 8.35 EGP (2.09/unit) PROTOZOLE 500 MG 12 F.C.TABS. MUP 39.00 EGP (3.25/unit) 4. SECNIDAZOLE [2nd line] Adult 2 g as a single dose; sexual partners should be treated at the same time - Single dose Peds No paediatric dose is stated in the sources held for this drug. Source Egyptian National Drug Formulary - Antimicrobial 2023 Why Longer half-life 5-nitroimidazole allowing single-dose compliance, an alternative when the 7-day metronidazole course or tinidazole is unsuitable. Caution Avoid alcoholic beverages or products containing ethanol or propylene glycol during therapy and for at least 2 days after therapy completion. Carcinogenicity has been observed in mice and rats with nitroimidazole agents structurally similar to secnidazole; avoid chronic use. Egypt SECNIDA-MISR 500MG 4 TAB. MISR 11.00 EGP (2.75/unit) SENIDAL 500MG 4 F.C. TAB. GLOBAL NAPI P... 11.00 EGP (2.75/unit) EUROZOLE 500MG 4 TAB. EUROPEAN EGYP... 11.50 EGP (2.88/unit) SECNIDAZOLE 500 MG 4 TAB. EIPICO 15.00 EGP (3.75/unit) FLAGENTYL 500MG 4 F.C. TABS. SANOFI 21.60 EGP (5.40/unit) FLADAZOLE 500MG 4 TAB. AMOUN 26.00 EGP (6.50/unit) Prices are indicative (dataset snapshot 2026-06); verify with the pharmacy. ``` --- Dawaa Reference is a reference for prescribers, not a medical device, and does not replace clinical judgement. [Privacy policy](/privacy)