For the most up to date information on treatment, go to

Treatment action Topical/behavioral Oral meds Testing/Notes
Comfort measures, general care Sitz bath, gentle cleansing, topical petrolatum, avoidance of irritants (e.g. daily panty liners) or tight clothing Trichomonads are usually easily seen on microscopy. Make sure you get to the microscope as soon as you take the sample because motility of the protozoa slows down with cooling, making them harder to identify.
Inflammation may cause a large number of WBCs on the slide, which may obscure trich.
If unsure, use the Affirm test or culture.
Link to trichomoniasis, Annotation P.
Anti-protozoal for treatment of non-pregnant women Metronidazole 2 g orally in a single doseOR

Tinidazole 2 g orally in a single dose



Metronidazole 500 mg orally twice a day for 7 days

Anti-protozoal for treatment of symptomatic trichomoniasis in pregnant women Metronidazole 500 mg orally twice a day for 7 days (preferable due to nausea associated with pregnancy),OR

Metronidazole 2 g orally in a single dose

Anti-protozoal for treatment with breastfeeding After a 2 g dose of metronidazole, pumping and discarding breast milk for 24 hours is recommended.1
CDC recommended treatment regimens2 in imidazole-resistant Trichomonas vaginalis Tinidazole orally in a single 2 g dose,


Metronidazole 500 mg orally twice daily for seven days (total dose 7 g),


Tinidazole or metronidazole 2 g orally a day for five days (total dose 10 g) for failure of the other two options.

For failure of the 10 gram dose regimen Therapeutic options include maximum tolerated doses of metronidazole, or preferably tinidazole (2 to 4 g daily in divided doses) for 14 days. Patients with high-level metronidazole resistance are usually successfully treated by prolonged and high-level tinidazole therapy, although cross-resistance to tinidazole is frequently reported.3 The optimal dose has not been established CDC recommends trichomonas culture and drug susceptibility testing (drug susceptibility available from the CDC, telephone 770-488-4115) and referral to a specialist.
Treatment for candidiasis related to antibiotic use Keep in mind that oral use of Metronidazole may cause secondary yeast and be prepared to offer treatment if the patient develops vulvar pruritus.

Updated 7/14/14 Link to Trichomoniasis Annotation P.


  1. Sobel JD, UptoDate, 2010.
  2. CDC 2006.
  3. Schwebke JR, Barrientes FJ. Prevalence of Trichomonas vaginalis isolates with resistance to metronidazole and tinidazole. Antimicrob Agents Chemother. 2006; 50:4209.