RHL practical aspects by Schmid G
FIRST CONTACT (PRIMARY CARE) LEVEL
Symptomatic or asymptomatic women with infection by T. vaginalis can be identified by microscopic examination of vaginal secretions (“wet mount” or “native preparation”). Depending upon the skill of the observer, this method will detect 50-70% of infections. Although women who are asymptomatically infected probably make up the majority of infected women, if a microscope is not available, only infected women who seek care because of the symptoms of a vaginal discharge can be treated. This treatment will be by the use of a clinical algorithm for the management of vaginal discharge (using so-called “syndromic management”). Because T. vaginalis is very common among women with a vaginal discharge in many resource-poor areas, these algorithms almost always include evaluation for T. vaginalis (if a microscope is available) or treatment for T. vaginalis (if a microscope is not available). Partners should be treated to prevent reinfection and transmission to others. Single dose treatment with nitroimidazole class drugs (metronidazole 2 g oral, for example) of the woman and her partner will achieve primary cure in over 90 % of cases.
REFERRAL HOSPITAL (SECONDARY CARE) LEVEL
Because treatment of trichomoniasis with either short- or long-course therapy is highly successful, only few women need referral to a secondary care level. First, however, if initial management did not include a microscopic or other laboratory test for trichomoniasis, this should be done as there are many other causes of vaginal discharge; the referral hospital may need to perform the test. Once infection has been confirmed, and reinfection has been excluded, then treatment with metronidazole, 500 mg twice a day for 7 days, or 2 g once a day for 3-5 days, will cure most women (partners of these women should be treated with the same dose). Women who fail to achieve cure on these doses require consultation with an expert. If routine management at the primary care level for vaginal discharge fails and trichomoniasis is only one of the considerations as a cause of the discharge, then efforts should be directed toward identifying the cause of the discharge.
AT HOME OR IN THE COMMUNITY
Since trichomoniasis is a sexually transmitted infection, health education messages that promote safer sex will help prevent trichomoniasis. If women are infected, health care seeking behaviour can be improved through community level interventions, and the availability and ability of primary health care facilities to manage cases of trichomoniasis can be enhanced through input of resources and training.
This document should be cited as: Schmid G. Managing trichomoniasis : RHL practical aspects (last revised: 28 July 2003). The WHO Reproductive Health Library; Geneva: World Health Organization.