Managing Sexually Transmitted Infections in Pregnant Women

Nadi K Gupta; Christine A Bowman


Women's Health. 2012;8(3):313-321. 

In This Article

Protozoal Infections

T. vaginalis

T. vaginalis is a flagellated protozoan. Women may experience offensive discharge, dysuria and vulval irritation but may also be asymptomatic. Infection in pregnancy is associated with premature delivery and low birth weight.[33,34] Neonatal infection is uncommon but should be considered in infants with vaginal discharge or unexplained respiratory disease. Nasal secretions, tracheal secretions, urine and vaginal swabs from the neonate should be closely examined for trichomonads.[35]

The diagnosis is confirmed by direct microscopy of a wet-mount preparation of vaginal secretions from the posterior fornix. This method of diagnosis is routinely employed in genitourinary medicine clinics. Microscopy has a sensitivity of approximately 70%.[36] Culture of vaginal secretions using specific media is more sensitive but rarely available now. Highly sensitive PCR techniques have been developed but are not yet in routine use.

Treatment of T. vaginalis During Pregnancy Metronidazole is the drug of choice and is highly efficacious. Metronidazole appears to be safe for use during the first trimester of pregnancy.[37] The British National Formulary advises avoiding high-dose metronidazole in pregnancy. Patients should be advised to abstain from alcohol while taking metronidazole and for 48 h afterwards because of possible disulfiram-like reaction.

Recommended regime for T. vaginalis can be found in Box 5 .

Patients should be advised to abstain from intercourse until they and their partner have been successfully treated. It is the authors' practice to perform a test of cure 1 week later in all cases.


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