Patients should be screened who report having one or more of the following: redness, edema, pruritis, dyspareunia, frothy malodorous vaginal discharge. Asymptomatic pregnant patients should not be screened for infection.

 

Saline wet mount of vaginal discharge is positive for trichomonads. If trichomonads were found on pap smear, this result is not diagnostic of active infection; therefore, wet prep should be performed in order to confirm the need for treatment.

 

 Recommendations:                

 

1.       Treat with metronidazole, 2.0g taken PO at one time or 500 mg taken orally BID x 7 days.  The medication may be taken at any time in pregnancy.

2.       Treat partner

3.       Refer for hepatitis B vaccination if not already obtained

4.       Instruct the patient as follows:

·       Observe correct perineal care (front to back wiping)

·       Wear cotton or cotton crotch panties

·       Avoid tight fitting pants and panty hose 

·       Avoid using scented sprays and pads

·       Use tub baths and adequate perineal drying

·       Use condoms

·       Alcohol may cause serious side effects and should be avoided 

·       Follow up if symptoms persist or recur

4.       In low risk asymptomatic patients who are diagnosed with infections (i.e. pap smear positive/wet mount positive) consult with outreach medical providers regarding treatment.

Prepared in conjunction with the

Division of Maternal-Fetal Medicine

Duke University Medical Center

 

                                         _                                                                                      Director 

          Date

 

 

                 The Clinical Care Guidelines Development Committee of the Perinatal Improvement Board of Duke University Health System has developed a series of multi-disciplinary protocols to offer guidance to health care providers who are caring for pregnant women with high risk conditions.

 

These protocols are designed to assist health care providers in the management of a variety of problems that occur in pregnancy and the time of delivery. They should not be interpreted as standard of care, but instead represent only general guidelines for the care of pregnant women with high risk conditions.  We recognize that services offered by individual providers depend not only on their training, experience and institutional resources, but on the medical facts and circumstances of the specific care situation.

The protocols remain the intellectual property of the Duke University Health System.  They cannot be reproduced in whole or part without the expressed permission of the Health System.

 

These protocols are reviewed by the Department of Obstetrics and Gynecology Division of Maternal-Fetal Medicine, the Department of Pediatrics Division of Neonatology and the Department of Anesthesiology Division of Women’s Anesthesia.  Please contact Andra H. James (andra.james@duke.edu), Chair, Clinical Care Guidelines Development Committee of the Perinatal Improvement Board with ideas for additional protocols.

 

 

         Trichomonas Vaginitis

1.               Read JS, Klebanoff MA.  Sexual intercourse during pregnancy and preterm delivery: effects of vaginal microorganisms . Vaginal Infections and Prematurity Study Goup. Am J. Obstet Gynecol 168:514-9, 1993.

 

2.               Czeizel AE, Rockenbauer M.  A population based case-control teratologic study of oral metronidazole treatment during pregnancy.  Br J Obstet Gynaecol. 1998.  March 105(3):322-7.

 

3.               Diav-Citrin O, Shechtman S, Gotteiner T, Arnon J, Ornoy A.  Pregnancy outcome after gestational exposure to metronidazole:  a prospective controlled cohort study.  Teratology 2001, May 63(5):186-92.

 

4.       Centers for Disease Control and Prevention.  Sexually Transmitted Diseases Treatment Guidelines 2006.  MMWR 2006:55 (No. RR-52).