Trichomoniasis in Pregnancy: Risks to Mother and Baby, and Treatment

Trichomonas vaginalis infection in pregnancy is associated with adverse outcomes and requires treatment.

Maternal Risks

• Preterm premature rupture of membranes (PPROM)
• Preterm labor/delivery
• Postpartum endometritis
• Increased HIV acquisition/transmission risk

Neonatal Risks

• Low birth weight
• Preterm birth
• Respiratory distress
• Rare: Neonatal trichomoniasis (conjunctivitis, respiratory)

Diagnosis

• NAAT (PCR) on vaginal swab – gold standard (sensitivity >95%)
• Wet mount (motile trichomonads) – low sensitivity (~50%)
• Culture – 70–90% sensitivity

Treatment in Pregnancy

• Metronidazole 2g single dose – FDA Category B; extensive safety data
• Alternative: 500 mg BID × 7 days (lower peak levels)
• Tinidazole – less pregnancy data; avoid first trimester
• Treat partner simultaneously to prevent reinfection
• Abstain until both cured

Follow-Up

• Test of cure at 2–4 weeks (NAAT)
• Retest in 3rd trimester if high risk

Screening: Not universal; test if symptomatic or high-risk (multiple partners, prior STI, incarceration, drug use).