Refractory Trichomoniasis in HIV-positive and HIV-negative Subjects

Trichomonas vaginalis, a common pathogen, remains widely unknown to the public. Its clinical consequences include upper genital tract infection, increased risk of preterm delivery, and increased risk of HIV transmission. Diagnostic tests, especially in men, have historically had low sensitivity, but the recent development of rapid, reliable point-of-care testing is a step toward improved detection. Reliable treatments for trichomoniasis are limited to the nitroimidazoles, and options for cases with either hypersensitivity or resistance remain limited. In select resistant cases, alternatives, most notably paromomycin, may play a role. A complex interaction exists between T. vaginalis and HIV, whereby women with trichomoniasis are at increased risk for HIV and vice versa. It is hoped that diagnosis and treatment of trichomoniasis in women at high risk for HIV may help to lower the incidence of both infections.