Epidemiology

 Trichomonas vaginalis (TV) causes the most common curable STI globally (77) and is highly prevalent among the Australian indigenous population (78). TV disproportionately affects older indigenous women living in remote settings (4, 78), but is rarely diagnosed in urban Australia (79-81). TV infection increases the risk of HIV acquisition by 50% (77) and has been reported to increase genital shedding of HIV among co-infected individuals (82). Nonetheless, the impact of TV treatment on reducing genital HIV shedding has been inconsistent among virologically suppressed individuals taking antiretroviral therapy (ART) (82, 83). Among women with HIV infection, TV infection is associated with an increased risk of PID (84). In contrast to most other STIs, TV infection is rare among MSM (85)

Clinical presentation

 Up to 50% of women with genital TV infection are asymptomatic, whereas men are usually asymptomatic (4). A frothy, malodorous vaginal discharge is the most common symptom in women, while urethral discharge and dysuria can rarely occur among men (4). There is no evidence to suggest distinct clinical features are present or different management approaches are required in HIV-positive individuals.

 Management

 First-line treatment of uncomplicated genital TV infection is a stat oral dose of 2mg tinidazole or metronidazole (4).