TV

Question 1

Where is it found?

Answer 1

Vagina, urethra, paraurethral glands

Question 2

Less obvious signs/sx?

Answer 2

Lower abdo pain and ulcers in women. Balanitis in men.

Question 3

Problems in pregnancy?

And when to test for it?

Answer 3

Preterm labour, low birth weight, post partum sepsis.

Don’t screen, only test if symptomatic.

Question 4

When to test for in men?

Answer 4

If contact or persistent NSU.

Question 5

Testing? Gold standard vs others?

Answer 5

NAAT is gold standard

But Culture better than micro if NAAT not possible.

Question 6

Treatment?
What about preg or BF’ing?
What about hiv patients?
Alternative?

Answer 6

Met 400-500mg BD for 5d-7d or 2g stat (avoid this high dose in preg. If BFing and given higher dose then discard milk for 12-24hrs)
If hiv, give 500mg bd for 7d
Avoid alcohol for 48hr after too due to disulfram reaction.

Alternative is Tinidazole 2g (but not if pregnant, particularly 1st trimester)

Question 7

PN look back ?
Abstinence period?
What about in male contacts with NSU?

Answer 7

4w look back. ALL partners to be treated despite test results.

Abstain for 7d and until everyone completed Rx

If male has NSU, reasonable to treat TV before NSU treatment, then repeat smear if still problems.

Question 8

Treatment failure options?

TOC?

Answer 8

1. Retreat again before moving onto different meds (7d metro 400-500)
2. Higher dose so 2g or metro or tinidazole daily for 5-7d
3. Resistance testing.
4. Very high dose of tinidazole (1g bd-tds and possibly over tinidazole!)
   TOC only if remains asymp