Trichomoniasis is treated with prescription oral antibiotics, and the infection is curable in the vast majority of cases. The specific medication and how long you take it depends on whether you’re a woman or a man, because the recommended regimens differ. You cannot treat trichomoniasis with over-the-counter medications or home remedies. A prescription is required.
Treatment for Women vs. Men
For women, the CDC recommends metronidazole 500 mg taken twice a day for seven days. This weeklong course has a higher cure rate in women than a single large dose, which is why the guidelines shifted to the longer regimen. For men, a single 2-gram dose of metronidazole taken all at once is the standard treatment. The difference exists because the parasite that causes trichomoniasis (Trichomonas vaginalis) tends to be harder to fully clear in the vaginal environment compared to the urethra.
An alternative option for both women and men is tinidazole, given as a single 2-gram oral dose. Tinidazole belongs to the same drug class as metronidazole and works the same way, killing the parasite by damaging its DNA. A newer option, secnidazole, is also FDA-approved for trichomoniasis as a single 2-gram dose of oral granules that can be taken with or without food. Your provider may choose one of these alternatives based on your tolerance, insurance coverage, or other factors.
Why Your Partner Needs Treatment Too
Both you and your sexual partner need to be treated at the same time. If only one person is treated, the untreated partner will almost certainly pass the infection right back. This is one of the most common reasons people think their treatment “didn’t work” when it actually did, only for reinfection to occur immediately after.
In many states, your provider can write a prescription for your partner without seeing them in person. This is called expedited partner therapy, and it’s designed to reduce the back-and-forth cycle of reinfection. You should avoid sexual contact until both you and your partner have completed the full course of treatment and any symptoms have resolved. For a single-dose regimen, that typically means waiting at least seven days after taking the medication.
Alcohol and Your Medication
Metronidazole and tinidazole both interact with alcohol, and mixing them can cause intense nausea, vomiting, flushing, and cramping. The recommended waiting periods are different for each drug. With metronidazole, you should avoid alcohol during treatment and for at least 48 hours after your last dose. With tinidazole, the recommended window is longer: 72 hours after your last dose, based on its chemical similarity to metronidazole. These waiting periods are printed on the prescription labeling, and taking them seriously will save you a miserable experience.
What to Expect After Treatment
Most people feel symptom relief within a few days of starting treatment. Discharge, itching, and irritation should gradually clear up over the course of the week. If you were given a single-dose regimen, improvement often begins within two to three days. Some mild stomach upset, nausea, or a metallic taste in your mouth is common while taking the medication. These side effects are temporary and typically mild.
The CDC recommends retesting three months after treatment to check for repeat infection. This isn’t because the medication failed. It’s because reinfection rates are high, often due to an untreated partner or a new exposure. Don’t skip this follow-up test even if you feel completely fine, since trichomoniasis can be present without symptoms, especially in men.
Treatment During Pregnancy
Trichomoniasis during pregnancy is associated with preterm delivery and low birth weight, so it is treated rather than left until after delivery. The recommended regimen for pregnant women is the same as for non-pregnant women: metronidazole 500 mg twice daily for seven days. Metronidazole has been studied extensively in pregnancy and is considered safe across all trimesters. Tinidazole, on the other hand, has less safety data in pregnancy and is generally not the first choice.
When Standard Treatment Doesn’t Work
In rare cases, the parasite shows resistance to standard doses of metronidazole. If your symptoms persist or your follow-up test is still positive after completing treatment correctly (and reinfection has been ruled out), your provider will likely try a higher dose or a longer course. Tinidazole at higher doses is sometimes effective when standard metronidazole fails, since it reaches higher concentrations in the body. True treatment-resistant trichomoniasis is uncommon, but it does happen. If you’ve gone through multiple rounds without clearing the infection, your provider may consult the CDC directly for guidance on specialized regimens.
If you have a known allergy to metronidazole or tinidazole, treatment becomes more complicated because both drugs belong to the same class. There are no effective alternatives outside this drug class for trichomoniasis, so the typical approach involves managed desensitization, where you’re given gradually increasing doses of the medication under medical supervision to build tolerance. This is done in a clinical setting where any allergic reaction can be treated immediately.
Why Trichomoniasis Shouldn’t Be Ignored
Untreated trichomoniasis increases your risk of acquiring or transmitting HIV by causing inflammation that makes genital tissue more vulnerable. In women, it can lead to pelvic inflammatory disease, and during pregnancy it raises the risk of complications. In men, it can cause urethritis and, less commonly, prostatitis. The infection will not resolve on its own. Unlike some viral infections that the immune system can eventually clear, trichomoniasis requires antibiotic treatment to eliminate the parasite.
Because trichomoniasis is so common (an estimated 3.7 million cases per year in the United States) and so frequently asymptomatic, many people carry it without knowing. If you’ve been diagnosed, completing your full course of medication, making sure your partner is treated simultaneously, and returning for that three-month retest are the three steps that matter most for clearing the infection and keeping it from coming back.