From the Guidelines
The treatment for trichomoniasis is a single dose of metronidazole 2 grams orally or tinidazole 2 grams orally, as these regimens have resulted in cure rates of approximately 90%--95% 1.
Treatment Options
- Metronidazole 2 grams orally in a single dose
- Metronidazole 500 mg twice daily for 7 days
- Tinidazole 2 grams orally in a single dose
Important Considerations
- Both sexual partners should be treated simultaneously to prevent reinfection, even if the partner has no symptoms
- Patients should abstain from alcohol during treatment and for 24 hours after taking metronidazole or 72 hours after tinidazole due to potential disulfiram-like reactions (nausea, vomiting, headache)
- Sexual intercourse should be avoided until both partners complete treatment and symptoms resolve, typically about a week
- For pregnant women, metronidazole is the preferred treatment as it's considered safe during all trimesters 1
Resistance and Follow-up
- If symptoms persist after treatment, patients should return for evaluation as resistance to metronidazole can occur, requiring higher doses or alternative treatments 1
- The use of metronidazole gel is not recommended for the treatment of trichomoniasis due to its lower efficacy compared to oral preparations 1
From the FDA Drug Label
Tinidazole is indicated for the treatment of trichomoniasis caused by Trichomonas vaginalis. The single oral 2 g tinidazole dose was also assessed in four open-label trials in men (one comparative to metronidazole and 3 single-arm studies). Parasitological evaluation of the urine was performed both pre- and post-treatment and reported cure rates ranged from 83% (25/30) to 100% (80/80) (n=142 total subjects).
The treatment for trichomoniasis is Tinidazole with a single oral dose of 2 g.
- The cure rates for tinidazole ranged from 83% to 100% in clinical studies 2.
- Metronidazole is also indicated for the treatment of symptomatic trichomoniasis in females and males when the presence of the trichomonad has been confirmed by appropriate laboratory procedures 3.
From the Research
Treatment Options for Trichomonas
- The treatment for trichomoniasis typically involves the use of antiprotozoal medications, such as metronidazole or tinidazole 4, 5, 6, 7, 8.
- Metronidazole is commonly prescribed as a single 2-g oral dose, but recent studies suggest that a 7-day dose of 500 mg twice daily may be more effective in clearing the infection 5, 6, 8.
- Tinidazole is another accepted treatment option, with a single 2-g dose showing similar efficacy to metronidazole in some studies 4, 7.
- The choice of treatment may depend on various factors, including the patient's medical history, the presence of any allergies or sensitivities, and the severity of the infection.
Efficacy of Treatment Options
- Studies have shown that the 7-day dose of metronidazole is nearly two times more efficacious at clearing infection compared to the single 2-g dose 6.
- A meta-analysis found that multidose metronidazole was associated with lower treatment failure rates compared to single-dose metronidazole 8.
- Tinidazole has been shown to be effective in treating trichomoniasis, with cure rates ranging from 95% to 97.5% in some studies 4, 7.
Considerations for Treatment
- Partner treatment is essential, as up to 70% of male sexual partners can be infected 6.
- Rescreening of treated women at 3 months is recommended due to high repeat infection rates 6.
- Future studies should examine the importance of treating asymptomatic T. vaginalis, the best treatment for men, and the influence of the microbiome on treatment efficacy 6.