From the Guidelines
Metronidazole is the first-line treatment for Trichomonas infections, typically prescribed as a single 2-gram oral dose or as 500 mg twice daily for 7 days, as recommended by the most recent guidelines 1.
Treatment Overview
The treatment of Trichomonas infections aims to relieve symptoms, achieve microbiologic cure, and reduce transmission. The recommended metronidazole regimens have resulted in cure rates of approximately 90%-95% 1.
Key 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 completing metronidazole (72 hours for tinidazole) to avoid a disulfiram-like reaction with symptoms such as flushing, headache, and nausea.
- Sexual intercourse should be avoided until both partners complete treatment and symptoms resolve.
- For pregnant women, metronidazole is considered safe and is recommended to prevent complications such as premature birth 1.
Alternative Treatments
Tinidazole is an effective alternative, given as a single 2-gram oral dose 1.
Follow-up
Follow-up testing is recommended if symptoms persist after treatment to assess for treatment failure and potential drug resistance.
From the FDA Drug Label
Tinidazole is indicated for the treatment of trichomoniasis caused by Trichomonas vaginalis. Metronidazole tablets are indicated for the treatment of symptomatic trichomoniasis in females and males when the presence of the trichomonad has been confirmed by appropriate laboratory procedures (wet smears and/or cultures)
The treatment for Trichomonas infections is Tinidazole or Metronidazole.
- Tinidazole is indicated for the treatment of trichomoniasis caused by Trichomonas vaginalis 2.
- Metronidazole is indicated for the treatment of symptomatic trichomoniasis in females and males when the presence of the trichomonad has been confirmed by appropriate laboratory procedures (wet smears and/or cultures) 3. Key points:
- The organism should be identified by appropriate diagnostic procedures.
- Partners of infected patients should be treated simultaneously in order to prevent re-infection.
From the Research
Treatment Options for Trichomonas Infections
- The treatment for Trichomonas infections typically involves the use of antiprotozoal medications, such as metronidazole or tinidazole 4, 5, 6, 7.
- A single 2g dose of metronidazole is often recommended as the first-line treatment for Trichomonas vaginalis infections in women 5, 6.
- However, recent studies have suggested that a 7-day dose of metronidazole (500mg twice daily) may be more effective in clearing the infection compared to the single 2g dose 5, 6, 7.
- Tinidazole has also been shown to be effective in treating Trichomonas infections, with a single 2g dose being equivalent to or superior to metronidazole in some studies 4.
- For patients who are hypersensitive to 5-nitroimidazoles, alternative treatments such as nitazoxanide and tizoxanide may be considered, as they have shown high levels of in vitro activity against metronidazole-susceptible and metronidazole-resistant Trichomonas vaginalis clinical isolates 8.
Considerations for Treatment
- Partner treatment is essential, as up to 70% of male sexual partners can be infected with Trichomonas vaginalis 7.
- Rescreening of treated women at 3 months is also recommended due to the high repeat infection rates 7.
- The importance of treating asymptomatic Trichomonas vaginalis infections, as well as the influence of the microbiome on treatment efficacy, requires further study 7.
- Different formulations of intravaginal treatments for hypersensitivity may also be explored in future studies 7.