From the Guidelines
The recommended treatment for Trichomonas vaginalis infection is metronidazole 500 mg orally twice daily for 7 days, or alternatively, a single 2-gram oral dose of metronidazole, as supported by the most recent and highest quality study 1.
Treatment Options
- Metronidazole (2 g po in a single dose)
- Metronidazole (500 mg po bid for 7 d)
- Tinidazole (2 g po in a single dose)
Important Considerations
- Sexual partners should be treated simultaneously to prevent reinfection, even if they are asymptomatic.
- Patients should abstain from alcohol consumption during treatment and for 24 hours after completing metronidazole (48 hours for tinidazole) due to potential disulfiram-like reactions.
- During pregnancy, the 7-day metronidazole regimen is preferred, as metronidazole use during pregnancy has not been shown to have a consistent association with teratogenic or mutagenic effects in the infant 1.
Rationale
Treatment is important even for asymptomatic infections as they can lead to complications such as increased HIV transmission risk and, in pregnant women, preterm delivery. These medications work by disrupting DNA synthesis in the parasite, effectively killing the organism. Follow-up testing is recommended if symptoms persist after treatment, as resistance to metronidazole occurs in approximately 5% of cases.
Additional Information
Other treatment options, such as clindamycin cream or metronidazole gel, are less effective and not recommended as first-line treatment 1.
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 recommended treatment for Trichomonas vaginalis infection 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 Vaginalis Infection
The recommended treatment for Trichomonas vaginalis infection is metronidazole, with two different dosing regimens being considered:
- Single-dose metronidazole: 2 g oral dose 4
- Multidose metronidazole: 500 mg twice daily for 7 days 5, 6, 7
Efficacy of Treatment Options
Studies have compared the efficacy of single-dose and multidose metronidazole regimens:
- A randomized controlled trial found that the 7-day dose of metronidazole was more effective than the single-dose regimen in clearing the infection 5
- A meta-analysis also found that multidose metronidazole was associated with lower treatment failure rates compared to single-dose metronidazole 7
- Another study found that the 7-day dose of metronidazole was nearly two times more efficacious at clearing the infection compared to the single-dose regimen 6
Considerations for Treatment
Other factors to consider when treating Trichomonas vaginalis infection:
- 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
- The influence of vaginal ecology on treatment efficacy may need to be considered 8
- Alternative treatments, such as tinidazole, may be effective, with a cure rate of 95% reported in one study 4