From the Guidelines
The recommended treatment for Trichomonas vaginalis infection is metronidazole or tinidazole, with the first-line regimen being oral metronidazole 500 mg twice daily for 7 days, or alternatively, a single 2-gram oral dose of metronidazole, as supported by the Centers for Disease Control and Prevention guidelines 1.
Key Considerations
- Metronidazole is the only oral medication available in the United States for the treatment of trichomoniasis, with cure rates of approximately 90%-95% in randomized clinical trials 1.
- Treatment of patients and sex partners results in relief of symptoms, microbiologic cure, and reduction of transmission 1.
- Metronidazole gel is not recommended for the treatment of trichomoniasis due to its low efficacy [<50%] compared to oral preparations of metronidazole 1.
Treatment Regimens
- Oral metronidazole 500 mg twice daily for 7 days
- Single 2-gram oral dose of metronidazole
- Tinidazole can be used as an alternative at a single 2-gram oral dose
Special Considerations
- Sexual partners should be treated simultaneously to prevent reinfection, even if they are asymptomatic 1.
- Patients should abstain from alcohol during treatment and for 24 hours after completing metronidazole (72 hours for tinidazole) due to potential disulfiram-like reactions.
- For pregnant women, metronidazole is safe and recommended at the standard dosage 1.
- Follow-up testing is recommended if symptoms persist after treatment to check for potential resistance or reinfection 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 a single oral dose of metronidazole or tinidazole, currently the only licensed class of drugs available for this indication 4.
- However, a 7-day dose of metronidazole 500 mg twice daily has been shown to be nearly two times more efficacious at clearing infection compared with the 2-g dose 5.
- Metronidazole intravaginal sponges (250-1,000 mg) used for 3 days may also be effective in the treatment of Trichomonas vaginalis infection 6.
- High-dose intravaginal metronidazole combined with miconazole offers the possibility of a well-tolerated treatment that avoids the systemic adverse effects of nitroimidazoles for the treatment of trichomoniasis 4.
Treatment Efficacy and Resistance
- Treatment failure can range from 7-10 % and even higher among HIV+ women, and may be influenced by vaginal ecology 7.
- In vitro antibiotic resistance to 5-nitroimidazole in T. vaginalis remains low (4.3%) but should be monitored 8.
- Repeat and persistent infections are common in women; thus, rescreening at 3 months after treatment is recommended 8.