From the Guidelines
The recommended treatment for trichomoniasis is metronidazole 500 mg orally twice daily for 7 days or a single 2-gram oral dose of metronidazole or tinidazole. This recommendation is based on the highest quality evidence available, which shows that these regimens have resulted in cure rates of approximately 90%-95% 1. The 7-day regimen is preferred for individuals with HIV infection. Sexual partners should also be treated simultaneously to prevent reinfection, and patients should abstain from alcohol during treatment and for 24 hours after completing metronidazole or 72 hours after tinidazole due to potential disulfiram-like reactions.
Key Considerations
- Common side effects include metallic taste, nausea, and vomiting.
- Pregnant women should be treated with the 7-day metronidazole regimen, as trichomoniasis during pregnancy is associated with adverse outcomes.
- Follow-up testing is recommended if symptoms persist after treatment.
- Metronidazole works by disrupting DNA synthesis in the Trichomonas vaginalis parasite, effectively killing the organism.
- Patients should complete the full course of medication even if symptoms resolve earlier to ensure complete eradication of the infection.
Treatment Options
- Metronidazole 500 mg orally twice daily for 7 days
- Single 2-gram oral dose of metronidazole
- Single 2-gram oral dose of tinidazole It's worth noting that metronidazole gel is not recommended for the treatment of trichomoniasis, as it is less efficacious than oral preparations of metronidazole 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 trichomoniasis 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. Partners of infected patients should be treated simultaneously to prevent re-infection.
From the Research
Treatment Options for Trichomoniasis
The recommended treatment for trichomoniasis is typically metronidazole or tinidazole, which are both part of the 5-nitroimidazole group of drugs 4, 5, 6.
First-Line Treatment
- Metronidazole is often given as a single dose of 2g, but a 7-day dose of 500mg twice daily may be more effective in clearing the infection 4.
- Tinidazole can be used as an alternative to metronidazole, especially in cases where metronidazole is not effective 6.
Treatment Failure and Resistance
- In cases where treatment fails, it may be due to resistance to metronidazole or tinidazole 5, 6.
- The minimal lethal concentration (MLC) of metronidazole associated with treatment failure is ≥50 μg/mL, while the MLC for tinidazole is ≥6.3 μg/mL 5.
- Intravenous metronidazole may be effective in treating refractory cases of trichomoniasis 7.
Alternative Therapies
- Other drugs such as disulfiram and nithiamide have shown promise in treating trichomoniasis, especially in cases where patients are hypersensitive to 5-nitroimidazole drugs 8.
- Albendazole and coenzyme B12 may be useful in combination with metronidazole or tinidazole to treat highly resistant T. vaginalis infections 8.