From the Guidelines
The recommended treatment for trichomoniasis is metronidazole 500 mg orally twice daily for 7 days, or alternatively, a single 2-gram oral dose of metronidazole or tinidazole. This treatment is based on the most recent and highest quality study available, which shows that metronidazole has a cure rate of approximately 90%-95% 1.
Key Considerations
- Sexual partners should also be treated simultaneously to prevent reinfection, even if they don't have symptoms.
- 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.
- During treatment, patients should avoid sexual intercourse or use condoms consistently until both partners complete therapy and symptoms resolve.
- Metronidazole works by disrupting DNA synthesis in the Trichomonas vaginalis parasite, effectively killing it.
- Follow-up testing is generally not necessary if symptoms resolve, but retesting may be considered if symptoms persist.
- Pregnant women should receive the 7-day course of metronidazole, as trichomoniasis during pregnancy is associated with adverse outcomes like preterm birth 1.
Treatment Efficacy
The efficacy of metronidazole in treating trichomoniasis has been well established, with cure rates ranging from 90%-95% 1. The treatment is also effective in preventing reinfection and reducing the transmission of the disease.
Special Considerations
In cases where the patient is pregnant, metronidazole use has not been shown to have a consistent association with teratogenic or mutagenic effects in the infant 1. However, pregnant women should be managed in consultation with an expert in infectious diseases.
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
Trichomoniasis Treatment Options
- The recommended treatment for trichomoniasis typically involves the use of antiprotozoal medications, with metronidazole and tinidazole being the most commonly used options 4, 5, 6, 7, 8.
- Metronidazole is often prescribed as a single 2g dose or as a 7-day course of 250mg three times daily 5, 7.
- Tinidazole has also been shown to be effective in treating trichomoniasis, with a single 2g dose being comparable to metronidazole in terms of efficacy 4, 6, 8.
Comparison of Treatment Regimens
- Studies have compared the efficacy of single-dose metronidazole versus 7-day courses, with some finding that the 7-day course may be more effective in clearing the infection 7.
- The presence of bacterial vaginosis may not significantly affect the efficacy of metronidazole treatment 7.
- Tinidazole has been shown to be effective in treating metronidazole-resistant cases of trichomoniasis, with advantages including greater in vitro potency and improved patient tolerability 8.
Treatment Considerations
- Patient compliance and adherence to treatment regimens are important considerations, with single-dose regimens often being preferred due to ease of administration and lower cost 5, 6.
- Side effects of treatment, such as nausea and headache, are generally similar across different regimens and are typically mild 5, 7.