From the Guidelines
The most effective treatment for trichomonas and bacterial vaginosis (BV) is metronidazole, with a recommended regimen of 500mg orally twice daily for 7 days for both conditions. This recommendation is based on the highest quality and most recent evidence available, which demonstrates that metronidazole is the only class of drugs useful for the oral or parenteral therapy of trichomoniasis, with cure rates of approximately 90-95% 1. For BV, metronidazole 500mg orally twice daily for 7 days, metronidazole gel 0.75% intravaginally once daily for 5 days, or clindamycin cream 2% intravaginally at bedtime for 7 days are recommended treatments 1.
Key Considerations
- Sexual partners should also be treated to prevent reinfection, as treatment of patients and sex partners results in relief of symptoms, microbiologic cure, and reduction of transmission 1.
- Patients should avoid alcohol while taking metronidazole or tinidazole and for 24-72 hours afterward to prevent disulfiram-like reactions 1.
- For pregnant women, oral metronidazole is preferred for both conditions, as topical treatments may be less effective.
- Recurrence is common with both infections, particularly BV, and may require extended or maintenance therapy in some cases.
Alternative Treatments
- Alternative options for BV include oral clindamycin 300mg twice daily for 7 days or tinidazole 2 grams once daily for 2-3 days 1.
- For trichomonas, tinidazole can be used as a single 2-gram oral dose, although metronidazole is the preferred treatment due to its higher efficacy and availability 1.
Follow-Up
- Follow-up visits are unnecessary if symptoms resolve, but recurrence of BV is not unusual, and women may require extended or maintenance therapy in some cases 1.
From the FDA Drug Label
1 INDICATIONS AND USAGE
- 1 Trichomoniasis Tinidazole is indicated for the treatment of trichomoniasis caused by Trichomonas vaginalis.
- 4 Bacterial Vaginosis Tinidazole is indicated for the treatment of bacterial vaginosis (formerly referred to as Haemophilus vaginitis, Gardnerella vaginitis, nonspecific vaginitis, or anaerobic vaginosis) in adult women
The treatment options for trichomoniasis and bacterial vaginosis (BV) include tinidazole.
- Trichomoniasis: Tinidazole is indicated for the treatment of trichomoniasis caused by Trichomonas vaginalis.
- Bacterial Vaginosis (BV): Tinidazole is indicated for the treatment of BV in adult women. Tinidazole can be given as either 2 g once daily for 2 days or 1 g once daily for 5 days for the treatment of BV 2 2.
From the Research
Treatment Options for Trichomonas and Bacterial Vaginosis (BV)
- The treatment for trichomoniasis typically involves metronidazole, with two common regimens: a single 2-g dose and a 7-day regimen of 250 mg three times daily or 500 mg twice daily 3, 4, 5, 6.
- Studies have shown that the 7-day dose of metronidazole is more efficacious at clearing infection compared to the single 2-g dose 4, 5.
- For bacterial vaginosis, treatment options include oral and intravaginal metronidazole, clindamycin, and tinidazole 7.
- Recurrent BV can be treated with an extended course of metronidazole or alternative regimens such as metronidazole vaginal gel 7.
- The choice of treatment may depend on factors such as patient compliance, cost, and potential side effects 3, 4, 6.
Considerations for Treatment
- Partner treatment is essential for trichomoniasis, as up to 70% of male sexual partners can be infected 5.
- Rescreening of treated women at 3 months is recommended due to high repeat infection rates 5.
- The underlying mechanisms of recurrent BV are not fully understood, but may involve persistence of residual infection, resistance, and reinfection from partners 7.
- Future studies should examine the importance of treating asymptomatic trichomoniasis, best treatment for men, and the influence of the microbiome on treatment efficacy 5.