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, as this regimen has resulted in cure rates of approximately 90%-95%. This treatment approach is based on the most recent and highest quality study available, which emphasizes the importance of treating both patients and their sex partners to ensure relief of symptoms, microbiologic cure, and reduction of transmission 1.
Key Considerations for Treatment
- Sexual partners should 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 (72 hours for tinidazole) due to potential disulfiram-like reactions.
- It's crucial to avoid sexual intercourse until both partners have completed treatment and are symptom-free.
- Pregnant women should use the 7-day metronidazole regimen rather than single-dose therapy.
- Treatment is highly effective, with cure rates of 90-95%, as these medications specifically target the anaerobic metabolism of the Trichomonas vaginalis parasite.
Follow-Up and Resistance
Follow-up testing is recommended if symptoms persist after treatment, as reinfection or resistance to metronidazole can occasionally occur. The choice of metronidazole over other treatments is supported by its high efficacy and the lower efficacy of topically applied antimicrobials, such as metronidazole gel, which is not recommended for the treatment of trichomoniasis 1.
Treatment Outcomes
The treatment outcomes for trichomoniasis, in terms of morbidity, mortality, and quality of life, are significantly improved with metronidazole treatment, reducing the risk of complications and improving symptoms and quality of life for affected individuals 1.
From the FDA Drug Label
The recommended dose in both females and males is a single 2 g oral dose taken with food. Since trichomoniasis is a sexually transmitted disease, sexual partners should be treated with the same dose and at the same time. The recommended treatment for Trichomoniasis is a single 2 g oral dose of tinidazole taken with food, and it is advised that sexual partners be treated simultaneously to prevent re-infection 2.
- The dose is the same for both females and males.
- Treatment should be taken with food to minimize gastrointestinal side effects.
- Sexual partners should be treated at the same time to prevent re-infection.
From the Research
Treatment Options for Trichomoniasis
- The recommended treatment for trichomoniasis is a 7-day dose of metronidazole, as it has been shown to be more effective than a single-dose treatment 3.
- A study published in The Lancet found that patients in the 7-day-dose group were less likely to be T vaginalis positive at test-of-cure than those in the single-dose group, with a relative risk of 0·55 3.
- However, other studies have found that a single, 2-gram dose of metronidazole can be effective in treating trichomoniasis, with cure rates ranging from 93.8% to 97.5% 4, 5.
- Alternative treatments, such as tinidazole, have also been shown to be effective, with cure rates of 95% to 100% 6, 5.
- It is important to note that simultaneous treatment of sexual partners is particularly important when treating trichomoniasis, and that pregnant women may require alternative treatments due to the potential risks of metronidazole 7.
Considerations for Treatment
- The choice of treatment may depend on factors such as patient compliance, cost, and potential side effects.
- Metronidazole is generally well-tolerated, but can cause side effects such as nausea, headache, and vomiting 3, 4.
- Tinidazole has been shown to be highly effective and have minimal side effects, making it a potential alternative to metronidazole 6, 5.
- The treatment of trichomoniasis in pregnant women requires special consideration, and may involve the use of alternative treatments such as clotrimazole vaginal suppositories 7.