What is the treatment for Trichomoniasis (Trich)?

From the Guidelines

Trichomoniasis should be treated with metronidazole, which has been shown to result in cure rates of approximately 90%--95% in randomized clinical trials 1. The treatment of Trichomoniasis (Trich) is crucial to prevent complications and reduce transmission.

• The recommended treatment is metronidazole, which is the only FDA-approved drug for the treatment of trichomoniasis in the United States 1.
• Metronidazole gel is not recommended for use due to its low efficacy (<50%) compared to oral preparations 1.
• Ensuring treatment of sex partners is essential to increase the cure rate and prevent reinfection.
• The use of other topically applied antimicrobials is not recommended due to their low efficacy compared to metronidazole 1. The goal of treatment is to achieve relief of symptoms, microbiologic cure, and reduction of transmission, which can be achieved with metronidazole treatment 1.
• It is essential to note that treatment of patients and sex partners is necessary to achieve the best outcomes.
• The treatment should be oral metronidazole, as it has been shown to be effective in achieving high cure rates 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 treatment for Trichomoniasis (Trich) 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.

From the Research

Treatment Options for Trichomoniasis

• The first-line treatment for trichomoniasis is metronidazole, with a single dose of 2 g being the standard treatment 4, 5.
• However, a 7-day dose of metronidazole (500 mg twice daily) has been shown to be more effective than a single dose, with a lower rate of treatment failure 4.
• Tinidazole is another accepted treatment for trichomoniasis, with a single dose of 2 g being as effective as a single dose of metronidazole 6.
• Intravaginal metronidazole/miconazole has also been studied as a treatment option, with cure rates comparable to oral metronidazole 7.

Resistant Trichomoniasis

• Resistant trichomoniasis is a growing public health concern, and new drug therapies and dosing regimens are being studied to treat resistant infection 8.
• Women with resistant trichomoniasis should be treated with high-dose regimens of metronidazole or tinidazole 8.
• Alternative treatment options, such as high-dose tinidazole/intravaginal paromomycin cream combination, intravaginal boric acid, and intravaginal metronidazole/miconazole, have shown some success in treating resistant trichomoniasis 8.

Side Effects and Adherence

• Side effects of metronidazole treatment are generally minimal, but can include nausea, headache, and vomiting 4, 5.
• Adherence to treatment is generally high, with self-reported adherence rates of 96-99% in studies 4.
• The ease of administration and lower cost of single-dose metronidazole regimens may improve patient compliance 5.