From the Guidelines
Metronidazole is the first-line treatment for trichomoniasis.
Treatment Options
- The recommended metronidazole regimens have resulted in cure rates of approximately 90%-95% 1.
- Oral metronidazole is the only recommended treatment for trichomoniasis, with metronidazole gel being less efficacious and not recommended for use 1.
- The FDA has approved Flagyl 375 mg twice a day for 7 days for treatment of trichomoniasis, although no clinical data are available to demonstrate clinical equivalency with the standard metronidazole regimen 1.
Important Considerations
- Treatment of patients and sex partners results in relief of symptoms, microbiologic cure, and reduction of transmission 1.
- Metronidazole use during pregnancy has not been shown to have a consistent association with teratogenic or mutagenic effects in the infant, but pregnant women should be managed in consultation with an expert in infectious diseases 1.
From the Research
First-Line Treatment for Trichomoniasis
- The first-line treatment for trichomoniasis is single-dose metronidazole, as stated in the study published in The Lancet. Infectious diseases 2.
- However, other studies suggest that multidose metronidazole may be more effective than single-dose metronidazole, with lower treatment failure rates 3, 4.
- Metronidazole is the recommended first-line treatment for trichomoniasis, and it is available in both oral and topical forms, with high efficacy rates 5.
- The Centers for Disease Control and Prevention and the World Health Organization recommend a single 2-g dose of metronidazole for the first line of treatment for T. vaginalis among HIV-negative women 3.
Treatment Failure and Resistance
- Treatment failure can occur due to patient non-compliance, re-infection, or metronidazole resistance 6.
- Metronidazole resistance has been documented, and antimicrobial susceptibility testing for T. vaginalis is currently not available in some countries, making treatment of resistant cases challenging 6.
- The use of metronidazole for vaginitis is reviewed, along with challenges to improving its more effective administration, and strategies are being developed to enhance drug cure rates 5.
Comparison of Single-Dose and Multidose Metronidazole
- A meta-analysis compared single-dose metronidazole with multidose metronidazole for the treatment of trichomoniasis in women, and found that multidose metronidazole had a lower treatment failure rate 3.
- Another meta-analysis found that single-dose metronidazole had a higher failure rate for trichomoniasis than multidose metronidazole, and the difference was statistically significant 4.
- The side-effects of single-dose metronidazole were higher than those of multidose metronidazole, but the difference was not statistically significant 4.