From the Guidelines
Trichomoniasis should be treated with metronidazole 2 g orally in a single dose or 500 mg orally twice daily for 7 days, as these regimens have resulted in cure rates of approximately 90%--95% 1.
Treatment Options
- Metronidazole is the recommended first-line treatment for trichomoniasis, with a single 2-gram oral dose or 500 mg orally twice daily for 7 days being the most effective regimens.
- Tinidazole 2 grams as a single oral dose is an effective alternative for patients who cannot tolerate metronidazole.
- Metronidazole gel, 0.75%, one full applicator (5 g) intravaginally, daily for 5 days, is not recommended as it is less efficacious than oral preparations of metronidazole.
Important Considerations
- Patients should abstain from alcohol consumption for 24 hours after taking metronidazole or 72 hours after tinidazole due to potential disulfiram-like reactions.
- Sexual partners should be treated simultaneously to prevent reinfection, even if they are asymptomatic.
- Symptoms in women typically include vaginal discharge with a fishy odor, vaginal itching, and discomfort during urination or intercourse, while men are often asymptomatic but can experience urethral discharge or irritation.
- The infection disrupts the normal vaginal microbiome, increasing susceptibility to other sexually transmitted infections including HIV.
- Follow-up testing is recommended if symptoms persist after treatment, and routine screening is advised for high-risk individuals or those with multiple sexual partners 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 Trichomonas vaginalis infection 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 3. Key points:
- The organism should be identified by appropriate diagnostic procedures.
- Partners of infected patients should be treated simultaneously in order to prevent re-infection.
From the Research
Trichomonas Vaginalis Infection Overview
- Trichomonas vaginalis is the most common non-viral sexually transmitted infection worldwide, affecting an estimated 3.7 million women and men in the United States 4.
- It is associated with serious reproductive morbidity, poor birth outcomes, and amplified HIV transmission 5.
Treatment Options
- Single-dose metronidazole is the first-line treatment for trichomoniasis, but it may not always clear the infection, especially in women with bacterial vaginosis 5.
- A 7-day dose of metronidazole has been shown to be more effective than a single dose in treating trichomoniasis in women, with a lower rate of treatment failure 5, 6.
- Multidose metronidazole (500 mg twice daily for 7 days) is recommended for all women with trichomoniasis, especially those with a history of the infection or symptoms at baseline 7.
Diagnosis and Management
- Newly available diagnostic methods, including point-of-care assays and multiple nucleic acid amplification tests, can be performed on a variety of genital specimens in women and men, allowing for more accurate and convenient testing and screening 4.
- Repeat and persistent infections are common in women, and rescreening at 3 months after treatment is recommended 4.
- In vitro antibiotic resistance to 5-nitroimidazole in T. vaginalis remains low (4.3%), but should be monitored 4.