Which medications are used for the treatment of trichomoniasis?

Updated: Jan 02, 2020
  • Author: Darvin Scott Smith, MD, MSc, DTM&H; Chief Editor: Michael Stuart Bronze, MD  more...
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Answer

The following treatment options are recommended by the CDC:

  • Single-dose 2-g oral metronidazole therapy
  • Prolonged metronidazole therapy with 500 mg twice daily for 7 days
  • Single-dose 2-g oral tinidazole therapy

Single-dose tinidazole or metronidazole appears to be equally effective in the treatment of trichomoniasis. Tinidazole is generally more expensive than metronidazole but may have fewer side-effects and remains in serum longer. Single-dose therapy with metronidazole or tinidazole improves patient compliance and results in a lower total dose than the week-long metronidazole schedule, although the week-long schedule may be useful in some situations, such as in patients with HIV infection or those who are breastfeeding. [11] Topical treatments are not recommended due to inadequate therapeutic levels. [11] Treatment with oral metronidazole has not been shown to have teratogenic effects [122, 123] and may prevent transmission to the infant. The CDC does not offer a definitive recommendation on treating pregnant patients with symptomatic trichomoniasis but currently recommends that a single 2-g dose of metronidazole be used when treatment is prescribed. [11] Infected asymptomatic pregnant women may wish to defer treatment to after 37 weeks’ gestation. [48] Tinidazole is a pregnancy Class C agent and should not be used by pregnant women.

Drug-resistance in T vaginalis infection is rare, despite the prevalent use of nitroimidazole drugs. Treatment failures may require a higher-dose regimen, a longer course of the agent, or the use of different nitroimidazoles. In cases of resistance, nimorazole, ornidazole, furazolidone, ornidazole, and hamycin have been used with success. [117]

Consultation with CDC experts may be advisable for patients in whom treatment fails and in whom reinfection is ruled out (770-488-4115). Consultation with an infectious diseases specialist, a gynecologist, or both may be helpful.


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