Materiały źródłowe

• #1 Trichomoniasis – STI Treatment Guidelines

  https://www.cdc.gov/std/treatment-guidelines/trichomoniasis.htm

  If treatment failure occurs in a woman after completing a regimen of metronidazole 500 mg 2 times/day for 7 days and she has been reexposed to an untreated partner, a repeat course of the same regimen is recommended. […] For persons who are experiencing persistent infection not attributable to reexposure, clinicians should request a kit from CDC to perform drug-resistance testing. […] Treatment reduces symptoms and signs of T. vaginalis infection, cures infection, and might reduce transmission. Likelihood of adverse outcomes among women with HIV infection is also reduced with T. vaginalis therapy. Recommended Regimen for Trichomonas and HIV Infection Among Women: Metronidazole 500 mg orally 2 times/day for 7 days.

• #2 Strategies for Prevention and Treatment of Trichomonas vaginalis Infections

  https://pmc.ncbi.nlm.nih.gov/articles/PMC5475227/

  The last estimated annual incidence of Trichomonas vaginalis worldwide exceeds that of chlamydia and gonorrhea combined. […] Oral metronidazole remains the recommended regimen for the treatment of trichomoniasis. However, treatment failure does occur, mainly due to significant gastrointestinal adverse effects, which have been found to be temporary and disappear after the cessation of treatment. […] This article offers an update on the progress in T. vaginalis diagnostics and chemotherapy for the treatment of trichomoniasis. […] Currently, 5-nitroimidazole drugs are commonly used for treatment of trichomoniasis by oral and parenteral routes. Among these drugs, only metronidazole and tinidazole are available in the United States and are authorized by the Food and Drug Administration (FDA) for the treatment of trichomoniasis.

• #3 A New Treatment Option for Trichomoniasis: Single-Dose Secnidazole

  https://www.contemporaryobgyn.net/view/a-new-treatment-option-for-trichomoniasis-single-dose-secnidazole

  Trichomoniasis is the most prevalent nonviral sexually transmitted infection (STI) worldwide. […] Trichomoniasis is associated with significant morbidity if not treated promptly and appropriately. In women, trichomoniasis can cause vaginitis, cervicitis, and pelvic inflammatory disease. […] Women with trichomoniasis have a two- to three-fold increased risk for acquiring HIV. […] The old 2015 CDC STD Treatment Guidelines recommended a single 2-g dose of oral metronidazole (MTZ) or tinidazole (TDZ) for T vaginalis infected women without HIV; for HIV-infected women, MTZ 500 mg orally twice daily for 7 days was preferred. […] A more recent similarly designed study compared single-dose MTZ with the 7-day MTZ regimen for trichomoniasis among women without HIV. […] This recommendation has been adopted by ACOG and was just adopted in the new updated 2021 CDC STI Treatment Guidelines.

• #4 Trichomoniasis – STI Treatment Guidelines

  https://www.cdc.gov/std/treatment-guidelines/trichomoniasis.htm

  Treatment reduces symptoms and signs of T. vaginalis infection and might reduce transmission. Treatment recommendations for women are based on a meta-analysis and a multicenter, randomized trial of mostly symptomatic women without HIV infection. The study demonstrated that multidose metronidazole (500 mg orally 2 times/day for 7 days) reduced the proportion of women retesting positive at a 1-month test of cure visit by half, compared with women who received the 2-g single dose. […] Recommended Regimen for Trichomoniasis Among Women: Metronidazole 500 mg 2 times/day for 7 days. Recommended Regimen for Trichomoniasis Among Men: Metronidazole 2 g orally in a single dose. Alternative Regimen for Women and Men: Tinidazole 2 g orally in a single dose. […] The nitroimidazoles are the only class of medications with clinically demonstrated efficacy against T. vaginalis infections. Tinidazole is usually more expensive, reaches higher levels in serum and the genitourinary tract, has a longer half-life than metronidazole (12.5 hours versus 7.3 hours), and has fewer gastrointestinal side effects. In randomized clinical trials, recommended metronidazole regimens have resulted in cure rates of approximately 84%98%, and the recommended tinidazole regimen has resulted in cure rates of approximately 92%100%.

• #5 Strategies for Prevention and Treatment of Trichomonas vaginalis Infections

  https://pmc.ncbi.nlm.nih.gov/articles/PMC5475227/

  The last estimated annual incidence of Trichomonas vaginalis worldwide exceeds that of chlamydia and gonorrhea combined. […] Oral metronidazole remains the recommended regimen for the treatment of trichomoniasis. However, treatment failure does occur, mainly due to significant gastrointestinal adverse effects, which have been found to be temporary and disappear after the cessation of treatment. […] This article offers an update on the progress in T. vaginalis diagnostics and chemotherapy for the treatment of trichomoniasis. […] Currently, 5-nitroimidazole drugs are commonly used for treatment of trichomoniasis by oral and parenteral routes. Among these drugs, only metronidazole and tinidazole are available in the United States and are authorized by the Food and Drug Administration (FDA) for the treatment of trichomoniasis.

• #6 Trichomoniasis Treatment & Management: Approach Considerations, Pharmacologic Therapy, Diet and Activity

  https://emedicine.medscape.com/article/230617-treatment

  Treatment of pregnant women with tinidazole has not been well-studied, however animal studies suggest that the drug poses moderate risks. […] Use of tinidazole is not recommended in pregnant women. […] 5-Nitroimidazole drugs are the only widely used pharmacological treatment for trichomoniasis. […] In the United States, several of these drugs, metronidazole, tinidazole, and secnidazole are approved by the FDA for trichomoniasis. […] The CDC recommends the following drug schedules in the treatment of trichomoniasis: A single 2-g dose of metronidazole, tinidazole, or secnidazole; A schedule of 500 mg of metronidazole, taken twice daily for 7 days. […] Each drug schedule has advantages and disadvantages, but, ultimately, they yield similar cure rates. […] In a 2003 Cochrane review, metronidazole and tinidazole had comparable efficacy in treating trichomoniasis.

• #7 Trichomoniasis – STI Treatment Guidelines

  https://www.cdc.gov/std/treatment-guidelines/trichomoniasis.htm

  Treatment reduces symptoms and signs of T. vaginalis infection and might reduce transmission. Treatment recommendations for women are based on a meta-analysis and a multicenter, randomized trial of mostly symptomatic women without HIV infection. The study demonstrated that multidose metronidazole (500 mg orally 2 times/day for 7 days) reduced the proportion of women retesting positive at a 1-month test of cure visit by half, compared with women who received the 2-g single dose. […] Recommended Regimen for Trichomoniasis Among Women: Metronidazole 500 mg 2 times/day for 7 days. Recommended Regimen for Trichomoniasis Among Men: Metronidazole 2 g orally in a single dose. Alternative Regimen for Women and Men: Tinidazole 2 g orally in a single dose. […] The nitroimidazoles are the only class of medications with clinically demonstrated efficacy against T. vaginalis infections. Tinidazole is usually more expensive, reaches higher levels in serum and the genitourinary tract, has a longer half-life than metronidazole (12.5 hours versus 7.3 hours), and has fewer gastrointestinal side effects. In randomized clinical trials, recommended metronidazole regimens have resulted in cure rates of approximately 84%98%, and the recommended tinidazole regimen has resulted in cure rates of approximately 92%100%.

• #8 Strategies for Prevention and Treatment of Trichomonas vaginalis Infections

  https://pmc.ncbi.nlm.nih.gov/articles/PMC5475227/

  Metronidazole is relatively cheap, effective, and generally well tolerated. […] Tinidazole is a nitroimidazole that was introduced in 1969 for the treatment of infections caused by T. vaginalis. […] Although the 5-nitroimidazole compounds are the most effective drugs for treating T. vaginalis infection, disulfiram and nithiamide might represent alternatives for treating patients with hypersensitivity to 5-nitroimidazole drugs. […] Vaginal administration of microbicide constitutes an alternative to prevent the acquisition of T. vaginalis infections. […] The major limitation related to vaginal administration of drugs for the treatment of trichomoniasis is the nonaccessibility of other infected organs. […] Nitroimidazoles for T. vaginalis treatment have been formulated for vaginal application.

• #9 Trichomoniasis Treatment & Management: Approach Considerations, Pharmacologic Therapy, Diet and Activity

  https://emedicine.medscape.com/article/230617-treatment

  Randomized clinical trials comparing single 2-g doses have also shown metronidazole and tinidazole to be equally effective. […] With recommended dosages, the expected cure rate of trichomoniasis is 95%. […] Tinidazole is generally more expensive than metronidazole but also seems to persist in serum longer. […] Some research suggests that tinidazole has fewer side effects than metronidazole, but not all studies have found this result. […] The advantages of single-dose therapy with metronidazole or tinidazole over the week-long metronidazole schedule include better patient compliance and a lower total dose. […] The week-long metronidazole schedule may be more effective in treating trichomoniasis in HIV-infected women. […] Because trichomoniasis is an infection of multiple sites, systemic (oral) treatment is needed.

• #10 Trichomoniasis Treatment & Management: Approach Considerations, Pharmacologic Therapy, Diet and Activity

  https://emedicine.medscape.com/article/230617-treatment

  Patients on tinidazole therapy should not consume alcohol during therapy or for 72 hours after completion of the medication. […] Secnidazole gained FDA approval in June 2021 for treatment of trichomoniasis caused by T vaginalis in adult females. […] Because trichomoniasis is transmitted sexually with potentially serious sequelae, treat partners of infected patients simultaneously to prevent reinfection. […] In 2022, the indication was expanded to include males and adolescents aged 12 years and older. […] Approval was based a US multicenter trial in 147 women with confirmed positive T vaginalis culture. […] Cure rates were significantly higher in the secnidazole group compared with placebo (92.2% vs 1.5%) for the modified intent-to-treat population and for the per-protocol population (94.9% vs 1.7%).

• #11 Solosec® for Trichomoniasis | Treat Patients in a Single Dose

  https://www.solosechcp.com/trichomoniasis

  The only single dose oral antibiotic that provides a complete course of therapy to treat both bacterial vaginosis (BV) and trichomoniasis. Trichomoniasis is the most common nonviral STI and is associated with serious health risks and reproductive morbidity in women. Help ensure patients and partners adhere to trichomoniasis treatment with a single-dose regimen. SOLOSEC demonstrated a cure rate of 92.2% for trichomoniasis in women in the phase-3 trial. ACOG and CDC no longer recommend single dose metronidazole to treat trichomoniasis in women. SOLOSEC is approved to treat partners of trichomoniasis patients with the same single dose each at the same time. SOLOSEC (secnidazole) 2 g oral granules is an antimicrobial agent indicated for the treatment of bacterial vaginosis in female patients 12 years of age and older and trichomoniasis in patients 12 years of age and older. Since trichomoniasis is a sexually transmitted disease, treat sexual partners of infected patients with the same dose and at the same time to prevent reinfection. SOLOSEC is a single-dose therapy for oral use. Avoid consumption of alcoholic beverages and preparations containing ethanol or propylene glycol during treatment with SOLOSEC and for at least 2 days after completing therapy.

• #12 Trichomoniasis – STI Treatment Guidelines

  https://www.cdc.gov/std/treatment-guidelines/trichomoniasis.htm

  Treatment reduces symptoms and signs of T. vaginalis infection and might reduce transmission. Treatment recommendations for women are based on a meta-analysis and a multicenter, randomized trial of mostly symptomatic women without HIV infection. The study demonstrated that multidose metronidazole (500 mg orally 2 times/day for 7 days) reduced the proportion of women retesting positive at a 1-month test of cure visit by half, compared with women who received the 2-g single dose. […] Recommended Regimen for Trichomoniasis Among Women: Metronidazole 500 mg 2 times/day for 7 days. Recommended Regimen for Trichomoniasis Among Men: Metronidazole 2 g orally in a single dose. Alternative Regimen for Women and Men: Tinidazole 2 g orally in a single dose. […] The nitroimidazoles are the only class of medications with clinically demonstrated efficacy against T. vaginalis infections. Tinidazole is usually more expensive, reaches higher levels in serum and the genitourinary tract, has a longer half-life than metronidazole (12.5 hours versus 7.3 hours), and has fewer gastrointestinal side effects. In randomized clinical trials, recommended metronidazole regimens have resulted in cure rates of approximately 84%98%, and the recommended tinidazole regimen has resulted in cure rates of approximately 92%100%.

• #13 Updates in Trichomonas Treatment including Persistent Infection and 5-Nitroimidazole Hypersensitivity

  https://pmc.ncbi.nlm.nih.gov/articles/PMC7371247/

  The purpose of this review is to update information on treatment of T. vaginalis. […] The efficacy of the recommended 2 gram oral single-dose metronidazole (MTZ) for the treatment of T. vaginalis in women has recently been challenged. […] 7 day 500 mg twice daily MTZ should be used as the first line treatment for T. vaginalis infected women. […] This finding remained robust in multiple sensitivity analyses. […] Taken together, these data strongly suggest that multi-dose MTZ should be the recommended T. vaginalis treatment regimen in all women moving forward, particularly those with a history of T. vaginalis infection and/or are symptomatic. […] If re-infection has been excluded, persistent trichomoniasis has been treated successfully with longer courses or higher doses of the same medications used in standard therapy.

• #14 Trichomoniasis – STI Treatment Guidelines

  https://www.cdc.gov/std/treatment-guidelines/trichomoniasis.htm

  Treatment reduces symptoms and signs of T. vaginalis infection and might reduce transmission. Treatment recommendations for women are based on a meta-analysis and a multicenter, randomized trial of mostly symptomatic women without HIV infection. The study demonstrated that multidose metronidazole (500 mg orally 2 times/day for 7 days) reduced the proportion of women retesting positive at a 1-month test of cure visit by half, compared with women who received the 2-g single dose. […] Recommended Regimen for Trichomoniasis Among Women: Metronidazole 500 mg 2 times/day for 7 days. Recommended Regimen for Trichomoniasis Among Men: Metronidazole 2 g orally in a single dose. Alternative Regimen for Women and Men: Tinidazole 2 g orally in a single dose. […] The nitroimidazoles are the only class of medications with clinically demonstrated efficacy against T. vaginalis infections. Tinidazole is usually more expensive, reaches higher levels in serum and the genitourinary tract, has a longer half-life than metronidazole (12.5 hours versus 7.3 hours), and has fewer gastrointestinal side effects. In randomized clinical trials, recommended metronidazole regimens have resulted in cure rates of approximately 84%98%, and the recommended tinidazole regimen has resulted in cure rates of approximately 92%100%.

• #15 Trichomoniasis: CDC Diagnosis and Treatment Guidelines – The ObG Project

  https://www.obgproject.com/2016/10/18/trichomoniasis-cdc-diagnosis-treatment-guidelines/

  Trichomoniasis is the most prevalent nonviral sexually transmitted infection worldwide. […] The nitroimidazoles are the only class of antimicrobial medications known to be effective against T. vaginalis infections. Of these drugs, metronidazole and tinidazole have been cleared by FDA for the oral or parenteral treatment of trichomoniasis. […] The CDC recommends the following: Women: Metronidazole 500 mg 2 times/day for 7 days. […] Men: Metronidazole 2 g orally in a single dose. […] Alternative regimen for men and women: Tinidazole 2 g orally in a single dose. […] ACOG also recommends metronidazole 500 mg orally twice a day for 7 days as the recommended treatment option with tinidazole, 2 g orally in a single dose as the alternative regimen. […] Alcohol consumption should be avoided during treatment with nitroimidazoles.

• #16 Trichomoniasis – STI Treatment Guidelines

  https://www.cdc.gov/std/treatment-guidelines/trichomoniasis.htm

  Treatment reduces symptoms and signs of T. vaginalis infection and might reduce transmission. Treatment recommendations for women are based on a meta-analysis and a multicenter, randomized trial of mostly symptomatic women without HIV infection. The study demonstrated that multidose metronidazole (500 mg orally 2 times/day for 7 days) reduced the proportion of women retesting positive at a 1-month test of cure visit by half, compared with women who received the 2-g single dose. […] Recommended Regimen for Trichomoniasis Among Women: Metronidazole 500 mg 2 times/day for 7 days. Recommended Regimen for Trichomoniasis Among Men: Metronidazole 2 g orally in a single dose. Alternative Regimen for Women and Men: Tinidazole 2 g orally in a single dose. […] The nitroimidazoles are the only class of medications with clinically demonstrated efficacy against T. vaginalis infections. Tinidazole is usually more expensive, reaches higher levels in serum and the genitourinary tract, has a longer half-life than metronidazole (12.5 hours versus 7.3 hours), and has fewer gastrointestinal side effects. In randomized clinical trials, recommended metronidazole regimens have resulted in cure rates of approximately 84%98%, and the recommended tinidazole regimen has resulted in cure rates of approximately 92%100%.

• #17 Trichomoniasis – STI Treatment Guidelines

  https://www.cdc.gov/std/treatment-guidelines/trichomoniasis.htm

  Treatment reduces symptoms and signs of T. vaginalis infection and might reduce transmission. Treatment recommendations for women are based on a meta-analysis and a multicenter, randomized trial of mostly symptomatic women without HIV infection. The study demonstrated that multidose metronidazole (500 mg orally 2 times/day for 7 days) reduced the proportion of women retesting positive at a 1-month test of cure visit by half, compared with women who received the 2-g single dose. […] Recommended Regimen for Trichomoniasis Among Women: Metronidazole 500 mg 2 times/day for 7 days. Recommended Regimen for Trichomoniasis Among Men: Metronidazole 2 g orally in a single dose. Alternative Regimen for Women and Men: Tinidazole 2 g orally in a single dose. […] The nitroimidazoles are the only class of medications with clinically demonstrated efficacy against T. vaginalis infections. Tinidazole is usually more expensive, reaches higher levels in serum and the genitourinary tract, has a longer half-life than metronidazole (12.5 hours versus 7.3 hours), and has fewer gastrointestinal side effects. In randomized clinical trials, recommended metronidazole regimens have resulted in cure rates of approximately 84%98%, and the recommended tinidazole regimen has resulted in cure rates of approximately 92%100%.

• #18 Trichomoniasis: CDC Diagnosis and Treatment Guidelines – The ObG Project

  https://www.obgproject.com/2016/10/18/trichomoniasis-cdc-diagnosis-treatment-guidelines/

  Trichomoniasis is the most prevalent nonviral sexually transmitted infection worldwide. […] The nitroimidazoles are the only class of antimicrobial medications known to be effective against T. vaginalis infections. Of these drugs, metronidazole and tinidazole have been cleared by FDA for the oral or parenteral treatment of trichomoniasis. […] The CDC recommends the following: Women: Metronidazole 500 mg 2 times/day for 7 days. […] Men: Metronidazole 2 g orally in a single dose. […] Alternative regimen for men and women: Tinidazole 2 g orally in a single dose. […] ACOG also recommends metronidazole 500 mg orally twice a day for 7 days as the recommended treatment option with tinidazole, 2 g orally in a single dose as the alternative regimen. […] Alcohol consumption should be avoided during treatment with nitroimidazoles.

• #19 Trichomoniasis – STI Treatment Guidelines

  https://www.cdc.gov/std/treatment-guidelines/trichomoniasis.htm

  Treatment reduces symptoms and signs of T. vaginalis infection and might reduce transmission. Treatment recommendations for women are based on a meta-analysis and a multicenter, randomized trial of mostly symptomatic women without HIV infection. The study demonstrated that multidose metronidazole (500 mg orally 2 times/day for 7 days) reduced the proportion of women retesting positive at a 1-month test of cure visit by half, compared with women who received the 2-g single dose. […] Recommended Regimen for Trichomoniasis Among Women: Metronidazole 500 mg 2 times/day for 7 days. Recommended Regimen for Trichomoniasis Among Men: Metronidazole 2 g orally in a single dose. Alternative Regimen for Women and Men: Tinidazole 2 g orally in a single dose. […] The nitroimidazoles are the only class of medications with clinically demonstrated efficacy against T. vaginalis infections. Tinidazole is usually more expensive, reaches higher levels in serum and the genitourinary tract, has a longer half-life than metronidazole (12.5 hours versus 7.3 hours), and has fewer gastrointestinal side effects. In randomized clinical trials, recommended metronidazole regimens have resulted in cure rates of approximately 84%98%, and the recommended tinidazole regimen has resulted in cure rates of approximately 92%100%.

• #20 Trichomoniasis Treatment & Management: Approach Considerations, Pharmacologic Therapy, Diet and Activity

  https://emedicine.medscape.com/article/230617-treatment

  Treatment of pregnant women with tinidazole has not been well-studied, however animal studies suggest that the drug poses moderate risks. […] Use of tinidazole is not recommended in pregnant women. […] 5-Nitroimidazole drugs are the only widely used pharmacological treatment for trichomoniasis. […] In the United States, several of these drugs, metronidazole, tinidazole, and secnidazole are approved by the FDA for trichomoniasis. […] The CDC recommends the following drug schedules in the treatment of trichomoniasis: A single 2-g dose of metronidazole, tinidazole, or secnidazole; A schedule of 500 mg of metronidazole, taken twice daily for 7 days. […] Each drug schedule has advantages and disadvantages, but, ultimately, they yield similar cure rates. […] In a 2003 Cochrane review, metronidazole and tinidazole had comparable efficacy in treating trichomoniasis.

• #21 Trichomoniasis – STI Treatment Guidelines

  https://www.cdc.gov/std/treatment-guidelines/trichomoniasis.htm

  Treatment reduces symptoms and signs of T. vaginalis infection and might reduce transmission. Treatment recommendations for women are based on a meta-analysis and a multicenter, randomized trial of mostly symptomatic women without HIV infection. The study demonstrated that multidose metronidazole (500 mg orally 2 times/day for 7 days) reduced the proportion of women retesting positive at a 1-month test of cure visit by half, compared with women who received the 2-g single dose. […] Recommended Regimen for Trichomoniasis Among Women: Metronidazole 500 mg 2 times/day for 7 days. Recommended Regimen for Trichomoniasis Among Men: Metronidazole 2 g orally in a single dose. Alternative Regimen for Women and Men: Tinidazole 2 g orally in a single dose. […] The nitroimidazoles are the only class of medications with clinically demonstrated efficacy against T. vaginalis infections. Tinidazole is usually more expensive, reaches higher levels in serum and the genitourinary tract, has a longer half-life than metronidazole (12.5 hours versus 7.3 hours), and has fewer gastrointestinal side effects. In randomized clinical trials, recommended metronidazole regimens have resulted in cure rates of approximately 84%98%, and the recommended tinidazole regimen has resulted in cure rates of approximately 92%100%.

• #22 Trichomoniasis Treatment: Is it Reinfection or Resistant Infection?

  https://www.clinicaladvisor.com/features/trichomoniasis-management-is-it-reinfection-resistant-infection/

  Although nitroimidazoles have been used as the standard therapy to treat trichomoniasis since the 1950s, rising rates of treatment failure due to resistant infection have prompted research into new therapies and new dosing regimens of standard therapies. The prevalence of resistant infection is estimated to be about 2% to 10%. Resistant cases often are difficult to differentiate from recurrent infection. […] Nitroimidazoles are the only class of antimicrobial medications known to be effective against trichomoniasis. Metronidazole and tinidazole are approved by the US Food and Drug Administration for oral and parenteral treatment of trichomoniasis. The CDC recommends a single oral dose of metronidazole or tinidazole 2 g. The cure rate for these single-dose regimens is 84% to 98% for metronidazole and 92% to 100% for tinidazole. An alternative first-line treatment recommended by the CDC is metronidazole 500 mg twice daily for 7 days. This 7-day regimen is recommended for patients coinfected with HIV.

• #23 Trichomoniasis – STI Treatment Guidelines

  https://www.cdc.gov/std/treatment-guidelines/trichomoniasis.htm

  Treatment reduces symptoms and signs of T. vaginalis infection and might reduce transmission. Treatment recommendations for women are based on a meta-analysis and a multicenter, randomized trial of mostly symptomatic women without HIV infection. The study demonstrated that multidose metronidazole (500 mg orally 2 times/day for 7 days) reduced the proportion of women retesting positive at a 1-month test of cure visit by half, compared with women who received the 2-g single dose. […] Recommended Regimen for Trichomoniasis Among Women: Metronidazole 500 mg 2 times/day for 7 days. Recommended Regimen for Trichomoniasis Among Men: Metronidazole 2 g orally in a single dose. Alternative Regimen for Women and Men: Tinidazole 2 g orally in a single dose. […] The nitroimidazoles are the only class of medications with clinically demonstrated efficacy against T. vaginalis infections. Tinidazole is usually more expensive, reaches higher levels in serum and the genitourinary tract, has a longer half-life than metronidazole (12.5 hours versus 7.3 hours), and has fewer gastrointestinal side effects. In randomized clinical trials, recommended metronidazole regimens have resulted in cure rates of approximately 84%98%, and the recommended tinidazole regimen has resulted in cure rates of approximately 92%100%.

• #24 Trichomoniasis: CDC Diagnosis and Treatment Guidelines – The ObG Project

  https://www.obgproject.com/2016/10/18/trichomoniasis-cdc-diagnosis-treatment-guidelines/

  Trichomoniasis is the most prevalent nonviral sexually transmitted infection worldwide. […] The nitroimidazoles are the only class of antimicrobial medications known to be effective against T. vaginalis infections. Of these drugs, metronidazole and tinidazole have been cleared by FDA for the oral or parenteral treatment of trichomoniasis. […] The CDC recommends the following: Women: Metronidazole 500 mg 2 times/day for 7 days. […] Men: Metronidazole 2 g orally in a single dose. […] Alternative regimen for men and women: Tinidazole 2 g orally in a single dose. […] ACOG also recommends metronidazole 500 mg orally twice a day for 7 days as the recommended treatment option with tinidazole, 2 g orally in a single dose as the alternative regimen. […] Alcohol consumption should be avoided during treatment with nitroimidazoles.

• #25 Trichomoniasis – STI Treatment Guidelines

  https://www.cdc.gov/std/treatment-guidelines/trichomoniasis.htm

  Treatment reduces symptoms and signs of T. vaginalis infection and might reduce transmission. Treatment recommendations for women are based on a meta-analysis and a multicenter, randomized trial of mostly symptomatic women without HIV infection. The study demonstrated that multidose metronidazole (500 mg orally 2 times/day for 7 days) reduced the proportion of women retesting positive at a 1-month test of cure visit by half, compared with women who received the 2-g single dose. […] Recommended Regimen for Trichomoniasis Among Women: Metronidazole 500 mg 2 times/day for 7 days. Recommended Regimen for Trichomoniasis Among Men: Metronidazole 2 g orally in a single dose. Alternative Regimen for Women and Men: Tinidazole 2 g orally in a single dose. […] The nitroimidazoles are the only class of medications with clinically demonstrated efficacy against T. vaginalis infections. Tinidazole is usually more expensive, reaches higher levels in serum and the genitourinary tract, has a longer half-life than metronidazole (12.5 hours versus 7.3 hours), and has fewer gastrointestinal side effects. In randomized clinical trials, recommended metronidazole regimens have resulted in cure rates of approximately 84%98%, and the recommended tinidazole regimen has resulted in cure rates of approximately 92%100%.

• #26 Trichomoniasis – STI Treatment Guidelines

  https://www.cdc.gov/std/treatment-guidelines/trichomoniasis.htm

  Treatment reduces symptoms and signs of T. vaginalis infection and might reduce transmission. Treatment recommendations for women are based on a meta-analysis and a multicenter, randomized trial of mostly symptomatic women without HIV infection. The study demonstrated that multidose metronidazole (500 mg orally 2 times/day for 7 days) reduced the proportion of women retesting positive at a 1-month test of cure visit by half, compared with women who received the 2-g single dose. […] Recommended Regimen for Trichomoniasis Among Women: Metronidazole 500 mg 2 times/day for 7 days. Recommended Regimen for Trichomoniasis Among Men: Metronidazole 2 g orally in a single dose. Alternative Regimen for Women and Men: Tinidazole 2 g orally in a single dose. […] The nitroimidazoles are the only class of medications with clinically demonstrated efficacy against T. vaginalis infections. Tinidazole is usually more expensive, reaches higher levels in serum and the genitourinary tract, has a longer half-life than metronidazole (12.5 hours versus 7.3 hours), and has fewer gastrointestinal side effects. In randomized clinical trials, recommended metronidazole regimens have resulted in cure rates of approximately 84%98%, and the recommended tinidazole regimen has resulted in cure rates of approximately 92%100%.

• #27 Trichomoniasis – STI Treatment Guidelines

  https://www.cdc.gov/std/treatment-guidelines/trichomoniasis.htm

  Treatment reduces symptoms and signs of T. vaginalis infection and might reduce transmission. Treatment recommendations for women are based on a meta-analysis and a multicenter, randomized trial of mostly symptomatic women without HIV infection. The study demonstrated that multidose metronidazole (500 mg orally 2 times/day for 7 days) reduced the proportion of women retesting positive at a 1-month test of cure visit by half, compared with women who received the 2-g single dose. […] Recommended Regimen for Trichomoniasis Among Women: Metronidazole 500 mg 2 times/day for 7 days. Recommended Regimen for Trichomoniasis Among Men: Metronidazole 2 g orally in a single dose. Alternative Regimen for Women and Men: Tinidazole 2 g orally in a single dose. […] The nitroimidazoles are the only class of medications with clinically demonstrated efficacy against T. vaginalis infections. Tinidazole is usually more expensive, reaches higher levels in serum and the genitourinary tract, has a longer half-life than metronidazole (12.5 hours versus 7.3 hours), and has fewer gastrointestinal side effects. In randomized clinical trials, recommended metronidazole regimens have resulted in cure rates of approximately 84%98%, and the recommended tinidazole regimen has resulted in cure rates of approximately 92%100%.

• #28 Trichomoniasis Treatment & Management: Approach Considerations, Pharmacologic Therapy, Diet and Activity

  https://emedicine.medscape.com/article/230617-treatment

  Patients on tinidazole therapy should not consume alcohol during therapy or for 72 hours after completion of the medication. […] Secnidazole gained FDA approval in June 2021 for treatment of trichomoniasis caused by T vaginalis in adult females. […] Because trichomoniasis is transmitted sexually with potentially serious sequelae, treat partners of infected patients simultaneously to prevent reinfection. […] In 2022, the indication was expanded to include males and adolescents aged 12 years and older. […] Approval was based a US multicenter trial in 147 women with confirmed positive T vaginalis culture. […] Cure rates were significantly higher in the secnidazole group compared with placebo (92.2% vs 1.5%) for the modified intent-to-treat population and for the per-protocol population (94.9% vs 1.7%).

• #29 Trichomoniasis – STI Treatment Guidelines

  https://www.cdc.gov/std/treatment-guidelines/trichomoniasis.htm

  If treatment failure occurs in a woman after completing a regimen of metronidazole 500 mg 2 times/day for 7 days and she has been reexposed to an untreated partner, a repeat course of the same regimen is recommended. […] For persons who are experiencing persistent infection not attributable to reexposure, clinicians should request a kit from CDC to perform drug-resistance testing. […] Treatment reduces symptoms and signs of T. vaginalis infection, cures infection, and might reduce transmission. Likelihood of adverse outcomes among women with HIV infection is also reduced with T. vaginalis therapy. Recommended Regimen for Trichomonas and HIV Infection Among Women: Metronidazole 500 mg orally 2 times/day for 7 days.

• #30 Trichomoniasis Treatment & Management: Approach Considerations, Pharmacologic Therapy, Diet and Activity

  https://emedicine.medscape.com/article/230617-treatment

  Consultation with an infectious diseases specialist, a gynecologist, or both may be helpful. […] Patients who are HIV-positive should generally receive the same treatment as those who are HIV negative. […] The notable exception is that the multiday treatment drug regimen (metronidazole 500 mg twice daily for 7 days) was recently shown to be more effective in treating T vaginalis in HIV-positive women than a single-dose treatment (metronidazole 2 g single dose). […] Thus, the CDC recommends considering the multidose treatment in HIV-positive women with trichomoniasis. […] The CDC also recommends rescreening at 3 months after the completion of therapy for HIV-positive women due to the likelihood of recurrent or persistent infection and the increased risk of HIV transmission with comorbid trichomoniasis.

• #31 Trichomoniasis – STI Treatment Guidelines

  https://www.cdc.gov/std/treatment-guidelines/trichomoniasis.htm

  If treatment failure occurs in a woman after completing a regimen of metronidazole 500 mg 2 times/day for 7 days and she has been reexposed to an untreated partner, a repeat course of the same regimen is recommended. […] For persons who are experiencing persistent infection not attributable to reexposure, clinicians should request a kit from CDC to perform drug-resistance testing. […] Treatment reduces symptoms and signs of T. vaginalis infection, cures infection, and might reduce transmission. Likelihood of adverse outcomes among women with HIV infection is also reduced with T. vaginalis therapy. Recommended Regimen for Trichomonas and HIV Infection Among Women: Metronidazole 500 mg orally 2 times/day for 7 days.

• #32 Trichomoniasis – STI Treatment Guidelines

  https://www.cdc.gov/std/treatment-guidelines/trichomoniasis.htm

  If treatment failure occurs in a woman after completing a regimen of metronidazole 500 mg 2 times/day for 7 days and she has been reexposed to an untreated partner, a repeat course of the same regimen is recommended. […] For persons who are experiencing persistent infection not attributable to reexposure, clinicians should request a kit from CDC to perform drug-resistance testing. […] Treatment reduces symptoms and signs of T. vaginalis infection, cures infection, and might reduce transmission. Likelihood of adverse outcomes among women with HIV infection is also reduced with T. vaginalis therapy. Recommended Regimen for Trichomonas and HIV Infection Among Women: Metronidazole 500 mg orally 2 times/day for 7 days.

• #33 Trichomoniasis Treatment & Management: Approach Considerations, Pharmacologic Therapy, Diet and Activity

  https://emedicine.medscape.com/article/230617-treatment

  Consultation with an infectious diseases specialist, a gynecologist, or both may be helpful. […] Patients who are HIV-positive should generally receive the same treatment as those who are HIV negative. […] The notable exception is that the multiday treatment drug regimen (metronidazole 500 mg twice daily for 7 days) was recently shown to be more effective in treating T vaginalis in HIV-positive women than a single-dose treatment (metronidazole 2 g single dose). […] Thus, the CDC recommends considering the multidose treatment in HIV-positive women with trichomoniasis. […] The CDC also recommends rescreening at 3 months after the completion of therapy for HIV-positive women due to the likelihood of recurrent or persistent infection and the increased risk of HIV transmission with comorbid trichomoniasis.

• #34 Trichomoniasis Treatment & Management: Approach Considerations, Pharmacologic Therapy, Diet and Activity

  https://emedicine.medscape.com/article/230617-treatment

  Pregnant individuals showing symptoms, regardless of their pregnancy stage, should be tested and treated. […] Managing T vaginalis infections can help relieve symptoms like vaginal discharge in pregnant individuals and reduce the likelihood of sexual transmission to partners. […] Although the occurrence of perinatal transmission of trichomoniasis is uncommon, treatment may also aid in preventing respiratory or genital infections in newborns. […] Healthcare providers should counsel symptomatic pregnant patients diagnosed with trichomoniasis about the potential risks and benefits of treatment, highlighting the necessity of partner treatment and the use of condoms to prevent sexual transmission. […] The effectiveness of routine screening for T vaginalis in asymptomatic pregnant individuals has not been established.

• #35 Trichomoniasis Treatment & Management: Approach Considerations, Pharmacologic Therapy, Diet and Activity

  https://emedicine.medscape.com/article/230617-treatment

  The CDC recommends a single 2-g dose of metronidazole if treatment is deemed necessary. […] One study has found an association between the use of metronidazole during pregnancy and premature delivery, but this result has not been reproduced by other studies. […] Treatment of trichomoniasis during pregnancy may relieve symptoms of vaginal discharge or prevent the rare complication of neonatal respiratory infection with trichomoniasis. […] Vertical transmission of trichomoniasis during delivery is relatively rare, but respiratory or genital infection of the newborn during delivery has been reported. […] In breastfeeding women, the CDC recommends stopping breastfeeding during the course of metronidazole treatment and for 12-24 hours after the last day. […] For treatment with tinidazole, the CDC recommends stopping breastfeeding for the course of treatment and for 3 days after the last dose.

• #36 Trichomoniasis Treatment & Management: Approach Considerations, Pharmacologic Therapy, Diet and Activity

  https://emedicine.medscape.com/article/230617-treatment

  The CDC recommends a single 2-g dose of metronidazole if treatment is deemed necessary. […] One study has found an association between the use of metronidazole during pregnancy and premature delivery, but this result has not been reproduced by other studies. […] Treatment of trichomoniasis during pregnancy may relieve symptoms of vaginal discharge or prevent the rare complication of neonatal respiratory infection with trichomoniasis. […] Vertical transmission of trichomoniasis during delivery is relatively rare, but respiratory or genital infection of the newborn during delivery has been reported. […] In breastfeeding women, the CDC recommends stopping breastfeeding during the course of metronidazole treatment and for 12-24 hours after the last day. […] For treatment with tinidazole, the CDC recommends stopping breastfeeding for the course of treatment and for 3 days after the last dose.

• #37 Trichomoniasis Treatment & Management: Approach Considerations, Pharmacologic Therapy, Diet and Activity

  https://emedicine.medscape.com/article/230617-treatment

  Reports now describe resistance to metronidazole approaching 5%-10%. […] If standard treatment with either single-dose or multidose therapy fails, a regimen of 2 g of oral metronidazole or tinidazole for 5 days may be considered. […] Metronidazole gel is effective in less than 50% of trichomoniasis cases and is not recommended to treat trichomoniasis. […] Patients should not consume alcohol during the course of treatment or during the 24 hours after the completion of the medication. […] Metronidazole crosses the placenta in pregnancy. […] A number of clinical trials and meta-analyses have not shown it to have teratogenic effects. […] The National Institute of Child Health and Human Development Maternal Fetal Medicine Units Network presented data suggesting that metronidazole treatment of asymptomatic carriers of T vaginalis increased the risk of preterm birth.

• #38 Trichomoniasis Treatment & Management: Approach Considerations, Pharmacologic Therapy, Diet and Activity

  https://emedicine.medscape.com/article/230617-treatment

  The CDC recommends a single 2-g dose of metronidazole if treatment is deemed necessary. […] One study has found an association between the use of metronidazole during pregnancy and premature delivery, but this result has not been reproduced by other studies. […] Treatment of trichomoniasis during pregnancy may relieve symptoms of vaginal discharge or prevent the rare complication of neonatal respiratory infection with trichomoniasis. […] Vertical transmission of trichomoniasis during delivery is relatively rare, but respiratory or genital infection of the newborn during delivery has been reported. […] In breastfeeding women, the CDC recommends stopping breastfeeding during the course of metronidazole treatment and for 12-24 hours after the last day. […] For treatment with tinidazole, the CDC recommends stopping breastfeeding for the course of treatment and for 3 days after the last dose.

• #39 Trichomoniasis Treatment & Management: Approach Considerations, Pharmacologic Therapy, Diet and Activity

  https://emedicine.medscape.com/article/230617-treatment

  This was a controversial conclusion in that the investigators treated T vaginalis infection with 4 doses of 2 g metronidazole, which is significantly more than what is standard practice. […] The women included in the study were between 16 and 23 weeks gestational age, suggesting a significant delay in treatment. […] A subsequent study by Mann et al showed no increased risk of preterm birth with the use of metronidazole for the treatment of trichomoniasis. […] Although the CDC does not take a definitive stance on treating trichomoniasis during pregnancy, it recommends a single 2-g dose of metronidazole if treatment is deemed necessary. […] Treatment of trichomoniasis during pregnancy may relieve symptoms of vaginal discharge or prevent the rare complication of neonatal respiratory infection with trichomoniasis.

• #40 Trichomoniasis Treatment & Management: Approach Considerations, Pharmacologic Therapy, Diet and Activity

  https://emedicine.medscape.com/article/230617-treatment

  The CDC recommends a single 2-g dose of metronidazole if treatment is deemed necessary. […] One study has found an association between the use of metronidazole during pregnancy and premature delivery, but this result has not been reproduced by other studies. […] Treatment of trichomoniasis during pregnancy may relieve symptoms of vaginal discharge or prevent the rare complication of neonatal respiratory infection with trichomoniasis. […] Vertical transmission of trichomoniasis during delivery is relatively rare, but respiratory or genital infection of the newborn during delivery has been reported. […] In breastfeeding women, the CDC recommends stopping breastfeeding during the course of metronidazole treatment and for 12-24 hours after the last day. […] For treatment with tinidazole, the CDC recommends stopping breastfeeding for the course of treatment and for 3 days after the last dose.

• #41 Trichomoniasis Treatment & Management: Approach Considerations, Pharmacologic Therapy, Diet and Activity

  https://emedicine.medscape.com/article/230617-treatment

  Metronidazole is typically administered as either a single-dose therapy taken with food or a 500-mg therapy taken twice daily with food for 7 days. […] Single-dose therapy is as effective as prolonged therapy, although single-dose therapy causes slightly fewer side effects and increases drug adherence. […] The 7-day schedule of metronidazole therapy may be more effective in treating trichomoniasis in women with HIV infection and should be considered in this population. […] A modified 7-day schedule (400 mg 3 times a day) should be considered in breastfeeding women. […] Studies suggest that this schedule produces a lower concentration of metronidazole in breast milk over longer periods. […] Treatment failure with single-dose metronidazole therapy increased from 0.4% to 3.5% between 1999 and 2002.

• #42 Trichomoniasis – STI Treatment Guidelines

  https://www.cdc.gov/std/treatment-guidelines/trichomoniasis.htm

  Metronidazole gel does not reach therapeutic levels in the urethra and perivaginal glands. Because it is less efficacious than oral metronidazole, it is not recommended. […] Providers should advise persons with T. vaginalis infections to abstain from sex until they and their sex partners are treated (i.e., when therapy has been completed and any symptoms have resolved). […] Because of the high rate of reinfection among women treated for trichomoniasis, retesting for T. vaginalis is recommended for all sexually active women approximately 3 months after initial treatment regardless of whether they believe their sex partners were treated. […] Concurrent treatment of all sex partners is vital for preventing reinfections. Current partners should be referred for presumptive therapy. […] The nitroimidazoles are the only class of antimicrobials known to be effective against trichomonas infection. Metronidazole resistance occurs in 4%10% of cases of vaginal trichomoniasis.

• #43 Trichomoniasis: Causes, Symptoms, Testing & Treatment

  https://my.clevelandclinic.org/health/diseases/4696-trichomoniasis

  Trichomoniasis is a common, but curable, sexually transmitted infection (STI). Treatment for trich involves taking antibiotics. […] Healthcare providers treat trichomoniasis with antibiotic medication to kill the parasite causing the infection. Without treatment, trich can last for months or even years. It won’t go away on its own. The entire time you’re infected, you can give the infection to your sexual partners. It’s important that all sex partners are treated to prevent re-infection. […] Oral antibiotic medications kill trich. Your healthcare provider may prescribe metronidazole or tinidazole. […] Yes, trich is curable. A healthcare provider treats trich infection with medication you take by mouth (swallow). […] No, trich doesn’t go away on its own. You need an antibiotic to treat the infection.

• #44 Trichomoniasis – STI Treatment Guidelines

  https://www.cdc.gov/std/treatment-guidelines/trichomoniasis.htm

  Metronidazole gel does not reach therapeutic levels in the urethra and perivaginal glands. Because it is less efficacious than oral metronidazole, it is not recommended. […] Providers should advise persons with T. vaginalis infections to abstain from sex until they and their sex partners are treated (i.e., when therapy has been completed and any symptoms have resolved). […] Because of the high rate of reinfection among women treated for trichomoniasis, retesting for T. vaginalis is recommended for all sexually active women approximately 3 months after initial treatment regardless of whether they believe their sex partners were treated. […] Concurrent treatment of all sex partners is vital for preventing reinfections. Current partners should be referred for presumptive therapy. […] The nitroimidazoles are the only class of antimicrobials known to be effective against trichomonas infection. Metronidazole resistance occurs in 4%10% of cases of vaginal trichomoniasis.

• #45

  https://www.nhs.uk/conditions/trichomoniasis/treatment/

  You may need more antibiotics or a different form of treatment. […] You should avoid having sex while you’re being treated for trichomoniasis, as you may become reinfected. […] It’s very important that your current sexual partner and any other recent partners are also tested and treated. If your sexual partner is not treated, this increases the risk of reinfection.

• #46 Trichomoniasis Treatment & Management: Approach Considerations, Pharmacologic Therapy, Diet and Activity

  https://emedicine.medscape.com/article/230617-treatment

  Evaluation for trichomoniasis is typically conducted in the outpatient setting. […] After positive diagnosis, treatment should be instituted immediately and, whenever possible, in conjunction with all sexual partners. […] Expedited partner therapy is a safe and effective means of treating the sexual partners of patients diagnosed with trichomoniasis and should be practiced whenever possible. […] Both patient and partner should abstain from sex until pharmacological treatment has been completed and they have no symptoms. […] Patients undergoing pharmacotherapy should be advised to avoid alcohol consumption during the course of treatment and for an appropriate amount of time after the completion of their medication. […] Because trichomoniasis is an infection of multiple sites (eg. vaginal epithelium, Skene glands, Bartholin glands, and urethra), systemic treatment is needed.

• #47 Trichomoniasis: Background, Pathophysiology, Etiology

  https://emedicine.medscape.com/article/230617-overview

  The CDC recommends two oral nitroimidazoles for the treatment of trichomoniasis: metronidazole (Flagyl) and tinidazole (Tindamax). Although generally more expensive, tinidazole is associated with fewer adverse effects than metronidazole and is equal or superior in resolving T vaginalis infection. […] When the first-line agent is ineffective (and reinfection by partner is ruled out), the other nitroimidazole or an alternative dosing schedule of metronidazole may be used. Topical metronidazole and other antimicrobials are not efficacious and should not be used to treat trichomoniasis. […] Sexual partners of the infected patient should also be treated. Both the patient and partners should abstain from sexual activity until pharmacologic treatment has been completed and they have no symptoms. […] In regions where expedited partner therapy (EPT) is legal, it may be useful in managing trichomoniasis. Infected women who are sexually active have a high rate of reinfection; thus, rescreening at 3 months posttreatment should be considered. Data are insufficient to support rescreening men.

• #48 Trichomoniasis – STI Treatment Guidelines

  https://www.cdc.gov/std/treatment-guidelines/trichomoniasis.htm

  Metronidazole gel does not reach therapeutic levels in the urethra and perivaginal glands. Because it is less efficacious than oral metronidazole, it is not recommended. […] Providers should advise persons with T. vaginalis infections to abstain from sex until they and their sex partners are treated (i.e., when therapy has been completed and any symptoms have resolved). […] Because of the high rate of reinfection among women treated for trichomoniasis, retesting for T. vaginalis is recommended for all sexually active women approximately 3 months after initial treatment regardless of whether they believe their sex partners were treated. […] Concurrent treatment of all sex partners is vital for preventing reinfections. Current partners should be referred for presumptive therapy. […] The nitroimidazoles are the only class of antimicrobials known to be effective against trichomonas infection. Metronidazole resistance occurs in 4%10% of cases of vaginal trichomoniasis.

• #49 Trichomoniasis – Diagnosis & treatment – Mayo Clinic

  https://www.mayoclinic.org/diseases-conditions/trichomoniasis/diagnosis-treatment/drc-20378613

  Drinking alcohol during and for a few days after treatment can cause severe nausea and vomiting. Don’t drink alcohol for 24 hours after taking metronidazole, 48 hours after taking secnidazole or 72 hours after taking tinidazole. […] Your health care provider will typically retest you for trichomoniasis after treatment. A retest two weeks to three months after treatment can check to be sure the infection is gone and that you haven’t been reinfected. […] Even if you’ve had treatment that gets rid of trichomoniasis, it’s possible to get it again if you’re exposed to someone with the infection.

• #50 Trichomoniasis – Diagnosis & treatment – Mayo Clinic

  https://www.mayoclinic.org/diseases-conditions/trichomoniasis/diagnosis-treatment/drc-20378613

  Drinking alcohol during and for a few days after treatment can cause severe nausea and vomiting. Don’t drink alcohol for 24 hours after taking metronidazole, 48 hours after taking secnidazole or 72 hours after taking tinidazole. […] Your health care provider will typically retest you for trichomoniasis after treatment. A retest two weeks to three months after treatment can check to be sure the infection is gone and that you haven’t been reinfected. […] Even if you’ve had treatment that gets rid of trichomoniasis, it’s possible to get it again if you’re exposed to someone with the infection.

• #51 Trichomoniasis Treatment: Is it Reinfection or Resistant Infection?

  https://www.clinicaladvisor.com/features/trichomoniasis-management-is-it-reinfection-resistant-infection/

  Single-dose therapy is not always sufficient for curing T vaginalis infection. Treatment failure is 1.87 times more likely with a single-dose regimen of metronidazole compared with a multidose regimen, according to findings from a recent meta-analysis. The CDC and ACOG recommend a test of cure within 3 months for all patients. Testing with use of nucleic acid amplification can be performed as early as 2 weeks post-treatment.

• #52 Trichomoniasis Treatment & Management: Approach Considerations, Pharmacologic Therapy, Diet and Activity

  https://emedicine.medscape.com/article/230617-treatment

  Because of the high rate of coinfection with other sexually transmitted infections (STIs), the healthcare provider should consider empiric treatment of gonorrhea and chlamydia. […] Patients should also be offered counseling and testing for HIV. […] In clinical practice, repeat testing is rarely performed unless symptoms do not improve with drug treatment. […] However, the CDC recommends rescreening at 3 months posttherapy for sexually active women, as they have a high rate of reinfection. […] Currently, no data are available on rescreening men. […] Inpatient therapy is usually not required but may be indicated when resistance is present and intravenous (IV) therapy is indicated. […] For patients in whom treatment fails and in whom reinfection is ruled out, consultation with experts from the CDC may be advisable (770-488-4115).

• #53 Trichomoniasis – STI Treatment Guidelines

  https://www.cdc.gov/std/treatment-guidelines/trichomoniasis.htm

  Metronidazole gel does not reach therapeutic levels in the urethra and perivaginal glands. Because it is less efficacious than oral metronidazole, it is not recommended. […] Providers should advise persons with T. vaginalis infections to abstain from sex until they and their sex partners are treated (i.e., when therapy has been completed and any symptoms have resolved). […] Because of the high rate of reinfection among women treated for trichomoniasis, retesting for T. vaginalis is recommended for all sexually active women approximately 3 months after initial treatment regardless of whether they believe their sex partners were treated. […] Concurrent treatment of all sex partners is vital for preventing reinfections. Current partners should be referred for presumptive therapy. […] The nitroimidazoles are the only class of antimicrobials known to be effective against trichomonas infection. Metronidazole resistance occurs in 4%10% of cases of vaginal trichomoniasis.

• #54 Trichomoniasis Treatment: Is it Reinfection or Resistant Infection?

  https://www.clinicaladvisor.com/features/trichomoniasis-management-is-it-reinfection-resistant-infection/

  Although nitroimidazoles have been used as the standard therapy to treat trichomoniasis since the 1950s, rising rates of treatment failure due to resistant infection have prompted research into new therapies and new dosing regimens of standard therapies. The prevalence of resistant infection is estimated to be about 2% to 10%. Resistant cases often are difficult to differentiate from recurrent infection. […] Nitroimidazoles are the only class of antimicrobial medications known to be effective against trichomoniasis. Metronidazole and tinidazole are approved by the US Food and Drug Administration for oral and parenteral treatment of trichomoniasis. The CDC recommends a single oral dose of metronidazole or tinidazole 2 g. The cure rate for these single-dose regimens is 84% to 98% for metronidazole and 92% to 100% for tinidazole. An alternative first-line treatment recommended by the CDC is metronidazole 500 mg twice daily for 7 days. This 7-day regimen is recommended for patients coinfected with HIV.

• #55 Trichomoniasis – STI Treatment Guidelines

  https://www.cdc.gov/std/treatment-guidelines/trichomoniasis.htm

  If treatment failure occurs in a woman after completing a regimen of metronidazole 500 mg 2 times/day for 7 days and she has been reexposed to an untreated partner, a repeat course of the same regimen is recommended. […] For persons who are experiencing persistent infection not attributable to reexposure, clinicians should request a kit from CDC to perform drug-resistance testing. […] Treatment reduces symptoms and signs of T. vaginalis infection, cures infection, and might reduce transmission. Likelihood of adverse outcomes among women with HIV infection is also reduced with T. vaginalis therapy. Recommended Regimen for Trichomonas and HIV Infection Among Women: Metronidazole 500 mg orally 2 times/day for 7 days.

• #56 Trichomoniasis – STI Treatment Guidelines

  https://www.cdc.gov/std/treatment-guidelines/trichomoniasis.htm

  If treatment failure occurs in a woman after completing a regimen of metronidazole 500 mg 2 times/day for 7 days and she has been reexposed to an untreated partner, a repeat course of the same regimen is recommended. […] For persons who are experiencing persistent infection not attributable to reexposure, clinicians should request a kit from CDC to perform drug-resistance testing. […] Treatment reduces symptoms and signs of T. vaginalis infection, cures infection, and might reduce transmission. Likelihood of adverse outcomes among women with HIV infection is also reduced with T. vaginalis therapy. Recommended Regimen for Trichomonas and HIV Infection Among Women: Metronidazole 500 mg orally 2 times/day for 7 days.

• #57 Trichomoniasis Treatment & Management: Approach Considerations, Pharmacologic Therapy, Diet and Activity

  https://emedicine.medscape.com/article/230617-treatment

  The CDC has reported incidents of trichomoniasis resistant to metronidazole that were susceptible to tinidazole. […] When standard treatment regimens fail, a regimen of 2 g of oral metronidazole or tinidazole for 5 days may be considered. […] Inpatient intravenous (IV) therapy may be indicated when resistance is present. […] For patients in whom treatment fails and in whom reinfection is ruled out, consultation with experts from the CDC may be advisable (770-488-4115). […] Consultation with an infectious diseases specialist, a gynecologist, or both may be helpful. […] Patients allergic to this class of drug should be referred to an allergist for desensitization. […] Before the introduction of tinidazole and secnidazole, metronidazole was the treatment of choice for trichomoniasis.

• #58 Trichomoniasis Treatment & Management: Approach Considerations, Pharmacologic Therapy, Diet and Activity

  https://emedicine.medscape.com/article/230617-treatment

  The CDC has reported incidents of trichomoniasis resistant to metronidazole that were susceptible to tinidazole. […] When standard treatment regimens fail, a regimen of 2 g of oral metronidazole or tinidazole for 5 days may be considered. […] Inpatient intravenous (IV) therapy may be indicated when resistance is present. […] For patients in whom treatment fails and in whom reinfection is ruled out, consultation with experts from the CDC may be advisable (770-488-4115). […] Consultation with an infectious diseases specialist, a gynecologist, or both may be helpful. […] Patients allergic to this class of drug should be referred to an allergist for desensitization. […] Before the introduction of tinidazole and secnidazole, metronidazole was the treatment of choice for trichomoniasis.

• #59 Strategies for Prevention and Treatment of Trichomonas vaginalis Infections

  https://pmc.ncbi.nlm.nih.gov/articles/PMC5475227/

  Metronidazole is relatively cheap, effective, and generally well tolerated. […] Tinidazole is a nitroimidazole that was introduced in 1969 for the treatment of infections caused by T. vaginalis. […] Although the 5-nitroimidazole compounds are the most effective drugs for treating T. vaginalis infection, disulfiram and nithiamide might represent alternatives for treating patients with hypersensitivity to 5-nitroimidazole drugs. […] Vaginal administration of microbicide constitutes an alternative to prevent the acquisition of T. vaginalis infections. […] The major limitation related to vaginal administration of drugs for the treatment of trichomoniasis is the nonaccessibility of other infected organs. […] Nitroimidazoles for T. vaginalis treatment have been formulated for vaginal application.

• #60 Strategies for Prevention and Treatment of Trichomonas vaginalis Infections

  https://pmc.ncbi.nlm.nih.gov/articles/PMC5475227/

  Metronidazole is relatively cheap, effective, and generally well tolerated. […] Tinidazole is a nitroimidazole that was introduced in 1969 for the treatment of infections caused by T. vaginalis. […] Although the 5-nitroimidazole compounds are the most effective drugs for treating T. vaginalis infection, disulfiram and nithiamide might represent alternatives for treating patients with hypersensitivity to 5-nitroimidazole drugs. […] Vaginal administration of microbicide constitutes an alternative to prevent the acquisition of T. vaginalis infections. […] The major limitation related to vaginal administration of drugs for the treatment of trichomoniasis is the nonaccessibility of other infected organs. […] Nitroimidazoles for T. vaginalis treatment have been formulated for vaginal application.

• #61 Strategies for Prevention and Treatment of Trichomonas vaginalis Infections

  https://pmc.ncbi.nlm.nih.gov/articles/PMC5475227/

  Combination therapy of metronidazole with other drugs is a good alternative strategy to administration of metronidazole alone. […] Alternative treatments include intravaginal preparations of paromomycin cream. […] To sum up, topically applied treatments are generally limited to adjunctive therapy or particular cases of allergy or resistance. […] Efficacious vaginally applied formulations must have different properties, such as stability in acidic medium, adhesion, nonliquefaction at body temperature, slow dissolution, lubricant properties, and nongreasiness.

• #62 Strategies for Prevention and Treatment of Trichomonas vaginalis Infections

  https://pmc.ncbi.nlm.nih.gov/articles/PMC5475227/

  Combination therapy of metronidazole with other drugs is a good alternative strategy to administration of metronidazole alone. […] Alternative treatments include intravaginal preparations of paromomycin cream. […] To sum up, topically applied treatments are generally limited to adjunctive therapy or particular cases of allergy or resistance. […] Efficacious vaginally applied formulations must have different properties, such as stability in acidic medium, adhesion, nonliquefaction at body temperature, slow dissolution, lubricant properties, and nongreasiness.

• #63 Strategies for Prevention and Treatment of Trichomonas vaginalis Infections

  https://pmc.ncbi.nlm.nih.gov/articles/PMC5475227/

  Combination therapy of metronidazole with other drugs is a good alternative strategy to administration of metronidazole alone. […] Alternative treatments include intravaginal preparations of paromomycin cream. […] To sum up, topically applied treatments are generally limited to adjunctive therapy or particular cases of allergy or resistance. […] Efficacious vaginally applied formulations must have different properties, such as stability in acidic medium, adhesion, nonliquefaction at body temperature, slow dissolution, lubricant properties, and nongreasiness.

• #64 Trichomoniasis Treatment & Management: Approach Considerations, Pharmacologic Therapy, Diet and Activity

  https://emedicine.medscape.com/article/230617-treatment

  Topical medications are not recommended by the CDC, as they are unlikely to reach therapeutic levels. […] Topical metronidazole and other antimicrobials yield low cure rates (50%). […] Patients should not consume alcohol during the course of treatment and for several days afterwards, as nitroimidazoles can create a disulfiram-like intolerance reaction, continue abstaining from alcohol for 72 hours after metronidazole or tinidazole, and for 48 hours after secnidazole. […] Treating the patients sexual partners to prevent reinfection further improves the cure rate. […] Where legal, this may be easier to accomplish with expedited partner therapy. […] Despite the widespread use of nitroimidazoles in the treatment of trichomoniasis, resistance to these drugs is rare and is typically solved by increasing the dose or switching to another nitroimidazole.

• #65 Trichomoniasis Treatment & Management: Approach Considerations, Pharmacologic Therapy, Diet and Activity

  https://emedicine.medscape.com/article/230617-treatment

  Evaluation for trichomoniasis is typically conducted in the outpatient setting. […] After positive diagnosis, treatment should be instituted immediately and, whenever possible, in conjunction with all sexual partners. […] Expedited partner therapy is a safe and effective means of treating the sexual partners of patients diagnosed with trichomoniasis and should be practiced whenever possible. […] Both patient and partner should abstain from sex until pharmacological treatment has been completed and they have no symptoms. […] Patients undergoing pharmacotherapy should be advised to avoid alcohol consumption during the course of treatment and for an appropriate amount of time after the completion of their medication. […] Because trichomoniasis is an infection of multiple sites (eg. vaginal epithelium, Skene glands, Bartholin glands, and urethra), systemic treatment is needed.

• #66 Trichomoniasis – Diagnosis & treatment – Mayo Clinic

  https://www.mayoclinic.org/diseases-conditions/trichomoniasis/diagnosis-treatment/drc-20378613

  Drinking alcohol during and for a few days after treatment can cause severe nausea and vomiting. Don’t drink alcohol for 24 hours after taking metronidazole, 48 hours after taking secnidazole or 72 hours after taking tinidazole. […] Your health care provider will typically retest you for trichomoniasis after treatment. A retest two weeks to three months after treatment can check to be sure the infection is gone and that you haven’t been reinfected. […] Even if you’ve had treatment that gets rid of trichomoniasis, it’s possible to get it again if you’re exposed to someone with the infection.

• #67 Trichomoniasis – Diagnosis & treatment – Mayo Clinic

  https://www.mayoclinic.org/diseases-conditions/trichomoniasis/diagnosis-treatment/drc-20378613

  Drinking alcohol during and for a few days after treatment can cause severe nausea and vomiting. Don’t drink alcohol for 24 hours after taking metronidazole, 48 hours after taking secnidazole or 72 hours after taking tinidazole. […] Your health care provider will typically retest you for trichomoniasis after treatment. A retest two weeks to three months after treatment can check to be sure the infection is gone and that you haven’t been reinfected. […] Even if you’ve had treatment that gets rid of trichomoniasis, it’s possible to get it again if you’re exposed to someone with the infection.

• #68 Trichomoniasis Treatment & Management: Approach Considerations, Pharmacologic Therapy, Diet and Activity

  https://emedicine.medscape.com/article/230617-treatment

  Topical medications are not recommended by the CDC, as they are unlikely to reach therapeutic levels. […] Topical metronidazole and other antimicrobials yield low cure rates (50%). […] Patients should not consume alcohol during the course of treatment and for several days afterwards, as nitroimidazoles can create a disulfiram-like intolerance reaction, continue abstaining from alcohol for 72 hours after metronidazole or tinidazole, and for 48 hours after secnidazole. […] Treating the patients sexual partners to prevent reinfection further improves the cure rate. […] Where legal, this may be easier to accomplish with expedited partner therapy. […] Despite the widespread use of nitroimidazoles in the treatment of trichomoniasis, resistance to these drugs is rare and is typically solved by increasing the dose or switching to another nitroimidazole.

• #69 Trichomoniasis Treatment & Management: Approach Considerations, Pharmacologic Therapy, Diet and Activity

  https://emedicine.medscape.com/article/230617-treatment

  Because of the high rate of coinfection with other sexually transmitted infections (STIs), the healthcare provider should consider empiric treatment of gonorrhea and chlamydia. […] Patients should also be offered counseling and testing for HIV. […] In clinical practice, repeat testing is rarely performed unless symptoms do not improve with drug treatment. […] However, the CDC recommends rescreening at 3 months posttherapy for sexually active women, as they have a high rate of reinfection. […] Currently, no data are available on rescreening men. […] Inpatient therapy is usually not required but may be indicated when resistance is present and intravenous (IV) therapy is indicated. […] For patients in whom treatment fails and in whom reinfection is ruled out, consultation with experts from the CDC may be advisable (770-488-4115).

• #70 Trichomoniasis – STI Treatment Guidelines

  https://www.cdc.gov/std/treatment-guidelines/trichomoniasis.htm

  If treatment failure occurs in a woman after completing a regimen of metronidazole 500 mg 2 times/day for 7 days and she has been reexposed to an untreated partner, a repeat course of the same regimen is recommended. […] For persons who are experiencing persistent infection not attributable to reexposure, clinicians should request a kit from CDC to perform drug-resistance testing. […] Treatment reduces symptoms and signs of T. vaginalis infection, cures infection, and might reduce transmission. Likelihood of adverse outcomes among women with HIV infection is also reduced with T. vaginalis therapy. Recommended Regimen for Trichomonas and HIV Infection Among Women: Metronidazole 500 mg orally 2 times/day for 7 days.

• #71 Trichomoniasis | Healthify

  https://healthify.nz/health-a-z/t/trichomoniasis/

  Trichomoniasis is easy to treat with antibiotics. […] If you have trichomoniasis, it’s easy to treat with antibiotics and you need to tell anyone you’ve had sex with in the past 3 months to get tested and treated too. […] Trichomoniasis can be easily treated with an antibiotic such as metronidazole or ornidazole. You can take it as a single dose or as a 1-week course. Your healthcare provider will advise on what’s best for you. […] So you don’t pass the infection on, avoid sex for 7 days after you and your partner(s) have finished your antibiotic treatment, or use condoms if this isn’t possible. […] It’s common to get infected with trichomonas again. To reduce the chance of re-infection: make sure all your sexual partners get treated too even if they don’t have symptoms. […] Trichomoniasis is unlikely to go away without treatment. […] It can increase your risk of getting or spreading other STIs, such as HIV. Trichomoniasis can cause genital inflammation, which makes it easier to get infected with the HIV virus, or to pass the HIV virus on to a sex partner. […] Both males and females are at increased risk of infertility.

• #72 Trichomoniasis Treatment & Management: Approach Considerations, Pharmacologic Therapy, Diet and Activity

  https://emedicine.medscape.com/article/230617-treatment

  Treatment of pregnant women with tinidazole has not been well-studied, however animal studies suggest that the drug poses moderate risks. […] Use of tinidazole is not recommended in pregnant women. […] 5-Nitroimidazole drugs are the only widely used pharmacological treatment for trichomoniasis. […] In the United States, several of these drugs, metronidazole, tinidazole, and secnidazole are approved by the FDA for trichomoniasis. […] The CDC recommends the following drug schedules in the treatment of trichomoniasis: A single 2-g dose of metronidazole, tinidazole, or secnidazole; A schedule of 500 mg of metronidazole, taken twice daily for 7 days. […] Each drug schedule has advantages and disadvantages, but, ultimately, they yield similar cure rates. […] In a 2003 Cochrane review, metronidazole and tinidazole had comparable efficacy in treating trichomoniasis.

• #73 Trichomoniasis Treatment & Management: Approach Considerations, Pharmacologic Therapy, Diet and Activity

  https://emedicine.medscape.com/article/230617-treatment

  Randomized clinical trials comparing single 2-g doses have also shown metronidazole and tinidazole to be equally effective. […] With recommended dosages, the expected cure rate of trichomoniasis is 95%. […] Tinidazole is generally more expensive than metronidazole but also seems to persist in serum longer. […] Some research suggests that tinidazole has fewer side effects than metronidazole, but not all studies have found this result. […] The advantages of single-dose therapy with metronidazole or tinidazole over the week-long metronidazole schedule include better patient compliance and a lower total dose. […] The week-long metronidazole schedule may be more effective in treating trichomoniasis in HIV-infected women. […] Because trichomoniasis is an infection of multiple sites, systemic (oral) treatment is needed.

• #74 Trichomoniasis Treatment & Management: Approach Considerations, Pharmacologic Therapy, Diet and Activity

  https://emedicine.medscape.com/article/230617-treatment

  Randomized clinical trials comparing single 2-g doses have also shown metronidazole and tinidazole to be equally effective. […] With recommended dosages, the expected cure rate of trichomoniasis is 95%. […] Tinidazole is generally more expensive than metronidazole but also seems to persist in serum longer. […] Some research suggests that tinidazole has fewer side effects than metronidazole, but not all studies have found this result. […] The advantages of single-dose therapy with metronidazole or tinidazole over the week-long metronidazole schedule include better patient compliance and a lower total dose. […] The week-long metronidazole schedule may be more effective in treating trichomoniasis in HIV-infected women. […] Because trichomoniasis is an infection of multiple sites, systemic (oral) treatment is needed.

• #75 Trichomoniasis Treatment & Management: Approach Considerations, Pharmacologic Therapy, Diet and Activity

  https://emedicine.medscape.com/article/230617-treatment

  Randomized clinical trials comparing single 2-g doses have also shown metronidazole and tinidazole to be equally effective. […] With recommended dosages, the expected cure rate of trichomoniasis is 95%. […] Tinidazole is generally more expensive than metronidazole but also seems to persist in serum longer. […] Some research suggests that tinidazole has fewer side effects than metronidazole, but not all studies have found this result. […] The advantages of single-dose therapy with metronidazole or tinidazole over the week-long metronidazole schedule include better patient compliance and a lower total dose. […] The week-long metronidazole schedule may be more effective in treating trichomoniasis in HIV-infected women. […] Because trichomoniasis is an infection of multiple sites, systemic (oral) treatment is needed.

• #76

  https://www.nhs.uk/conditions/trichomoniasis/treatment/

  Trichomoniasis is unlikely to go away without treatment. The infection may cure itself in rare cases, but you risk passing the infection on to someone else if you are not treated. […] Trichomoniasis is usually treated quickly and easily with antibiotics. […] Most people are prescribed an antibiotic called metronidazole, which is very effective if taken correctly. You’ll usually have to take metronidazole twice a day, for 5 to 7 days. […] Sometimes this antibiotic can be prescribed in a single, larger dose. However, this may have a higher risk of side effects and it’s not recommended for pregnant or breastfeeding women as a precaution. […] A specialist can recommend alternative treatments if metronidazole is unsuitable for you (for example, if you’re allergic to it). […] If you take your antibiotics correctly, you will not normally need any follow-up tests or examinations for trichomoniasis.

• #77 Trichomoniasis: Causes, Symptoms, Testing & Treatment

  https://my.clevelandclinic.org/health/diseases/4696-trichomoniasis

  Trichomoniasis is a common, but curable, sexually transmitted infection (STI). Treatment for trich involves taking antibiotics. […] Healthcare providers treat trichomoniasis with antibiotic medication to kill the parasite causing the infection. Without treatment, trich can last for months or even years. It won’t go away on its own. The entire time you’re infected, you can give the infection to your sexual partners. It’s important that all sex partners are treated to prevent re-infection. […] Oral antibiotic medications kill trich. Your healthcare provider may prescribe metronidazole or tinidazole. […] Yes, trich is curable. A healthcare provider treats trich infection with medication you take by mouth (swallow). […] No, trich doesn’t go away on its own. You need an antibiotic to treat the infection.

• #78

  https://www.nhs.uk/conditions/trichomoniasis/treatment/

  Trichomoniasis is unlikely to go away without treatment. The infection may cure itself in rare cases, but you risk passing the infection on to someone else if you are not treated. […] Trichomoniasis is usually treated quickly and easily with antibiotics. […] Most people are prescribed an antibiotic called metronidazole, which is very effective if taken correctly. You’ll usually have to take metronidazole twice a day, for 5 to 7 days. […] Sometimes this antibiotic can be prescribed in a single, larger dose. However, this may have a higher risk of side effects and it’s not recommended for pregnant or breastfeeding women as a precaution. […] A specialist can recommend alternative treatments if metronidazole is unsuitable for you (for example, if you’re allergic to it). […] If you take your antibiotics correctly, you will not normally need any follow-up tests or examinations for trichomoniasis.

• #79 Trichomoniasis Treatment & Management: Approach Considerations, Pharmacologic Therapy, Diet and Activity

  https://emedicine.medscape.com/article/230617-treatment

  Because of the high rate of coinfection with other sexually transmitted infections (STIs), the healthcare provider should consider empiric treatment of gonorrhea and chlamydia. […] Patients should also be offered counseling and testing for HIV. […] In clinical practice, repeat testing is rarely performed unless symptoms do not improve with drug treatment. […] However, the CDC recommends rescreening at 3 months posttherapy for sexually active women, as they have a high rate of reinfection. […] Currently, no data are available on rescreening men. […] Inpatient therapy is usually not required but may be indicated when resistance is present and intravenous (IV) therapy is indicated. […] For patients in whom treatment fails and in whom reinfection is ruled out, consultation with experts from the CDC may be advisable (770-488-4115).

• #80 About Trichomoniasis | Trichomoniasis | CDC

  https://www.cdc.gov/trichomoniasis/about/index.html

  Trich is the most common curable STI. A healthcare provider can treat the infection with medication (pills) taken by mouth. This treatment is also safe for pregnant women. […] If you receive and complete treatment for trich, you can still get it again. Reinfection occurs in about 1 in 5 people within 3 months after receiving treatment. This can happen if you have sex without a condom with a person who has trich. To avoid reinfection, your sex partners should receive treatment at the same time. […] You should not have sex again until you and your sex partner(s) complete treatment. You should receive testing again about three months after your treatment, even if your sex partner(s) received treatment.

• #81 About Trichomoniasis | Trichomoniasis | CDC

  https://www.cdc.gov/trichomoniasis/about/index.html

  Trich is the most common curable STI. A healthcare provider can treat the infection with medication (pills) taken by mouth. This treatment is also safe for pregnant women. […] If you receive and complete treatment for trich, you can still get it again. Reinfection occurs in about 1 in 5 people within 3 months after receiving treatment. This can happen if you have sex without a condom with a person who has trich. To avoid reinfection, your sex partners should receive treatment at the same time. […] You should not have sex again until you and your sex partner(s) complete treatment. You should receive testing again about three months after your treatment, even if your sex partner(s) received treatment.

• #82 Trichomoniasis Treatment & Management: Approach Considerations, Pharmacologic Therapy, Diet and Activity

  https://emedicine.medscape.com/article/230617-treatment

  Randomized clinical trials comparing single 2-g doses have also shown metronidazole and tinidazole to be equally effective. […] With recommended dosages, the expected cure rate of trichomoniasis is 95%. […] Tinidazole is generally more expensive than metronidazole but also seems to persist in serum longer. […] Some research suggests that tinidazole has fewer side effects than metronidazole, but not all studies have found this result. […] The advantages of single-dose therapy with metronidazole or tinidazole over the week-long metronidazole schedule include better patient compliance and a lower total dose. […] The week-long metronidazole schedule may be more effective in treating trichomoniasis in HIV-infected women. […] Because trichomoniasis is an infection of multiple sites, systemic (oral) treatment is needed.

• #83

  https://www.who.int/news-room/fact-sheets/detail/trichomoniasis

  Trichomoniasis is treatable and curable. […] It is best treated with the antibiotics metronidazole or tinidazole. Although resistance is uncommon, treatment failure occurs in a small proportion of cases. Several second-line regimens are available and should be initiated by the healthcare professionals. […] Recommendations for the treatment of Trichomonas vaginalis, Mycoplasma genitalium, Candida albicans, bacterial vaginosis and human papillomavirus (anogenital warts) […] In 2024, WHO published Recommendations for the treatment of Trichomonas vaginalis, Mycoplasma genitalium, Candida albicans, bacterial vaginosis and human papillomavirus (anogenital warts) to provide evidence-informed clinical and practical recommendations on case management of Trichomonas vaginalis.

• #84 Updates in Trichomonas Treatment including Persistent Infection and 5-Nitroimidazole Hypersensitivity

  https://pmc.ncbi.nlm.nih.gov/articles/PMC7371247/

  The purpose of this review is to update information on treatment of T. vaginalis. […] The efficacy of the recommended 2 gram oral single-dose metronidazole (MTZ) for the treatment of T. vaginalis in women has recently been challenged. […] 7 day 500 mg twice daily MTZ should be used as the first line treatment for T. vaginalis infected women. […] This finding remained robust in multiple sensitivity analyses. […] Taken together, these data strongly suggest that multi-dose MTZ should be the recommended T. vaginalis treatment regimen in all women moving forward, particularly those with a history of T. vaginalis infection and/or are symptomatic. […] If re-infection has been excluded, persistent trichomoniasis has been treated successfully with longer courses or higher doses of the same medications used in standard therapy.

• #85 Updates in Trichomonas Treatment including Persistent Infection and 5-Nitroimidazole Hypersensitivity

  https://pmc.ncbi.nlm.nih.gov/articles/PMC7371247/

  Single-dose 2 gram MTZ or TDZ should be avoided in this circumstance. […] Women with trichomoniasis who report a previous serious adverse reaction to 5-nitroimidazoles present a difficult therapeutic conundrum. […] MTZ desensitization per a validated protocol with the assistance of an allergy specialist is recommended in these situations. […] While 5-nitroimidazoles are the only antimicrobial class known to be effective against T. vaginalis, there is anecdotal evidence for alternative regimens. […] CDC and WHO are likely to adopt the 7-day 500 mg twice daily treatment as standard of care for women. […] 7-day 500 mg oral MTZ is superior to 2 gram single-dose and should be the preferred treatment.

• #86 Trichomoniasis Treatment & Management: Approach Considerations, Pharmacologic Therapy, Diet and Activity

  https://emedicine.medscape.com/article/230617-treatment

  The CDC has reported incidents of trichomoniasis resistant to metronidazole that were susceptible to tinidazole. […] When standard treatment regimens fail, a regimen of 2 g of oral metronidazole or tinidazole for 5 days may be considered. […] Inpatient intravenous (IV) therapy may be indicated when resistance is present. […] For patients in whom treatment fails and in whom reinfection is ruled out, consultation with experts from the CDC may be advisable (770-488-4115). […] Consultation with an infectious diseases specialist, a gynecologist, or both may be helpful. […] Patients allergic to this class of drug should be referred to an allergist for desensitization. […] Before the introduction of tinidazole and secnidazole, metronidazole was the treatment of choice for trichomoniasis.

• #87 A New Treatment Option for Trichomoniasis: Single-Dose Secnidazole

  https://www.contemporaryobgyn.net/view/a-new-treatment-option-for-trichomoniasis-single-dose-secnidazole

  Secnidazole demonstrated an efficacy of 92.2% in a similarly designed trial and is newly approved for the treatment of trichomoniasis in adults while also covering BV simultaneously. […] Thus, data show single-dose SEC to be an effective option for treatment of trichomoniasis in women. SEC is currently the only single-dose treatment available for both BV and trichomoniasis. […] Accurate diagnostic testing and appropriate screening are needed for successful treatment of trichomoniasis. Treatment of trichomoniasis is recommended to relieve symptoms and reduce a patient’s risk of transmission and acquisition of HIV, other STIs, and adverse reproductive outcomes. […] Now FDA-approved, oral 2-g SEC offers a new single-dose option for treating both BV and trichomoniasis, which is likely to improve patient adherence, especially in populations at risk for medication nonadherence.

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