Trichomoniasis: 7-day course tops single-dose metronidazole in women

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Takeaway

  • 7-day metronidazole is superior to single-dose metronidazole for treatment of Trichomonas vaginalis (T vaginalis) infection in women, regardless of bacterial vaginosis (BV) status.
  • Findings match recent shift in treatment duration for other sexually transmitted infections.

Why this matters

  • Consider metronidazole 500 mg twice daily for 7 days in women, thereby also providing first-line coverage for concomitant BV.

Key results

  • 623 women randomly assigned to 7-day (n=312) or single-dose (n=311) group.
  • 77% (n=239), 76% (n=237) of women in 7-day, single-dose groups, respectively, were screened for T vaginalis by nucleic acid amplification test and culture.
  • 11% (n=34) vs 19% (n=58) of women randomly assigned to 7-day, single-dose groups, respectively, were positive at test of cure (TOC) (relative risk [RR], 0.55; 95% CI, 0.34-0.70; P=.0008).
    • Women randomly assigned to 7-day treatment were less likely to have a positive result at TOC, even in the presence of BV (RR, 0.59; 95% CI, 0.43-0.80; P=.0002).
  • Treatment adherence was lower in 7-day vs single-dose group (96% [n=253] vs 99% [n=264], respectively; P=.006).

Study design

  • Open-label, randomized, controlled trial comparing efficacy of 7-day vs single-dose metronidazole for treatment of trichomoniasis in HIV-negative women.
  • Funding: NIH.

Limitations

  • Open-label.
  • Reduced power due to sample size.
  • Self-report adherence bias.
  • Nongeneralizable.