Trichomoniasis Medication

  • Author: Darvin Scott Smith, MD, MSc, DTM&H; Chief Editor: Burke A Cunha, MD   more...
 
Updated: Jan 5, 2010
 

Medication Summary

The 5-nitroimidazole group of drugs includes antiprotozoal agents (metronidazole, tinidazole, nimorazole, carnidazole) used for the treatment of trichomoniasis. In the Cochrane treatment review, metronidazole and other nitroimidazole group drugs were found to have comparable efficacy in treating trichomoniasis.[1] The mechanism of action is not well understood; however, anaerobic organisms preferentially reduce the 5-nitro group, and active metabolites likely interact with anaerobic bacterial and protozoal DNA.

Resistance to these drugs is rare despite their widespread use in the treatment of trichomoniasis and is typically solved by increasing the dose or switching to another nitroimidazole.[1] When standard treatment regimens fail, metronidazole or tinidazole at 2 g PO for 5 days should be considered.[2]

Drugs may also be applied locally in the vagina or rectum, although oral treatment is usually preferred. Local intravaginal medications include clotrimazole, povidone-iodine, and nonoxynol-9 (N-9). Metronidazole may also be applied vaginally or rectally to reach therapeutic concentrations in the blood. Topical drugs other than nitroimidazoles yield low cure rates (< 50%).

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Antiprotozoal agents

Class Summary

Therapy must be comprehensive and should cover all likely pathogens in the context of this clinical setting.

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Metronidazole (Flagyl)

 

This medication is available PO, IV, and as intravaginal suppository gel. Highly effective in the treatment of many anaerobic bacterial and protozoal infections. Cure rates for trichomoniasis have been reported at 90-95% by the CDC.

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Tinidazole (Tindamax)

 

Nitroimidazole antiprotozoal agent. Nitro group is reduced by cell extract of Trichomonas. The free nitro radical generated is thought to be responsible for antiprotozoal activity against T vaginalis. Indicated to treat trichomoniasis caused by T vaginalis in both males and females. Cure rates for trichomoniasis have been reported at 86-100% by the CDC.

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Contributor Information and Disclosures
Author

Darvin Scott Smith, MD, MSc, DTM&H,  Adjunct Assistant Professor, Department of Microbiology and Immunology, Stanford University; Chief of Infectious Diseases and Geographic Medicine, Department of Internal Medicine, Kaiser Redwood City Hospital

Darvin Scott Smith, MD, MSc, DTM&H, is a member of the following medical societies: American Medical Association, American Society of Tropical Medicine and Hygiene, Infectious Diseases Society of America, and International Society of Travel Medicine

Disclosure: Nothing to disclose.

Coauthor(s)

Natalia Ramos  Stanford University, Keck School of Medicine of the University of Southern California

Natalia Ramos, is a member of the following medical societies: American Medical Student Association/Foundation and American Medical Women's Association

Disclosure: Nothing to disclose.

Specialty Editor Board

Jeffrey M Zaks, MD  Clinical Associate Professor of Medicine, Wayne State University School of Medicine; Vice President, Medical Affairs, Chief Medical Officer, Department of Internal Medicine, Providence Hospital

Jeffrey M Zaks, MD is a member of the following medical societies: American College of Cardiology, American College of Healthcare Executives, American College of Physician Executives, and American Medical Association

Disclosure: Nothing to disclose.

Francisco Talavera, PharmD, PhD  Senior Pharmacy Editor, eMedicine

Disclosure: eMedicine Salary Employment

John L Brusch, MD, FACP  Assistant Professor of Medicine, Harvard Medical School; Consulting Staff, Department of Medicine and Infectious Disease Service, Cambridge Health Alliance

John L Brusch, MD, FACP is a member of the following medical societies: American College of Physicians and Infectious Diseases Society of America

Disclosure: Nothing to disclose.

Eleftherios Mylonakis, MD  Clinical and Research Fellow, Department of Internal Medicine, Division of Infectious Diseases, Massachusetts General Hospital

Eleftherios Mylonakis, MD is a member of the following medical societies: American Association for the Advancement of Science, American College of Physicians, American Society for Microbiology, and Infectious Diseases Society of America

Disclosure: Nothing to disclose.

Chief Editor

Burke A Cunha, MD  Professor of Medicine, State University of New York School of Medicine at Stony Brook; Chief, Infectious Disease Division, Winthrop-University Hospital

Burke A Cunha, MD is a member of the following medical societies: American College of Chest Physicians, American College of Physicians, and Infectious Diseases Society of America

Disclosure: Nothing to disclose.

References

  1. Forna F, Gülmezoglu AM. Interventions for treating trichomoniasis in women. Cochrane Database Syst Rev. 2003;CD000218. [Medline].

  2. [Guideline] Centers for Disease Control and Prevention (CDC), Workowski KA, Berman SM. Sexually transmitted diseases treatment guidelines, 2006. MMWR Recomm Rep. Aug 4 2006;55:1-94. [Medline].

  3. Soper D. Trichomoniasis: under control or undercontrolled?. Am J Obstet Gynecol. Jan 2004;190(1):281-90. [Medline].

  4. Gerbase AC, Rowley JT, Mertens TE. Global epidemiology of sexually transmitted diseases. Lancet. 1998;351 Suppl 3:2-4. [Medline].

  5. Sobel JD. What's new in bacterial vaginosis and trichomoniasis?. Infect Dis Clin North Am. Jun 2005;19(2):387-406. [Medline].

  6. Miller M, Liao Y, Gomez AM, Gaydos CA, D'Mellow D. Factors associated with the prevalence and incidence of Trichomonas vaginalis infection among African American women in New York city who use drugs. J Infect Dis. Feb 15 2008;197(4):503-9. [Medline].

  7. Patel SR, Wiese W, Patel SC, Ohl C, Byrd JC, Estrada CA. Systematic review of diagnostic tests for vaginal trichomoniasis. Infect Dis Obstet Gynecol. 2000;8(5-6):248-57. [Medline].

  8. Huppert JS. Trichomoniasis in teens: an update. Curr Opin Obstet Gynecol. Oct 2009;21(5):371-8. [Medline].

  9. Laga M, Manoka A, Kivuvu M, et al. Non-ulcerative sexually transmitted diseases as risk factors for HIV-1 transmission in women: results from a cohort study. AIDS. Jan 1993;7(1):95-102. [Medline].

  10. Moodley P, Wilkinson D, Connolly C, et al. Trichomonas vaginalis is associated with pelvic inflammatory disease in women infected with human immunodeficiency virus. Clin Infect Dis. Feb 15 2002;34(4):519-22. [Medline].

  11. Grodstein F, Goldman MB, Ryan L, et al. Relation of female infertility to consumption of caffeinated beverages. Am J Epidemiol. Jun 15 1993;137(12):1353-60. [Medline].

  12. Shafir SC, Sorvillo FJ, Smith L. Current issues and considerations regarding trichomoniasis and human immunodeficiency virus in African-Americans. Clin Microbiol Rev. Jan 2009;22(1):37-45, Table of Contents. [Medline].

  13. Mann JR, McDermott S, Zhou L, Barnes TL, Hardin J. Treatment of trichomoniasis in pregnancy and preterm birth: an observational study. J Womens Health (Larchmt). Apr 2009;18(4):493-7. [Medline].

  14. [Guideline] ACOG Practice Bulletin. Clinical management guidelines for obstetrician-gynecologists, Number 72, May 2006: Vaginitis. Obstet Gynecol. May 2006;107(5):1195-1206. [Medline].

  15. Burtin P, Taddio A, Ariburnu O, et al. Safety of metronidazole in pregnancy: a meta-analysis. Am J Obstet Gynecol. Feb 1995;172(2 Pt 1):525-9. [Medline].

  16. Guenthner PC, Secor WE, Dezzutti CS. Trichomonas vaginalis-induced epithelial monolayer disruption and human immunodeficiency virus type 1 (HIV-1) replication: implications for the sexual transmission of HIV-1. Infect Immun. Jul 2005;73(7):4155-60. [Medline]. [Full Text].

  17. Nanda N, Michel RG, Kurdgelashvili G, et al. Trichomoniasis and its treatment. Expert Rev Anti Infect Ther. Feb 2006;4(1):125-35. [Medline].

  18. Radonjic IV, Dzamic AM, Mitrovic SM, Arsic Arsenijevic VS, Popadic DM, Kranjcic Zec IF. Diagnosis of Trichomonas vaginalis infection: The sensitivities and specificities of microscopy, culture and PCR assay. Eur J Obstet Gynecol Reprod Biol. May 1 2006;126(1):116-20. [Medline].

 
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Trichomonas vaginalis on a saline wet mount at 40X on the microscope. Several motile parasites transit through the field, surrounded by white blood cells and squamous epithelial cells.
 
 
 
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