5.5.3 Trichomonas vaginalis
All patients with T. vaginalis should be treated.
Metronidazole is the only treatment available for T.
vaginalis in the USA. The recommended treatment achieves a 95% cure rate.
Sexual partners should always be treated. Resistance is rare and
can usually be overwhelmed by using higher doses. (Metronidazole
gel is ineffective for T. vaginalis and should not be used).
2 g orally in a single dose
||500 mg twice a day for 7 days.
Treatment failures- Treatment
should be repeated with the 7 day regimen. If treatment fails again,
patient should be given a 2
gram daily dose for 3-5 days. Patients not responding to the high-dose
multiday regimen should have a subspecialist evaluation including
determination of the susceptibility of the T. vaginalis to
a special hotline for clinical consultation (770-488-4115). Increasing
dose and duration of metronidazole or IV administration
may be of use. Published regimens are available. Options in the
setting of metronidazole allergy include the use of an alternative
drug (paromomycin) or desensitization.
Prior to the approval of tinidazole
in the US, the Food and Drug Administration has requested that
Presutti Laboratories make Tinidazole available to physicians
for treating metronidazole resistant trichomoniasis. Tinidazole
is available for metronidazole resistant TV through a compassionate
use protocol which was developed by the CDC, IDSOG and Presutti
For more information, call the CDC at
(770) 488-4115 or Dawn Flynn (of Presutti laboratories) at (847)
Pregnancy: no evidence of teratogenicity.
Treatment may be administrated during the first trimester of pregnancy.