A Randomized Treatment Trial: Single Versus 7-Day Dose of Metronidazole for The Treatment of Trichomonas Vaginalis Among HIV-Infected Women

Abstract

Objective To determine if the metronidazole (MTZ) 2 gm single dose (recommended) is as effective as the 7 day 500 mg BID dose (alternative) for treatment of Trichomonas vaginalis (TV) among HIV+ women. Methods Phase IV randomized clinical trial; HIV+ women with culture confirmed TV were randomized to treatment arm: MTZ 2 gm single dose or MTZ 500 mg BID 7 day dose. All women were given 2 gm MTZ doses to deliver to their sex partners. Women were re-cultured for TV at a test-of-cure (TOC) visit occurring 6-12 days after treatment completion. TV-negative women at TOC were again re-cultured at a 3 month visit. Repeat TV infection rates were compared between arms. Results 270 HIV+/TV+ women were enrolled (mean age = 40 years, ± 9.4; 92.2% African-American). Treatment arms were similar with respect to age, race, CD4 count, viral load, ART status, site, and loss-to-follow up. Women in the 7 day arm had: lower repeat TV infection rates at TOC [8.5% (11/130) versus 16.8% (21/125) (R.R. 0.50, 95% CI=0.25, 1.00; P<0.05)], and at 3 months [11.0% (8/73) versus 24.1% (19/79) (R.R. 0.46, 95% CI=0.21, 0.98; P=0.03)] compared to the single dose arm. Conclusions The 7 day MTZ dose was more effective than the single dose for the treatment of TV among HIV+ women.

Co-occurrence of Trichomonas vaginalis and Bacterial Vaginosis and Vaginal Shedding of HIV-1 RNA

“…17 The second cohort, cohort B, consisted of 125 HIV-positive, TV-positive women recruited from HIV outpatient clinics in Houston, TX; Jackson, MS; and New Orleans, LA; between May 2006 and July 2009 to participate in a randomized treatment trial that sought to determine whether a 2-g single dose of metronidazole (MTZ) was as effective as a 7-day 500-mg twice-a-day dose for treatment of TV in HIV-positive women. 35 To be eligible for either study, women were required to provide consent, be HIV positive, be 18 years or older, and have their positive test result for TV confirmed by InPouch culture technique (InPouch; Biomed Diagnostics, White City, OR). 35 Exclusion criteria for both cohorts were as follows: pregnancy, incarceration, alcoholism, taking disulfiram, having received MTZ within the previous 14 days (to avoid persistent TV), or having a medical contraindications to MTZ.…”

Vaginal discharge: evaluation of syndromic management in Chhattisgarh Institute of Medical Sciences, Bilaspur, C.G.

“…10 Kissinger et al studied effect of single versus 7 days dose of metronidazole for treatment of Trichomonas vaginalis among 270 HIV positive patients. 11 They found 7 days treatment is more effective in HIV positive patients.…”

Genital Infections of HIV-Infected Women Assisted by a Specialized Service

“…Hence, treatment failure may be an important cause of recurrence. Although several studies indicate a single dose of oral metronidazole as the �rst alternative for treatment, Kissinger et al [58], in a randomized clinical study on HIV-infected women, showed that oral metronidazole for seven days was more effective in eradicating T. vaginalis.…”