Trichomoniasis treatment in women: a systematic review

Abstract

SummaryOBJECTIVE To compare the effectiveness of various treatment strategies for trichomoniasis in women. DATA SOURCES Medline from 1966 to1996, Embase from 1986 to 1996, Science Citation Index from 1990 to 1996; reference lists of existing reviews; through the manufacturers of metronidazole and tinidazole in the UK, the Cochrane Controlled Trials Register until October 1997 and informal discovery. STUDY SELECTION Any randomized or quasi-randomized trial in nonpregnant women with trichomoniasis where different treatment strategies were compared. 45 of the 124 identified studies met the criteria and were included in the review. DATA EXTRACTION Settings, diagnostic methods, exclusions, loss to follow-up and partner treatment strategies were extracted. Outcomes sought were parasitological cure, clinical cure and side-effects of treatment. RESULTS Most trials were small, with only two trials containing more than 100 women in each comparison group. Only 11 trials followed up women for more than one month. Oral nitroimidazoles were effective in achieving parasitological cure. Fourteen trials compared different treatment strategies with the remainder comparing different doses or different drugs. Partner treatment was effective in decreasing longer-term reinfection rates in the one trial testing this. CONCLUSIONS Parasitological cure can be achieved by a single oral dose of nitroimidazoles. There is, however, very little data on partner treatment strategies and long-term cure rates after initial treatment. Further research should test various partner treatment strategies to prevent re-infections and reduce trichomoniasis prevalence.keywords Trichomonas vaginalis, nitroimidazoles, systematic review

In Vitro Metronidazole and Tinidazole Activities against Metronidazole- Resistant Strains of Trichomonas vaginalis

“…Tinidazole, another nitroimidazole, has emerged as an effective antitrichomonas medication in other countries (6). It has also been shown to be effective in clinical trials conducted in the United States (20), though it is not yet Food and Drug Administration approved.…”

“…Differences in the pharmacokinetics of the two drugs may also play a significant role in their relative in vivo efficacies. In addition, tinidazole appears to have less severe side effects than those of metronidazole (6). Thus, broader testing of tinidazole as an The MLC was determined for each drug as described in the text.…”

The syndromic management of vaginal discharge using only single-dose treatments: a randomized controlled trial in West Africa

“…Given its longer halfmlife (12-14 hours versus 6-7 hours for metronidazole), 24 tinidazole would be expected to be more effective as a singlemdose therapy. It is better tolerated than metronidazole 25,26 and very cheap (wholesale price per 2 g dose ≈ US$ 0.07). Studies of singlemdose tinidazole in women with BV have shown a wide range of effectiveness (51-97%) [27][28][29][30] but used different definitions of BV and cure.…”

“…31 To treat T. vaginalis infections, WHO and others recommend as first choice, singlemdose metronidazole (2 g), 2,22,23 which has an effectiveness comparable to that of a 5-7 day course of the same drug. 25,26 Tinidazole was compared to metronidazole in early randomized trials; 32,33 a metamanalysis of these sugm m gested that singlemdose tinidazole was superior to singlemdose metronidazole. 25 We showed that singlemdose tinidazole was as effective against TV as 7 days of metronidazole.…”

Sexually Transmitted Diseases of the Vulva

“…Tinidazole 2 g orally as a single dose may also be used. Metronidazole and tinidazole have a cure rate of approximately 95% (Gülmezoglu & Garner 1998). Spontaneous cure occurs in 20-25% (Sherrard 2007).…”