The Minimum Single Oral Metronidazole Dose for Treating Trichomoniasis: A Randomized, Blinded Study

Spence, Michael R.; Harwell, Todd S.; Davies, Mary C.; Smith, Joan L.

doi:10.1016/s0029-7844(97)81437-8

Cited by 36 publications

(16 citation statements)

References 16 publications

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“…In order to compare the efficacy of different regimens of MTZ and TNZ some studies were already conducted. MTZ in two different single doses (1.5 or 2.0 g) demonstrated equivalent efficacy for trichomoniasis treatment 154. The multidose regimen (500 mg twice a day for 7 days) was more effective than the single dose (2 g orally) for the treatment of trichomoniasis among co-infected HIV- T. vaginalis subjects 155.…”

Section: Treating Trichomoniasis: Are We Succeeding?mentioning

confidence: 95%

Trichomoniasis – are we giving the deserved attention to the most common non-viral sexually transmitted disease worldwide?

Menezes

Frasson

Tasca

2016

MIC

119

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Etiology: Trichomonas vaginalis is the etiologic agent of trichomoniasis, the most common non-viral sexually transmitted disease (STD) in the world. Transmission: Trichomoniasis is transmitted by sexual intercourse and transmission via fomites is rare. Epidemiology, incidence and prevalence: The WHO estimates an incidence of 276 million new cases each year and prevalence of 187 million of infected individuals. However, the infection is not notifiable. Pathology/Symptomatology: The T. vaginalis infection results in a variety of clinical manifestations - in most cases the patients are asymptomatic, but some may develop signs typically associated to the disease. Importantly, the main issue concerning trichomoniasis is its relationship with serious health consequences such as cancer, adverse pregnancy outcomes, infertility, and HIV acquisition. Molecular mechanisms of infection: To achieve success in parasitism trichomonads develop a complex process against the host cells that includes dependent- and independent-contact mechanisms. This multifactorial pathogenesis includes molecules such as soluble factors, secreted proteinases, adhesins, lipophosphoglycan that culminate in cytoadherence and cytotoxicity against the host cells. Treatment and curability: The treatment with metronidazole or tinidazole is recommended; however, cure failures remain problematic due to noncompliance, reinfection and/or lack of treatment of sexual partners, inaccurate diagnosis, or drug resistance. Therefore, new therapeutic alternatives are urgently needed. Protection: Strategies for protection including sexual behavior, condom usage, and therapy have not contributed to the decrease on disease prevalence, pointing to the need for innovative approaches. Vaccine development has been hampered by the lack of long-lasting humoral immunity associated to the absence of good animal models.

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Section: Treating Trichomoniasis: Are We Succeeding?mentioning

confidence: 95%

Trichomoniasis – are we giving the deserved attention to the most common non-viral sexually transmitted disease worldwide?

Menezes

Frasson

Tasca

2016

MIC

119

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“…Repeat infections are common, ranging from 5 to 31 % [69, 91–93, 94•], and share similar sequelae to primary infections. While it is clear that the T. vaginalis repeat infection rate is unacceptably high, the source of these repeat infections is less clear.…”

Section: Management and Treatmentmentioning

confidence: 99%

Epidemiology and Treatment of Trichomoniasis

Kissinger

2015

Curr Infect Dis Rep

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Trichomonas vaginalis is the most common nonviral sexually transmitted infection (STI) in the world. It was once thought to be a nuisance STI, but it is now being recognized as an important source of reproductive morbidity and a facilitator of HIV transmission and acquisition, and thus it is an important public health problem. The prevalence of T. vaginalis varies greatly by geography and risk group, but is more common among persons of African descent and appears to increase with age, though this may be a screening phenomenon. Wet mount and culture are simple diagnostics, but have lower sensitivity than nucleic acid amplification techniques presently approved for women only. Single dose (2 g) metronidazole (MTZ) for both the index patient and their sexual partners is the preferred treatment. High rates of retest positivity are found after single-dose treatment which are likely due to clinical resistance rather than re-infection and/or drug resistance.

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“…Recommended treatment regimes range from a single 1.5 or 2 g oral dose to split doses of 500 mg twice daily over a period of 7 d [26,27]. Although metronidazole and tinidazole are the recommended drugs to treat trichomoniasis, their broad antimicrobial spectrum extends across the other anaerobic protozoa including, Entamoeba histolytica, Giardia duodenalis and Blastocystis hominis and anaerobic bacteria, Helicobacter pylori, Bacteroides spp and Clostridium spp [28].…”

Section: Treatment Of Trichomoniasismentioning

confidence: 99%

Drug resistance in the sexually transmitted protozoan Trichomonas vaginalis

et al. 2003

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Trichomoniasis is the most common, sexually transmitted infection. It is caused by the flagellated protozoan parasite Trichomonas vaginalis. Symptoms include vaginitis and infections have been associated with preterm delivery, low birth weight and increased infant mortality, as well as predisposing to HIV/AIDS and cervical cancer. Trichomoniasis has the highest prevalence and incidence of any sexually transmitted infection. The 5-nitroimidazole drugs, of which metronidazole is the most prescribed, are the only approved, effective drugs to treat trichomoniasis. Resistance against metronidazole is frequently reported and cross-resistance among the family of 5-nitroimidazole drugs is common, leaving no alternative for treatment, with some cases remaining unresolved. The mechanism of metronidazole resistance in T. vaginalis from treatment failures is not well understood, unlike resistance which is developed in the laboratory under increasing metronidazole pressure. In the latter situation, hydrogenosomal function which is involved in activation of the prodrug, metronidazole, is down-regulated. Reversion to sensitivity is incomplete after removal of drug pressure in the highly resistant parasites while clinically resistant strains, so far analysed, maintain their resistance levels in the absence of drug pressure. Although anaerobic resistance has been regarded as a laboratory induced phenomenon, it clearly has been demonstrated in clinical isolates. Pursuit of both approaches will allow dissection of the underlying mechanisms. Many alternative drugs and treatments have been tested in vivo in cases of refractory trichomoniasis, as well as in vitro with some successes including the broad spectrum anti-parasitic drug nitazoxanide. Drug resistance incidence in T. vaginalis appears to be on the increase and improved surveillance of treatment failures is urged.

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The Minimum Single Oral Metronidazole Dose for Treating Trichomoniasis: A Randomized, Blinded Study

Abstract: A single 1.5-g dose of metronidazole has efficacy equivalent to a single 2-g dose for the treatment of T vaginalis vaginitis.

Cited by 36 publications

References 16 publications

Trichomoniasis – are we giving the deserved attention to the most common non-viral sexually transmitted disease worldwide?

Trichomoniasis – are we giving the deserved attention to the most common non-viral sexually transmitted disease worldwide?

Epidemiology and Treatment of Trichomoniasis

Drug resistance in the sexually transmitted protozoan Trichomonas vaginalis

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