Updates in trichomonas treatment including persistent infection and 5-nitroimidazole hypersensitivity

PURPOSE OF THE REVIEW: The purpose of this review is to update information on treatment of T. vaginalis. Trichomonas vaginalis is estimated to be the most common treatable sexually transmitted infection (STI) In the world and is associated with poor birth outcomes, cervical cancer, sperm motility and morphology issues, and HIV acquisition and transmission. RECENT FINDINGS: The efficacy of the recommended 2 gram oral single-dose metronidazole (MTZ) for the treatment of T. vaginalis in women has recently been challenged. Two recent multi-centered randomized trials and a meta-analysis have demonstrated that the 7-day dose of MTZ 500 mg twice daily was nearly two times more efficacious at clearing infection compared to the 2 gram dose. Partner treatment is also essential, since up to 70% of male sexual partners can be infected and rescreening of treated women at 3-months is also recommended given the high repeat infection rates. Future studies should examine the importance of treating asymptomatic T. vaginalis, best treatment for men, the influence of the microbiome on treatment efficacy, and different formulations of intra-vaginal treatments for hypersensitivity. SUMMARY: 7 day 500 mg twice daily MTZ should be used as the first line treatment for T. vaginalis infected women.