The 2006 CDC STD Treatment Guidelines recommend only oral preparations for the treatment of trichomoniasis.
Metronidazole 2g orally in a single dose
Tinidazole 2g orally in a single dose
Metronidazole 500 mg twice a day for 7 days
Metronidazole has a 90-95% cure rate and tinidazole has a 86-100% cure rate. All patients diagnosed with trichomoniasis should be treated. Sex partners should also be treated. Both should be tested for other STDs as well.
Metronidazole gel (intravaginal) is ineffective for the treatment of trichomoniasis and is not recommended. In the case of metronidazole allergy, the use of an alternative drug (e.g., paromomycin) is appropriate, or for a desensitization protocol, see the references cited in 2006 CDC STD Treatment Guidelines.
Vaginal trichomoniasis in pregnant women has been associated with adverse outcomes such as premature rupture of the membranes, preterm delivery, and low birthweight. Pregnant women with symptomatic trichomoniasis should be treated.
The CDC recommendation for treatment of trichomoniasis in pregnancy is:
Metronidazole 2g orally in single dose
There is no consistent association between metronidazole use in pregnancy and teratogenic effects, and treatment may be administered throughout pregnancy.
If the recommended treatment fails, the following treatment failure regimen is recommended:
Metronidazole 500 mg orally twice a day for 7 days (if initial treatment was 2g orally in a single dose)
Tinidazole 2g orally single dose
With failure of either regimens, consider treatment with:
Metronidazole or Tinidazole 2g orally once a day for 5 days
If repeated treatment failures occur on the higher dose regimens, consider metronidazole susceptibility testing through the CDC. Consultation is available by phone at 770 (488-4115).