Multidose metronidazole important for women with T. vaginalis history: Study

USA: Metronidazole (MTZ) is suggested for all women with Trichomonas vaginalis, it is more critical for women with a T. vaginalis history, that a Test of Cure (TOC) should be conducted due to high post-treatment infection rates, says an article published in the journal Sexually Transmitted Diseases.

For Trichomonas vaginalis therapy, a randomized controlled study compared 2 g (single-dose MTZ) to 500 mg twice daily for 7 days (multidose). To see if therapy suggestions might be targeted Christina A Muzny and team conducted this study where the effect was investigated and compared to specific clinical characteristics. T. vaginalis recurrence at the test-of-cure (TOC) 4 weeks following the end of treatment was the main outcome. T. vaginalis history, concurrent diagnosis of bacterial vaginosis (BV) per Nugent score at baseline and baseline genital symptoms, were used to stratify analyses.

The results of this study stated as follow:

1. Women who came back for TOC (n = 540) were included in the study.

2. At the start of the study, 52.9% had a history of T. vaginalis, 79.3% had genital symptoms, 5.8% had a gonorrhea diagnosis, and 47.5% had BV. 97.4% took all MTZ as directed throughout follow-up, and 34.5% had interval condom-less intercourse with a baseline partner.

3. T. vaginalis was found in 14.8% of TOC participants. If they were symptomatic at baseline (21.45 vs. 10.85) or had a documented history of T. vaginalis (24.15 vs. 12.65), women assigned to single-dose MTZ had a greater risk of TOC.

4. T. vaginalis is more positive than those randomized to multidose MTZ.

5. Regardless of baseline BV status, test-of-cure T. vaginalis positive was greater in women who received a single dosage (18.9%) than multidose (10.8%).

6. With the history of single-dose MTZ and T. vaginalis were independently linked with a positive TOC for T. vaginalis in multivariable analysis.

In conclusion, "the findings of this study impresses upon the efficiency of the MTZ in women with a history of T. vaginalis and must have TOC performed" said the Authors.

Reference:

Muzny, C. A., Mena, L. A., Lillis, R. A., Schmidt, N., Martin, D. H., & Kissinger, P. (2021). A Comparison of Single-Dose Versus Multidose Metronidazole by Select Clinical Factors for the Treatment of Trichomonas vaginalis in Women. In Sexually Transmitted Diseases (Vol. 49, Issue 3, pp. 231–236). Ovid Technologies (Wolters Kluwer Health). https://doi.org/10.1097/olq.0000000000001574