Quick Take: Single-dose versus 7-day-dose metronidazole (Flagyl) for the treatment of trichomoniasis in women: an open-label, randomized controlled trial

Trichomoniasis is the most common sexually transmitted infection among women worldwide. Untreated, this can lead to poor reproductive outcomes and increased rates of HIV transmission. Current guidelines recommend a single 2 g dose of oral metronidazole or tinidazole as first-line treatment, and a 7-day course of oral metronidazole as second-line treatment. However, recent meta-analyses have indicated that a single-dose of metronidazole may be insufficient to cure this disease. In this open-label, randomized controlled trial, 623 women were assigned to receive either a single dose of 2 g metronidazole or 500 mg metronidazole twice daily for 7 days to determine the prevalence of trichomoniasis infection at 4 weeks after completion of treatment. Adherence to treatment was lower in the 7-day-dose group than in the single-dose group (96% vs. 99% respectively, p=0.006). Researchers found that the proportion of women who tested positive for trichomoniasis at 4 weeks was lower in the 7-day dose group than in the single-dose group (11% vs. 19%, RR 0.55, 95% CI 0.34 to 0.70, p<0.0001). The presence of bacterial vaginosis had no significant impact this result (p=0.17 for interaction). There was no significant difference in the proportion of adverse events between the two study groups. However, there were two reported spontaneous abortions among women receiving the 7-day-dose. Limitations of this study included its open-label design and low enrollment. Overall, this study supports the use of a 7-day-dose of metronidazole rather than a single-dose for women with trichomoniasis.

Click to read the study in The Lancet

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