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.
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