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| Pap Test-Trichomonas |
Women
receiving the recommended single dose therapy for Trichomonas vaginalis are 1.8
times more likely to have relapse of infection as compared to women receiving multi
dose treatment says results of a recent Meta-analysis published in Journal of
American Sexually Transmitted Disease Association.
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| Trichomonas vaginalis |
Trichomonas
vaginalis (TV) is the most common nonviral sexually transmitted infection in US
and worldwide. It is an important public health problem because it acts as a
facilitator for HIV transmission, besides other reproductive morbidities like
PROM, preterm delivery and low birth weight.
WHO estimated
that there occurred 276.4 million cases of Trichomonas globally in 2008, with 90% of these occurring
in low resource population.[1]
In the United States, an estimated 3.7 million people have trichomoniasis.[2]
Since, 40
years, Metronidazole has been the corner stone for treatment of TV infection
along with tinidazole (TNZ) and seconidazole.
The World
Health Organization (WHO) and the United States Centers for Disease Control and
Prevention (CDC) guidelines for treatment of TV include: MTZ or TNZ 2 gm single
dose as the recommended regimens, and MTZ 500 mg BID 7-day dose as the
alternative treatment regimen.[3]
CDC also advocates “Concurrent treatment of all sex partners is critical for
symptomatic relief, microbiologic cure, and prevention of transmission and
reinfections.”
The Meta- analysis
found 487 articles that were relevant to study criteria. Out of which 6 were
included in the final analysis.
The pooled data
analysis of nearly 1,300 participants showed 1.87 times the risk of treatment
failure in women that were treated with single dose of Metronidazole as
compared to multi dose. (95% confidence interval, 1.23–2.82; P < 0.01).
The study has
many drawbacks of including studies conducted at least 30 years back and the
diagnosis of T.vaginalis infection made with saline microscopy instead of
culture or DNA testing. The study also did not follow whether the sexual
partner was adequately treated.
The authors advocate the need of more recent RCTs utilizing modern diagnostic techniques
and keeping records of partner follow up.But, for the
time being until such studies are conducted, the authors conclude that the same
multi dose treatment strategy should be applied to women without HIV infection
to prevent relapse instead of single dose regimen.
The current guidelines
recommend different dosing strategy for HIV patients infected with TV. As per
CDC “women with HIV infection who receive a diagnosis of T. vaginalis infection
should be treated with metronidazole 500 mg orally twice daily for 7 days
(rather than with a 2-g single dose of metronidazole).
The abstract of the article can be accessed here.
