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Sex Transm Dis. 2013 Sep;40(9):710-4. doi: 10.1097/01.olq.0000431069.38601.d5.

Intravaginal metronidazole/miconazole for the treatment of vaginal trichomoniasis.

Author information

1
Department of Medicine, University of Alabama at Birmingham, Birmingham, AL, USA. schwebke@uab.edu

Abstract

BACKGROUND:

Trichomonas vaginalis is the causative agent of the most common curable sexually transmitted disease in the world. The infection is treated with a single oral dose of metronidazole or tinidazole, currently the only licensed class of drugs available for this indication; however, both of these antimicrobials are associated with significant gastrointestinal adverse effects, and some individuals are unable to tolerate them because of these adverse effects.

METHODS:

Randomized, dose-ranging pilot study conducted in 2 phases consisting of 20 participants in each phase. In the first phase, participants were randomized to the vaginal suppository (metronidazole 750 mg/miconazole nitrate 200 mg) twice a day for 7 days versus oral metronidazole 2 g single dose. In the second phase, participants randomized to suppository used it once a day for 7 days. Women were reevaluated on days 12 to 15 and 30 to 35. Treatment failures were defined as persistence of trichomonas by wet prep and/or culture.

RESULTS:

There were no significant differences in cure rates between the vaginal suppositories and oral metronidazole in either phase. The overall efficacy across both follow-up visits was 80% versus 90% for the suppository (2×/d) versus oral medication arms in phase 1 (P = 1.00) and 78% versus 70% for the suppository (1×/d) versus oral medication arms in phase 2 (P = 1.00). The results were also nonsignificant when combining results across arm (P = 1.00).

CONCLUSIONS:

High-dose intravaginal metronidazole combined with miconazole offers the possibility of a well-tolerated treatment that avoids the systemic adverse effects of nitroimidazoles for the treatment of trichomoniasis.

[Indexed for MEDLINE]

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