![[ Visit Client Website ]](images/banner.gif)
Background: Trichomonas Vaginalis (TV) is the most common curable sexually transmitted infection worldwide. The Centers for Disease Control and Prevention (CDC) recommends a single 2-gram dose of metronidazole as the first line and multi-dose as the second line of therapy for the treatment of TV among HIV negative women. These recommendations were made after a series of small studies conducted from 1970-1985 that declared equivalency of the regimens. Most of these studies, however, were not powered for equivalence and actually demonstrated a non-statistical trend in favor of single dose over multi-dose. The purpose of this meta-analysis was to compare treatment failure between single versus multi-dose metronidazole for the treatment of TV.
Methods: A systematic literature search was performed using search terms including metronidazole AND trichomoniasis AND women. Embase, MEDLINE, and Clinicaltrials.gov were used to search for relevant studies as well as hand searching relevant articles. These databases were last searched on January 25, 2016. To be included in this meta-analysis the study had to be written in English, conducted in women 18 years or older, conducted in a clinical trial setting, evaluated TV, used metronidazole, and compared single dose oral metronidazole to multi-dose metronidazole.
Results: There were 487 articles that were assessed for relevance and quality. Of these articles, 6 met eligibility and were included in the final results. The pooled risk ratio indicated higher treatment failure for single dose compared to multi-dose 1.87 (95% confidence interval of 1.23-2.82, p<0.01). When the one study that included HIV+ women was excluded from analysis, the findings were similar with a pooled risk ratio of 1.80 (95% confidence interval 1.07-3.02, p < 0.03).
Conclusions: CDC recently changed treatment recommendations for HIV+ women to multi- rather than single-dose. These data suggest that those recommendations should be extended to all women.