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Management of Resistant Trichomoniasis

  • Female Genital Tract Infections (J Sobel, Section Editor)
  • Published:
Current Infectious Disease Reports Aims and scope Submit manuscript

Abstract

Purpose of Review

Trichomonas vaginalis is the most prevalent sexually transmitted parasite in the USA; resistant infection is emerging. New drug therapies and dosing regimens of standard therapies are being studied to treat resistant infection.

Recent Findings

Diagnosis of trichomoniasis has become more sensitive, specific, and widely available with the advent of nucleic acid amplification tests (NAATs). Women with resistant trichomoniasis should be treated with high-dose regimens of metronidazole or tinidazole. Alternative treatment options have been described, and there has been some success particularly with high-dose tinidazole/intravaginal paromomycin cream combination, intravaginal boric acid, and intravaginal metronidazole/miconazole.

Summary

Resistant trichomoniasis is a growing public health concern with implications for long-term health consequences. More data are needed to further evaluate mechanisms by which resistance occurs as well as promising therapies for those affected.

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References

Papers of particular interest, published recently, have been highlighted as: • Of importance •• Of major importance

  1. Meites E, Gaydos CA, Hobbs MM, Kissinger P, Nyirjesy P, Schwebke JR, et al. A review of evidence-based care of symptomatic trichomoniasis and asymptomatic Trichomonas vaginalis infections. Clin Infect Dis. 2015;61(Suppl 8):S837–48. https://doi.org/10.1093/cid/civ738.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  2. Kissinger P. Trichomonas vaginalis: a review of epidemiologic, clinical and treatment issues. BMC Infect Dis. 2015;15:307. https://doi.org/10.1186/s12879-015-1055-0.

    Article  PubMed  PubMed Central  Google Scholar 

  3. Seña AC, Bachmann LH, Hobbs MM, et al. Persistent and recurrent Trichomonas vaginalis infections: epidemiology, treatment and management considerations. Expert Rev Anti Infect Ther. 2014;12(6):637–685. https://doi.org/10.1586/14787210.2014.887440.

    Article  Google Scholar 

  4. Allsworth JE, Ratner JA, Peipert JF. Trichomoniasis and other sexually transmitted infections: results from the 2001e2004 National Health and Nutrition Examination Surveys. Sex Transm Dis. 2009;36:738e44.

    Article  Google Scholar 

  5. Byun JM, Jeong DH, Kim YN, et al. Experience of successful treatment of patients with metronidazole-resistant Trichomonas vaginalis with zinc sulfate: a case series. Taiwan J Obstet Gynecol. 2015;54(5):617–20. https://doi.org/10.1016/j.tjog.2015.08.018.

    Article  PubMed  Google Scholar 

  6. Miller MR, Nyirjesy P. Refractory trichomoniasis in HIV-positive and HIV-negative subjects. Curr Infect Dis Rep. 2011;13(6):595–603. https://doi.org/10.1007/s11908-011-0213-9.

    Article  PubMed  Google Scholar 

  7. Lobo T, Feijo G, Carvalho S, Costa P, Chagas C, Xavier J, et al. A comparative evaluation of the Papanicolaou test for the diagnosis of trichomoniasis. Sex Transm Dis. 2003;30(9):694–9. https://doi.org/10.1097/01.OLQ.0000079525.04451.05.

    Article  PubMed  Google Scholar 

  8. Nyirjesy, P. Trichomoniasis and the 2015 CDC STD treatment guidelines: new insights, new urgency. OBG Manag 2016:S4–S6.

  9. Lossick JG. The diagnosis of vaginal trichomoniasis. JAMA. 1988;259(8):1230. https://doi.org/10.1001/jama.1988.03720080064030.

    Article  CAS  PubMed  Google Scholar 

  10. Van Der Pol B, Kraft CS, Williams JA. Use of an adaptation of a commercially available PCR assay aimed at diagnosis of chlamydia and gonorrhea to detect Trichomonas vaginalis in urogenital specimens. J Clin Microbiol. 2006;44:366–73.

    Article  Google Scholar 

  11. Hillier SL, Danby C The end of the wet mount. OBG Manag 2016: S2–S4.

  12. Schwebke JR, Gaydoes CA, Davis T, et al. Clinical evaluation of the Cepheid Xpert TV assay for detection of Trichomonas vaginalis with prospectively collected specimens from men and women. J Clin Microbiol. 2018;56(2):e01091–17. https://doi.org/10.1128/JCM.01091-17.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  13. Van Der Pol B, Williams JA, Fuller D, et al. Combined testing for chlamydia, gonorrhea, and trichomonas by use of the BD Max CT/GC/TV assay with genitourinary specimen types. J Clin Microbiol. 2017;55(1):155–64.

    Article  Google Scholar 

  14. Kawa D, Kostiha B, Yu JH, et al. Elevating the standard of care for STIs: the BD Max CT/GC/TV assay. 2017.

  15. Workowski KA, Bolan GA. Centers for Disease Control and Prevention. Sex Transm Dis Guidel. 2015;64(RR-03):1–137.

    Google Scholar 

  16. Cartwright CP, Lembke BD, Ramachandran K, Body BA, Nye MB, Rivers CA, et al. Comparison of nucleic-acid amplification assays with BD affirm VPIII for the diagnosis of vaginitis/vaginosis in symptomatic women. J Clin Microbiol. 2013;51(11):3694–9. https://doi.org/10.1128/JCM.01537-13.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  17. •• Howe K, Kissinger PJ. Single-dose compared with multidose metronidazole for the treatment of trichomoniasis in women: a meta-analysis. Sex Transm Dis. 2017;44(1):29–34. https://doi.org/10.1097/OLQ.0000000000000537 Study shows single dose has a higher failure rate than multidose regimen.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  18. Crowell AL, Sanders-Lewis KA, Secor WE. In vitro metronidazole and tinidazole activities against metronidazole-resistant strains of Trichomonas vaginalis. Antimicrob Agents Chemother. 2003;47:1407–9.

    Article  CAS  Google Scholar 

  19. Craig-Kuhn MC, Granade C, Muzny C, et al. Optimal timing for Trichomonas vaginalis test of cure using nucleic acid amplification testing. Sex Transm Dis. 2019;46:312–6.

    Article  Google Scholar 

  20. Moraes ME, Cunha GH, Bezerra MM, et al. Efficacy of the Mentha crispa in the treatment of women with Trichomonas vaginalis infection. Arch Gynecol Obstet. 2012;286:125–30.

    Article  Google Scholar 

  21. Ghosh AP, Aycock C, Schwebke JR. In vitro study of the susceptibility of clinical isolates of Trichomonas vaginalis to metronidazole and secnidazole. Antimicrob Agents Chemother. 2018;62(4):e02329–17.

    Article  CAS  Google Scholar 

  22. Bosserman EA, Helms DJ, Mosure DJ, Secor WE, Workowski KA. Utility of antimicrobial susceptibility testing in Trichomonas vaginalis- infected women with clinical treatment failure. Sex Transm Dis. 2011;38(10):983–7.

    Article  CAS  Google Scholar 

  23. • Chacon MO, Fonseca THS, Oliveira MA, et al. Chlorinated metronidazole as a promising alternative for treating trichomoniasis. Parasitol Res. 2018;117(5):1333–40 In vitro study demonstrating that altering the nitro group of metronidazole may make the drug more efficacious for treating resistant strains of T. vaginalis .

    Article  CAS  Google Scholar 

  24. Leitsch D. Recent advances in the trichomonas vaginalis field. F1000Res. 2016;5:F1000 Faculty Rev-162. https://doi.org/10.12688/f1000research.7594.1.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  25. Ertabaklar H, Yaman KS, Malatyali E, et al. Investigation of in vitro metronidazole resistance in the clinical isolates of Trichomonas vaginalis. Mikrobiyol Bul. 2016;50(4):552–8.

    Article  Google Scholar 

  26. Abdel-Magied AA, El-Kholya EI, Abou El-Khair SM, et al. The genetic diversity of metronidazole susceptibility in Trichomonas vaginalis clinical isolates in an Egyptian population. Parasitol Res. 2017;116(11):3125–30. https://doi.org/10.1007/s00436-017-5627-3.

    Article  PubMed  Google Scholar 

  27. Matini M, Maghsood AH, Mohebali M, Rabiee S, Fallah M, Rezaie S, et al. In vitro susceptibility of Iranian isolates of Trichomonas vaginalis to metronidazole. Iran J Parasitol. 2016;11(1):46–51.

    PubMed  PubMed Central  Google Scholar 

  28. Waters LJ, Dave SS, Deayton JR, French PD. Recalcitrant Trichomonas vaginalis infection – a case series. Int J STD AIDS. 2005;16:505–9.

    Article  CAS  Google Scholar 

  29. Sobel JD, Nyirjesy P, Brown W. Tinidazole therapy for metronidazole-resistant vaginal trichomoniasis. Clin Infect Dis. 2001;33:1341–6.

    Article  CAS  Google Scholar 

  30. Hager DW. Treatment of metronidazole-resistant trichomonas vaginalis with tinidazole: case reports of three patients. Sex Transm Dis. 2004;31:343–5.

    Article  Google Scholar 

  31. Tayal SC, Ochogwu SA, Bunce H. Paromomycin treatment of recalcitrant Trichomonas vaginalis. Int J STD AIDS. 2010;21:217–8.

    Article  CAS  Google Scholar 

  32. Nyirjesy P. Paromomycin for nitroimidazole-resistant trichomonosis. Lancet. 1995;346:1110.

    Article  CAS  Google Scholar 

  33. Coelho DD. Metronidazole resistant trichomoniasis successfully treated with paromomycin. Genitourin Med. 1997;73:397–8.

    CAS  PubMed  PubMed Central  Google Scholar 

  34. Poppe WAJ. Nitroimidazole-resistant vaginal trichomoniasis treated with paromomycin. Eur J Obstet Gynecol. 2001;96:119–20.

    Article  CAS  Google Scholar 

  35. Nyirjesy P, Gilbert J, Mulcahy LJ. Resistant trichomoniasis: successful treatment with combination therapy. Sex Transm Dis. 2011;38(10):962–3. https://doi.org/10.1097/OLQ.0b013e31822037e4.

    Article  PubMed  Google Scholar 

  36. •• Henien M, Nyirjesy P, Smith K. Metronidazole-resistant trichomoniasis: beneficial pharmacodynamic relationship with high-dose oral tinidazole and vaginal paromomycin combination therapy. Sex Transm Dis. 2019;46(1):e1–2. https://doi.org/10.1097/OLQ.0000000000000903 Combination therapy with high-dose tinidazole and paromomycin shows promising results.

    Article  PubMed  Google Scholar 

  37. •• Thorley N, Ross J. Intravaginal boric acid: is it an alternative therapeutic option for vaginal trichomoniasis? Sex Transm Infect. 2018;94:574–7. https://doi.org/10.1136/sextrans-2017-053343 Boric acid may be a good alternative therapeutic option for resistant infection.

    Article  PubMed  Google Scholar 

  38. Helms DJ, Mosure DJ, Secor WE, et al. Management of Trichomonas vaginalis in women with suspected metronidazole hypersensitivity. Am J Obstet Gynecol. 2008;198:370–7.

    Article  Google Scholar 

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Authors and Affiliations

  1. Department of Obstetrics and Gynecology, Drexel University College of Medicine, 245 N. 15th St. MS 495, Philadelphia, PA, 19102, USA

    Cynthia Alessio & Paul Nyirjesy

Authors
  1. Cynthia Alessio
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  2. Paul Nyirjesy
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Correspondence to Paul Nyirjesy.

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Conflict of Interest

Dr. Alessio has no conflicts of interest to disclose.

Dr. Nyirjesy has received grants from Mycovia Pharmaceuticals; Curatek Pharmaceuticals; Scynexis, Inc.; and Hologic. He also serves as a consultant for Mycovia Pharmaceuticals; Lupin Pharmaceuticals; Hologic; Scynexis, Inc.; Daré Bioscience; Inc.; and BD.

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This article does not contain any studies with human or animal subjects performed by any of the authors.

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This article is part of the Topical Collection on Female Genital Tract Infections

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Alessio, C., Nyirjesy, P. Management of Resistant Trichomoniasis. Curr Infect Dis Rep 21, 31 (2019). https://doi.org/10.1007/s11908-019-0687-4

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  • DOI: https://doi.org/10.1007/s11908-019-0687-4

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