Longer metronidazole treatment is better than 1-day dose for women with trichomoniasis
From 37 years of experience as a Women's Healthcare Nurse Practitioner, I have found it is always better to prescribe metronidazole 500 mg bid for 7 days rather than 1-day treatment for women. I will prescribe 1-day treatment for men. I have been treating men and women using these regimens in a sexually transmitted diseases clinic for nearly 5 years. Colleagues have used the 1-time dose for women and it rarely works as well as the 7-day dose. However, I am always concerned about men taking the medication for 7 days, because often they are not symptomatic and they may stop taking their medication early if given the 1-week regimen, so I usually prescribe the 1-day dose for men. I wish more prescribers would offer treatment for the male partners, as they may not be symptomatic or may not want to spend the money to visit a provider. In my state, it is legal to prescribe for the partner without seeing him, and the Centers for Disease Control and Prevention suggests doing so. We encourage the men to come in but if the partner says he is unlikely to, we will treat without seeing him.
Carol Glascock, WHNP-BC
Dr. Duff responds
I appreciate Ms. Glascock's thoughtful comments. I am pleased that her years of clinical experience support the main conclusion reached by Howe and Kissinger that, in general, patients do better when they receive multidose therapy for trichomonas infection.1 I agree with Ms. Glascock's observation that single-dose therapy still has a role in situations in which patients may not be adherent with multidose therapy, such as the asymptomatic male partner of an infected woman. I also agree wholeheartedly that women will have less likelihood of recurrence when their partner receives adequate antibiotic treatment. I concur that, in states where this practice is legally permissible, we should be willing to offer antibiotic therapy to the partner of our female patient.
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