Tuesday, December 20, 2016

Metronidazole: Trichomoniasis in Pregnancy

  • Treatment reduces symptoms and signs of T. vaginalis infection and might reduce transmission. Likelihood of adverse outcomes in women with HIV also is reduced with T. vaginalis therapy
Recommended Regimen
  • Metronidazole 2 g orally in a single dose
    OR
  • Tinidazole 2 g orally in a single dose
Alternative Regimen 
  • Metronidazole 500 mg orally twice a day for 7 days
  • The nitroimidazoles are the only class of antimicrobial medications known to be effective against T. vaginalis infections.
  • Of these drugs, metronidazole and tinidazole have been cleared by FDA for the oral or parenteral treatment of trichomoniasis
Rationale in Pregnancy
  • Pregnancy Category : B. Use of metronidazole for trichomoniasis is contraindicated during the first trimester; the manufacturer makes no further recommendations regarding use during pregnancy
  • T. vaginalis infection in pregnant women is associated with adverse pregnancy outcomes, particularly premature rupture of membranes, preterm delivery, and delivery of a low birthweight infant
  • Although metronidazole treatment produces parasitologic cure, certain trials have shown no significant difference in perinatal morbidity following metronidazole treatment.
  • One trial suggested the possibility of increased preterm delivery in women with T. vaginalis infection who received metronidazole treatment, yet study limitations prevented definitive conclusions regarding the risks of treatment.
  • More recent, larger studies have shown no positive or negative association between metronidazole use during pregnancy and adverse outcomes of pregnancy
  • If treatment is considered, the recommended regimen in pregnant women is metronidazole 2 g orally in a single dose.
  • Symptomatic pregnant women, regardless of pregnancy stage, should be tested and considered for treatment.
  • Treatment of T. vaginalis infection can relieve symptoms of vaginal discharge in pregnant women and reduce sexual transmission to partners.
  • Although perinatal transmission of trichomoniasis is uncommon, treatment also might prevent respiratory or genital infection of the newborn
  • Although metronidazole crosses the placenta, data suggest that it poses a low risk to pregnant women
  • No evidence of teratogenicity or mutagenic effects in infants has been found in multiple cross-sectional and cohort studies of pregnant women
  • Women can be treated with 2 g metronidazole in a single dose at any stage of pregnancy.
Reference:
  1. https://www.cdc.gov/std/tg2015/trichomoniasis.htm
  2. https://www.drugs.com/pregnancy/metronidazole.html

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