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Effective treatment options for trichomonas vaginalis

Effective treatment for Trichomonas vaginalis (TV) requires systemic treatment with a 5-nitroimidazole. Metronidazole (MTZ) is the mainstay of treatment. Options for women with persistent infection after MTZ or those with true MTZ allergy are limited and have become more so with the discontinuation of tinidazole in early 2021. Recently, limited data have emerged on the efficacy of secnidazole in 64 adult females with trichomoniasis with 59 (92.2%) having a negative TV culture 6–12 days after treatment. All the nitroimidazoles have a similar nitroimidazole ring but different side chains. Although all these molecules have been used for a long time without many sideeffects, only metronidazole and tinidazole have been reported to cause fixed drug eruptions (FDE) with cross sensitivity to each other. There is a case report of FDE caused by ornidazole which showed cross-sensitivity to secnidazole but not to metronidazole, tinidazole or satranidazole. Given the limited data on use of secnidazole in treating TVand data on cross-sensitivity in people with true allergy caution should be exercised in administering any 5nitroimidazole to someone who gives a history of possible or definite MTZ allergy. Regimens for desensitisation have been published. If a decision is taken to administer the drug without desensitisation it would be advisable to do so in a clinic setting with facilities to manage anaphylaxis and the patient remaining in clinic for a period of observation.