Howe Katharine, Kissinger Patricia J
From the Department of Epidemiology, Tulane University School of Public Health and Tropical Medicine, New Orleans, LA.
Sex Transm Dis. 2017 Jan;44(1):29-34. doi: 10.1097/OLQ.0000000000000537.
Trichomonas vaginalis is the most common curable sexually transmitted infection worldwide. Although the Centers for Disease Control and Prevention and the World Health Organization recommend a single 2-g dose of metronidazole for the first line of treatment for T. vaginalis among human immunodeficiency virus (HIV) negative women, high rates of repeat infections are found. The purpose of this meta-analysis was to compare treatment failure between single versus multidose metronidazole for the treatment of T. vaginalis.
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 a clinical trial, evaluate T. vaginalis, use oral metronidazole, and compare single dose metronidazole to multidose metronidazole.
There were 487 articles that were assessed for relevance and quality. Of these articles, 6 met the eligibility criteria and were included in the final results. The pooled risk ratio indicated higher treatment failure for single dose compared to multidose 1.87 (95% confidence interval, 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).
Centers for Disease Control and Prevention recently changed treatment recommendations for HIV+ women to multidose rather than single-dose. These data suggest that those recommendations should be considered for all women.
阴道毛滴虫是全球最常见的可治愈性传播感染病原体。尽管美国疾病控制与预防中心及世界卫生组织推荐，对于人类免疫缺陷病毒（HIV）阴性女性，一线治疗阴道毛滴虫采用单次2克剂量的甲硝唑，但重复感染率仍较高。本荟萃分析的目的是比较单次与多次剂量甲硝唑治疗阴道毛滴虫的治疗失败率。
采用包括甲硝唑、滴虫病和女性等检索词进行系统的文献检索。使用Embase、MEDLINE和Clinicaltrials.gov检索相关研究，并人工检索相关文章。这些数据库最近一次检索时间为2016年1月25日。要纳入本荟萃分析，研究必须是一项临床试验，评估阴道毛滴虫，使用口服甲硝唑，并比较单次剂量甲硝唑与多次剂量甲硝唑。
共评估了487篇文章的相关性和质量。其中，6篇符合纳入标准并纳入最终结果。汇总风险比表明，单次剂量的治疗失败率高于多次剂量，为1.87（95%置信区间，1.23 - 2.82；P < 0.01）。当将纳入HIV阳性女性的一项研究排除在分析之外时，结果相似，汇总风险比为1.80（95%置信区间，1.07 - 3.02；P < 0.03）。
美国疾病控制与预防中心最近将HIV阳性女性的治疗建议改为多次剂量而非单次剂量。这些数据表明，所有女性都应考虑这些建议。
