Management of Trichomoniasis in the Setting of 5-Nitroimidazole Hypersensitivity

Sex Transm Dis. 2021 Aug 1;48(8):e111-e115. doi: 10.1097/OLQ.0000000000001326.


Metronidazole and other 5-nitroimidazoles are the mainstay of Trichomonas vaginalis treatment, with few efficacious and safe treatment options available outside of this class. Patients with trichomoniasis and a history of a clinically confirmed hypersensitivity reaction to 5-nitroimidazoles present a management challenge for clinicians. The first step in managing such patients is metronidazole desensitization. In situations where this cannot be performed or tolerated, treatment with alternative regimens outside of the 5-nitroimidazole class, such as intravaginal boric acid or paromomycin, may be possible.

Publication types

  • Research Support, N.I.H., Extramural
  • Research Support, U.S. Gov't, P.H.S.

MeSH terms

  • Female
  • Humans
  • Metronidazole / adverse effects
  • Nitroimidazoles* / adverse effects
  • Trichomonas Infections* / drug therapy
  • Trichomonas Vaginitis* / drug therapy
  • Trichomonas vaginalis*


  • Nitroimidazoles
  • Metronidazole
  • 4-nitroimidazole