Global Prevalence of 5-nitroimidazole Resistance in Trichomonas vaginalis: A Systematic Review and Meta-analysis

Although 5-nitroimidazoles, primarily metronidazole (MTZ), are the primary drugs of choice for trichomoniasis, resistance to metronidazole appears to be increasing. Considering observed differences in drug resistance across various populations, this systematic review and meta-analysis was designed to determine the global prevalence of 5-nitroimidazole resistance among T. vaginalis.

We conducted a thorough search of international databases, including Web of Science, Medline, Scopus, SID, Magiran, and Iran-Medex using a variety of relevant keywords and their synonyms. Studies meeting the inclusion criteria were selected for the meta-analysis phase. To combine the findings, we employed a random-effects model.

Of the 469 studies initially assessed, 16 were selected for the meta-analysis. Based on a random effect meta-analysis (I2 = 94.87 %, P= 0.001), the pooled prevalence rate of resistance to metronidazole was estimated at 14.8% (95% CI: 7.8-26.2%), which was statistically significant.

The results of this study highlight the emergence of resistance to 5-nitroimidazoles, which poses a significant public health challenge.

Our findings emphasize the need for further research and the pursuit of new treatment options for resistant strains of T. vaginalis.