title: Successful treatment of four patients with recalcitrant vaginal trichomoniasis with a combination of zinc sulfate douche and metronidazole therapy.
abstract: OBJECTIVE
  There is no certain cure available for patients suffering from recalcitrant trichomoniasis. Zinc sulfate is reported to have antitrichomonal properties. We report our experience in treating four patients empirically with a combination of zinc sulfate douche and metronidazole.
  
  
  METHODS
  A retrospective case analysis. Patients who presented to the tertiary referral clinic with chronic recurrent trichomoniasis without evidence of reinfection were treated empirically with a combination of zinc sulfate douching (1%) followed by a metronidazole 500 mg suppository per vaginale twice daily and 200 to 400 mg three times a day orally. The douching and suppository were used prophylactically for 3 nights after menstruation for some months.
  
  
  RESULTS
  Four patients who had a history of 4 months to 4 years of culture-positive symptomatic trichomoniasis and received a variety of therapies before referral were treated successfully. At the review of 2 to 5 months after therapy, all had remained asymptomatic and the results of clinical and laboratory examinations were normal.
  
  
  CONCLUSIONS
  The exact role of zinc sulfate douching in the successful outcome is not certain, but the combination therapy requires only a moderate dose of metronidazole (1.6-2.2 g/day), avoiding the side effects of larger doses. The combination therapy therefore merits further evaluation.
authors.affiliation: Department of Microbiology, Queen Charlotte's and Chelsea Hospital, London, United Kingdom.
authors.forename: E T
authors.initials: ET
authors.lastname: Houang
authors.forename: Z
authors.initials: Z
authors.lastname: Ahmet
authors.forename: A G
authors.initials: AG
authors.lastname: Lawrence
mesh_terms: D000328:Adult; D004359:Drug Therapy, Combination; D005260:Female; D006801:Humans; D008795:Metronidazole / Q000008:administration & dosage*; D012189:Retrospective Studies; D007507:Therapeutic Irrigation; D014247:Trichomonas Vaginitis / Q000188:drug therapy*; D019287:Zinc Sulfate / Q000008:administration & dosage*
chemical_list: D008795:Metronidazole; D019287:Zinc Sulfate