Prolonged vaginal and oral metronidazole for refractory Trichomonas vaginalis: a case report.
BACKGROUND
Resistant Trichomonas vaginalis infection is typically treated with increased doses of oral metronidazole. Because of side effects that limit compliance, such treatment may be ineffective.


METHODS
A young woman had an 8-year history of T vaginalis that was refractory to multiple courses of metronidazole, tinidazole and intravaginal paromomycin. After microscopic examination confirmed trichomonads, she began an extended, 14-day course of combined oral and vaginal metronidazole. Six weeks later her symptoms were unchanged, but microscopy revealed fewer trichomonads. After a 5% acetic acid vaginal wash and dilute silver nitrate bladder instillation, she was given the same treatment for 21 days. Symptoms and trichomonads resolved, and 3 years later she remained asymptomatic.


CONCLUSIONS
Prolonged vaginal and oral metronidazole, in combination with bladder and vaginal irrigation, should be considered in women with refractory T vaginalis.
Wood
Sara
S
epartment of Obstetrics and Gynecology, Roy J and Lucille A Carver College of Medicine, University of Iowa Hospitals and Clinics, Iowa City 52242, USA.
Kennedy
Colleen M
CM
Galask
Rudolph P
RP
D019342:Acetic Acid / Q000627:therapeutic use; D000282:Administration, Intravaginal; D000284:Administration, Oral; D000328:Adult; D000818:Animals; D000981:Antiprotozoal Agents / Q000009:adverse effects / Q000627:therapeutic use*; D003131:Combined Modality Therapy; D005260:Female; D006801:Humans; D008795:Metronidazole / Q000009:adverse effects / Q000627:therapeutic use*; D010349:Patient Compliance; D012835:Silver Nitrate / Q000627:therapeutic use; D013997:Time Factors; D016896:Treatment Outcome; D014247:Trichomonas Vaginitis / Q000188:drug therapy*; D014246:Trichomonas vaginalis / Q000187:drug effects*; D044364:Vaginal Douching / Q000379:methods*
D000981:Antiprotozoal Agents; D008795:Metronidazole; D012835:Silver Nitrate; D019342:Acetic Acid