title: Recalcitrant Trichomonas vaginalis infections successfully treated with vaginal acidification.
abstract: BACKGROUND
  Recalcitrant vaginal trichomoniasis is extremely distressing for patients and frustrating for physicians because there are no current guidelines for treatment. Numerous studies have shown that an increase in vaginal pH creates a better environment for the growth of Trichomonas vaginalis. We describe two patients with recalcitrant trichomoniasis who were successfully treated using vaginal acidification.
  
  
  METHODS
  The first patient with trichomoniasis had a severe reaction to metronidazole, but the infection subsequently resolved after treatment with a combination of boric acid and clotrimazole. The second patient with resistant trichomoniasis had been treated unsuccessfully with multiple courses of metronidazole but was treated successfully with vaginal acidification using boric acid.
  
  
  CONCLUSIONS
  A process of vaginal acidification resulted in resolution of recalcitrant Trichomonas vaginalis in two patients.
authors.affiliation: Department of Obstetrics and Gynaecology, University of Toronto, Toronto ON.
authors.forename: Anjali
authors.initials: A
authors.lastname: Aggarwal
authors.affiliation: Department of Obstetrics and Gynaecology, University of Toronto, Toronto ON.
authors.forename: R Michael
authors.initials: RM
authors.lastname: Shier
mesh_terms: D019342:Acetic Acid / Q000627:therapeutic use; D000328:Adult; D000818:Animals; D000891:Anti-Infective Agents, Local / Q000627:therapeutic use; D000981:Antiprotozoal Agents / Q000627:therapeutic use*; D001888:Boric Acids / Q000494:pharmacology / Q000627:therapeutic use*; D003022:Clotrimazole / Q000627:therapeutic use*; D005260:Female; D005840:Gentian Violet / Q000627:therapeutic use; D006801:Humans; D006863:Hydrogen-Ion Concentration; D008875:Middle Aged; D012008:Recurrence; D016896:Treatment Outcome; D014247:Trichomonas Vaginitis / Q000188:drug therapy*; D014246:Trichomonas vaginalis / Q000187:drug effects*; D014621:Vagina / Q000187:drug effects / Q000469:parasitology*
chemical_list: D000891:Anti-Infective Agents, Local; D000981:Antiprotozoal Agents; D001888:Boric Acids; D003022:Clotrimazole; D005840:Gentian Violet; D019342:Acetic Acid