title: Successful treatment of refractory Trichomonas vaginalis infection using intravenous metronidazole.
abstract: Trichomonas vaginalis is a sexually transmitted protozoan infection resulting in a vulvo-vaginitis and altered vaginal discharge in symptomatic women. Since its introduction in the 1960 s, metronidazole has been the first-line drug for trichomonal infection. Other nitroimidazoles, such as tinidazole, are used as alternative regimens with similar activity but at a greater expense. Treatment failure usually represents patient non-compliance or reinfection, although metronidazole resistance has previously been documented. Sensitivity testing is currently not available in the UK. Patients with disease unresponsive to first-line treatments pose a major challenge, as therapeutic options are limited. This case looks at a patient with refractory disease over an 18-month period, where intravenous infusion of metronidazole resulted in cure after multiple previous therapy failures. There is limited evidence to endorse the use of intravenous metronidazole, and this case report provides further support for its efficacy.
authors.affiliation: Addenbrookes Hospital, Cambridge University Hospitals NHS Foundation Trust, Cambridge Biomedical Campus, Cambridge, UK isobel.hawkins@doctors.org.uk.
authors.forename: Isobel
authors.initials: I
authors.lastname: Hawkins
authors.affiliation: Addenbrookes Hospital, Cambridge University Hospitals NHS Foundation Trust, Cambridge Biomedical Campus, Cambridge, UK.
authors.forename: Christopher
authors.initials: C
authors.lastname: Carne
authors.affiliation: Addenbrookes Hospital, Cambridge University Hospitals NHS Foundation Trust, Cambridge Biomedical Campus, Cambridge, UK.
authors.forename: Christopher
authors.initials: C
authors.lastname: Sonnex
authors.affiliation: Addenbrookes Hospital, Cambridge University Hospitals NHS Foundation Trust, Cambridge Biomedical Campus, Cambridge, UK.
authors.forename: Andrew
authors.initials: A
authors.lastname: Carmichael
mesh_terms: D000328:Adult; D000890:Anti-Infective Agents / Q000627:therapeutic use*; D005260:Female; D006801:Humans; D007262:Infusions, Intravenous; D008795:Metronidazole / Q000627:therapeutic use*; D016896:Treatment Outcome; D014247:Trichomonas Vaginitis / Q000175:diagnosis / Q000188:drug therapy*; D014246:Trichomonas vaginalis / Q000187:drug effects / Q000302:isolation & purification*
chemical_list: D000890:Anti-Infective Agents; D008795:Metronidazole
keywords: Trichomonas vaginalis; metronidazole; resistance; sexually transmitted infection; treatment; vaginal discharge