title: A case of metronidazole-resistant Trichomonas vaginalis in pregnancy.
abstract: Trichomonas vaginalis is a sexually transmitted protozoan infection resulting in vulvo-vaginitis and altered vaginal discharge in symptomatic women. Trichomoniasis has been implicated in causing adverse pregnancy outcomes such as low birth weight and pre-term labour. Metronidazole is the recommended first-line treatment 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 re-infection, although metronidazole resistance has previously been documented. Antimicrobial susceptibility testing for T. vaginalis is currently not available in the UK. Patients with disease unresponsive to first-line treatments pose a major challenge, as therapeutic options are limited. We present the case of a patient with presumed resistant infection during pregnancy, and the additional treatment issues that this presented.
authors.affiliation: Department of Sexual Health, Cardiff Royal Infirmary, Cardiff, UK georgina.forbes@wales.nhs.uk.
authors.forename: Georgina L
authors.initials: GL
authors.lastname: Forbes
authors.affiliation: Department of Sexual Health, Cardiff Royal Infirmary, Cardiff, UK.
authors.forename: Rachel
authors.initials: R
authors.lastname: Drayton
authors.affiliation: Public Health Wales Microbiology Cardiff, University Hospital of Wales, Cardiff, UK.
authors.forename: Gavin D
authors.initials: GD
authors.lastname: Forbes
mesh_terms: D000994:Antitrichomonal Agents / Q000627:therapeutic use*; D004351:Drug Resistance; D005260:Female; D006801:Humans; D008795:Metronidazole / Q000627:therapeutic use*; D011247:Pregnancy; D015597:Pregnancy Complications, Parasitic / Q000175:diagnosis / Q000188:drug therapy*; D011256:Pregnancy Outcome; D014011:Tinidazole / 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: D000994:Antitrichomonal Agents; D014011:Tinidazole; D008795:Metronidazole
keywords: T. Vaginalis; Trichomonas vaginalis; metronidazole; pregnancy; resistance; sexually transmitted infection; trichomoniasis