Cure of Metronidazole- and Tinidazole-Resistant Trichomoiasis with Use of High-Dose Oral and Intravaginal Tinidazole

Physical examination showed an obese, 330-lb woman in no Tinidazole therapy was initiated (500 mg orally q.i.d. in addition distress. Significant findings included erythematous vulvar muto 500 mg intravaginally b.i.d.) and was continued for a total of cosa, introital tenderness, and a purulent vaginal discharge. A wet 14 days. All of her symptoms resolved. Cultures of vaginal secremount preparation revealed many motile trichomonads. In additions and urinary sediments in modified Diamonds media, 21 and tion, the organisms were grown in modified Diamonds media (Re60 days after completion of treatment, were negative for mel Microbiology Products, Lenexa, KS). Results of susceptibility T. vaginalis. Tinidazole was well tolerated by the patient, causing testing at the Centers for Disease Control and Prevention (CDC) only mild nausea. She remains symptom free 5 months later. indicated resistance to metronidazole and tinidazole (table 1). This case illustrates resistance in T. vaginalis organisms. Among Administration of a combination of oral (2.5 g/d) and intravagicases of trichomoniasis that fail to respond to treatment, clinicians nal (0.5 g at bedtime) metronidazole for 20 days with oral protend to attribute the treatment failure to poor compliance or to chlorperazine caused vomiting and failed to eradicate the infection. reinfection. As is true for any antimicrobial treatment, resistant Treatment with oral furazolidone, 300–400 mg q.i.d. for 7 days, strains should be considered in cases of persistent infection. Estiwas initiated. The patient developed nausea and brown-colored mates of the prevalence of infection due to metronidazole-resistant urine but was able to complete the treatment course, which resulted T. vaginalis range from marginal (one in 50–75 cases) to high in minimal symptomatic improvement. Wet mount preparations (one in 2,000–3,000 cases) [3]. The case we have described demand cultures of vaginal secretions continued to be positive for onstrates that high doses of tinidazole may be an option for patients trichomonads. Subsequently, she received a vaginal preparation who have infections due to resistant T. vaginalis, even in instances containing 100 mg of furazolidone in 5 g of 3% nonoxynol-9 one of in vitro resistance to the agent. High doses tinidazole therapy to three times daily for 7 days. She noted clinical improvement that were well tolerated in this case. There were fewer side effects persisted for ú1 month after treatment. Her symptoms eventually than associated with metronidazole therapy. The organisms were returned, and trichomonads were again noted in her vaginal secresusceptible to furazolidone. However, oral treatment with furazolitions. There was no interim sexual activity. done was ineffective, whereas a vaginal preparation containing