A previously healthy woman in her 30s presented to an infectious diseases clinic for evaluation of persistent Trichomonas vaginalis infection. She had developed vaginal discharge and irritation 2 years earlier after sexual intercourse with a male partner. She was diagnosed with trichomoniasis and treated with oral metronidazole, 2 g, in a single dose. However, her symptoms did not resolve. Over the course of the next 8 months she returned at least 6 times and saw different health care providers for treatment of persistent discharge. Each time, samples were sent for microscopy or nucleic acid amplification testing (NAAT), test results were positive for T vaginalis, and she was treated with different nitroimidazole regimens. In sequence, these treatments included oral metronidazole, 500 mg, twice daily for 7 days; oral tinidazole, 2 g, once daily for 5 days; oral metronidazole, 500 mg, twice daily plus intravaginal metronidazole for 7 days; oral tinidazole, 2 g, once; oral tinidazole, 2 g, once daily for 5 days; and oral metronidazole, 2 g, daily for 5 days.
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Salas A, Hamill MM, Tuddenham S. Nitroimidazole Resistance in Trichomonas vaginalis Infection: A Teachable Moment. JAMA Intern Med. Published online December 21, 2018. doi:10.1001/jamainternmed.2018.7241
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