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. 1995;2(5):242–247. doi: 10.1155/S1064744995000111

Bacterial Vaginosis and Trichomoniasis: Epidemiology and Management of Recurrent Disease

David E Soper 1,
PMCID: PMC2364397  PMID: 18475402

Abstract

Effective therapies exist for the treatment of both vaginal trichomoniasis and bacterial vaginosis (BV). Recurrent trichomonas infection is uncommon, and significant metronidazole resistance remains rare. The management of metronidazole-resistant trichomoniasis is dependent on susceptibility studies, which can be used to guide higher doses of metronidazole therapy. Recurrent BV is common. A mechanism for reestablishing the normal vaginal flora with H2O2-producing lactobacilli remains elusive. The management of this recurrent infection is based upon a longer duration of therapy with currently available antibiotic regimens and documentation of a clinical response using composite clinical criteria and Gram's stain of the vaginal secretions.

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Selected References

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  1. Ahmed-Jushuf I. H., Murray A. E., McKeown J. Managing trichomonal vaginitis refractory to conventional treatment with metronidazole. Genitourin Med. 1988 Feb;64(1):25–29. doi: 10.1136/sti.64.1.25. [DOI] [PMC free article] [PubMed] [Google Scholar]
  2. Cook R. L., Redondo-Lopez V., Schmitt C., Meriwether C., Sobel J. D. Clinical, microbiological, and biochemical factors in recurrent bacterial vaginosis. J Clin Microbiol. 1992 Apr;30(4):870–877. doi: 10.1128/jcm.30.4.870-877.1992. [DOI] [PMC free article] [PubMed] [Google Scholar]
  3. Eschenbach D. A., Hillier S., Critchlow C., Stevens C., DeRouen T., Holmes K. K. Diagnosis and clinical manifestations of bacterial vaginosis. Am J Obstet Gynecol. 1988 Apr;158(4):819–828. doi: 10.1016/0002-9378(88)90078-6. [DOI] [PubMed] [Google Scholar]
  4. Fischbach F., Petersen E. E., Weissenbacher E. R., Martius J., Hosmann J., Mayer H. Efficacy of clindamycin vaginal cream versus oral metronidazole in the treatment of bacterial vaginosis. Obstet Gynecol. 1993 Sep;82(3):405–410. [PubMed] [Google Scholar]
  5. Forsgren A., Forssman L. Metronidazole-resistant Trichomonas vaginalis. Br J Vener Dis. 1979 Oct;55(5):351–353. doi: 10.1136/sti.55.5.351. [DOI] [PMC free article] [PubMed] [Google Scholar]
  6. Grossman J. H., 3rd, Galask R. P. Persistent vaginitis caused by metronidazole-resistant trichomonas. Obstet Gynecol. 1990 Sep;76(3 Pt 2):521–522. [PubMed] [Google Scholar]
  7. Hillier S. L., Lipinski C., Briselden A. M., Eschenbach D. A. Efficacy of intravaginal 0.75% metronidazole gel for the treatment of bacterial vaginosis. Obstet Gynecol. 1993 Jun;81(6):963–967. [PubMed] [Google Scholar]
  8. Hilton E., Isenberg H. D., Alperstein P., France K., Borenstein M. T. Ingestion of yogurt containing Lactobacillus acidophilus as prophylaxis for candidal vaginitis. Ann Intern Med. 1992 Mar 1;116(5):353–357. doi: 10.7326/0003-4819-116-5-353. [DOI] [PubMed] [Google Scholar]
  9. Hughes V. L., Hillier S. L. Microbiologic characteristics of Lactobacillus products used for colonization of the vagina. Obstet Gynecol. 1990 Feb;75(2):244–248. [PubMed] [Google Scholar]
  10. Kent H. L. Epidemiology of vaginitis. Am J Obstet Gynecol. 1991 Oct;165(4 Pt 2):1168–1176. doi: 10.1016/s0002-9378(12)90722-x. [DOI] [PubMed] [Google Scholar]
  11. Livengood C. H., 3rd, Lossick J. G. Resolution of resistant vaginal trichomoniasis associated with the use of intravaginal nonoxynol-9. Obstet Gynecol. 1991 Nov;78(5 Pt 2):954–956. [PubMed] [Google Scholar]
  12. Livengood C. H., 3rd, McGregor J. A., Soper D. E., Newton E., Thomason J. L. Bacterial vaginosis: efficacy and safety of intravaginal metronidazole treatment. Am J Obstet Gynecol. 1994 Mar;170(3):759–764. doi: 10.1016/s0002-9378(94)70278-0. [DOI] [PubMed] [Google Scholar]
  13. Lossick J. G., Kent H. L. Trichomoniasis: trends in diagnosis and management. Am J Obstet Gynecol. 1991 Oct;165(4 Pt 2):1217–1222. doi: 10.1016/s0002-9378(12)90730-9. [DOI] [PubMed] [Google Scholar]
  14. Lossick J. G., Müller M., Gorrell T. E. In vitro drug susceptibility and doses of metronidazole required for cure in cases of refractory vaginal trichomoniasis. J Infect Dis. 1986 May;153(5):948–955. doi: 10.1093/infdis/153.5.948. [DOI] [PubMed] [Google Scholar]
  15. Lossick J. G. Treatment of sexually transmitted vaginosis/vaginitis. Rev Infect Dis. 1990 Jul-Aug;12 (Suppl 6):S665–S681. doi: 10.1093/clinids/12.supplement_6.s665. [DOI] [PubMed] [Google Scholar]
  16. Lugo-Miro V. I., Green M., Mazur L. Comparison of different metronidazole therapeutic regimens for bacterial vaginosis. A meta-analysis. JAMA. 1992 Jul 1;268(1):92–95. [PubMed] [Google Scholar]
  17. Lyng J., Christensen J. A double-blind study of the value of treatment with a single dose tinidazole of partners to females with trichomoniasis. Acta Obstet Gynecol Scand. 1981;60(2):199–201. [PubMed] [Google Scholar]
  18. Mead P. B., Gibson M., Schentag J. J., Ziemniak J. A. Possible alteration of metronidazole metabolism by phenobarbital. N Engl J Med. 1982 Jun 17;306(24):1490–1490. doi: 10.1056/nejm198206173062418. [DOI] [PubMed] [Google Scholar]
  19. Meingassner J. G., Thurner J. Strain of Trichomonas vaginalis resistant to metronidazole and other 5-nitroimidazoles. Antimicrob Agents Chemother. 1979 Feb;15(2):254–257. doi: 10.1128/aac.15.2.254. [DOI] [PMC free article] [PubMed] [Google Scholar]
  20. Mengel M. B., Berg A. O., Weaver C. H., Herman D. J., Herman S. J., Hughes V. L., Koepsell T. D. The effectiveness of single-dose metronidazole therapy for patients and their partners with bacterial vaginosis. J Fam Pract. 1989 Feb;28(2):163–171. [PubMed] [Google Scholar]
  21. Müller M., Lossick J. G., Gorrell T. E. In vitro susceptibility of Trichomonas vaginalis to metronidazole and treatment outcome in vaginal trichomoniasis. Sex Transm Dis. 1988 Jan-Mar;15(1):17–24. doi: 10.1097/00007435-198801000-00004. [DOI] [PubMed] [Google Scholar]
  22. Pattman R. S., Sprott M. S., Kearns A. M., Earnshaw M. Failure of mebendazole to cure trichomonal vaginitis resistant to metronidazole: case reports. Genitourin Med. 1989 Aug;65(4):274–275. doi: 10.1136/sti.65.4.274. [DOI] [PMC free article] [PubMed] [Google Scholar]
  23. Redondo-Lopez V., Meriwether C., Schmitt C., Opitz M., Cook R., Sobel J. D. Vulvovaginal candidiasis complicating recurrent bacterial vaginosis. Sex Transm Dis. 1990 Jan-Mar;17(1):51–53. [PubMed] [Google Scholar]
  24. Sands R. X. Pregnancy, trichomoniasis, and metronidazole. A novel dose schedule. Am J Obstet Gynecol. 1966 Feb 1;94(3):350–353. doi: 10.1016/0002-9378(66)90655-7. [DOI] [PubMed] [Google Scholar]
  25. Schmitt C., Sobel J. D., Meriwether C. Bacterial vaginosis: treatment with clindamycin cream versus oral metronidazole. Obstet Gynecol. 1992 Jun;79(6):1020–1023. [PubMed] [Google Scholar]
  26. Sobel J. D., Schmitt C., Meriwether C. Long-term follow-up of patients with bacterial vaginosis treated with oral metronidazole and topical clindamycin. J Infect Dis. 1993 Mar;167(3):783–784. doi: 10.1093/infdis/167.3.783. [DOI] [PubMed] [Google Scholar]
  27. Spiegel C. A. Bacterial vaginosis. Clin Microbiol Rev. 1991 Oct;4(4):485–502. doi: 10.1128/cmr.4.4.485. [DOI] [PMC free article] [PubMed] [Google Scholar]
  28. Swedberg J., Steiner J. F., Deiss F., Steiner S., Driggers D. A. Comparison of single-dose vs one-week course of metronidazole for symptomatic bacterial vaginosis. JAMA. 1985 Aug 23;254(8):1046–1049. [PubMed] [Google Scholar]
  29. Sweet R. L. New approaches for the treatment of bacterial vaginosis. Am J Obstet Gynecol. 1993 Aug;169(2 Pt 2):479–482. doi: 10.1016/0002-9378(93)90346-k. [DOI] [PubMed] [Google Scholar]
  30. Thomason J. L., Gelbart S. M., Scaglione N. J. Bacterial vaginosis: current review with indications for asymptomatic therapy. Am J Obstet Gynecol. 1991 Oct;165(4 Pt 2):1210–1217. doi: 10.1016/s0002-9378(12)90729-2. [DOI] [PubMed] [Google Scholar]
  31. Wong C. A., Wilson P. D., Chew T. A. Povidone-iodine in the treatment of metronidazole-resistant trichomonas vaginalis. Aust N Z J Obstet Gynaecol. 1990 May;30(2):169–171. doi: 10.1111/j.1479-828x.1990.tb03255.x. [DOI] [PubMed] [Google Scholar]
  32. Wood J. R., Sweet R. L., Catena A., Hadley W. K., Robbie M. In vitro adherence of Lactobacillus species to vaginal epithelial cells. Am J Obstet Gynecol. 1985 Dec 1;153(7):740–743. doi: 10.1016/0002-9378(85)90336-9. [DOI] [PubMed] [Google Scholar]
  33. van der Weiden R. M., van der Meijden W. I., Bogchelman D. H., Polderman A. M. Treatment failure in trichomoniasis and persistence of the parasite after Lactobacillus immunotherapy; two case reports. Eur J Obstet Gynecol Reprod Biol. 1990 Jan-Feb;34(1-2):171–178. doi: 10.1016/0028-2243(90)90021-r. [DOI] [PubMed] [Google Scholar]

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