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.

Chlamydia trachomatis, Neisseria gonorrhoeae, and Trichomonas vaginalis screening and treatment of pregnant women in Port-au-Prince, Haiti

“…However, that means that treated individuals may continue to test positive using a molecular test after treatment beyond the period of infectivity. In addition, there is emerging evidence of metronidazole-resistant TV globally 22 and this could be another explanation for the high positive TV rates at the test-of-cure; however, we were unable to explore these possibilities in the present study. Further research is needed to determine the time to organism clearance to inform appropriate timing for test-of-cure; however, some evidence suggests that nucleic acid-based tests for NG infection will be negative at 7 to 14 days after treatment 23 and over 85% of women will be negative for TV and CT nucleic acid after 21 days of treatment.…”

Nichtvirale sexuell übertragene Infektionen – Epidemiologie, Klinik, Labordiagnostik und Therapie

“…Metronidazol ist Mittel der Wahl zur Therapie der Trichomoniasis (In-vitro-Resistenz findet sich nur selten) [15,47]. Mit einer Einzeldosis von 2 g können mehr als 90 % der Frauen erfolgreich behandelt werden.…”

Therapeutic effects of Iranian herbal extracts against Trichomonas vaginalis

“…Studies have shown an incomplete cross-resistance to tinidazole in metronidazole-resistant isolates that can possibly be treated by tinidazole, but the similarity of metabolic pathways in metronidazole and tinidazole causes the rapid spread of resistance to tinidazole. Also, its cost is more than metronidazole; therefore, it cannot be used commonly[ 22 , 42 ].…”