Difficult‐to‐Treat Trichomoniasis: Results with Paromomycin Cream

Abstract

Vaginal trichomoniasis poses a difficult therapeutic challenge when metronidazole is ineffective or contraindicated. We conducted a retrospective study of 6.25% paromomycin cream in the treatment of nine women referred with cases of vaginal trichomoniasis where metronidazole resistance or allergy was present. Results obtained immediately and 1 month after treatment were reviewed. The median age of the patients was 46 years; four women were nulliparous. The median symptom duration was 1 year. Five women were allergic to metronidazole. In four cases, resistance to high doses of metronidazole was demonstrated. Smears or cultures were positive immediately after treatment for three patients; a fourth relapsed 2 weeks later. Of these patients for whom treatment failed, one was cured with a 3-week course of paromomycin cream, and another was successfully treated with paromomycin cream and oral tinidazole. Three patients developed vaginal ulcerations that resolved spontaneously. Adverse effects may be a result of local formulation. Paromomycin cream was useful for treatment of cases of trichomonas infection where metronidazole resistance or allergy was encountered.

Molecular Characterization of Trichomonas tenax Causing Pulmonary Infection

“…Pulmonary infections caused by other trichomonads such as P. hominis, a parasite of the gastrointestinal tract, or T. vaginalis, a pathogen of the genitourinary system, are very unusual (4,6). However as clinical resistance and in vitro resistance to metronidazole have been regularly reported for T. vaginalis, species characterization by molecular methods is of clinical importance (1,5,8,12,14).…”

United Kingdom National Guideline on the Management of Trichomonas vaginalis 2014

“…Paromomycin* intravaginally 250 mg once or twice daily for 14 days -56-58% cure rate reported 78,80 Furazolidone* intravaginally 100 mg twice daily for 12-14 days -33% cure rate reported 72,81 Acetarsol* pessaries 500 mg nocte for 2 weeks 6% Nonoxynol-9* pessaries nightly for 2 weeks Availability *The medicines suggested for use in treatment failure are unlicensed products and may not be readily available for purchase in the UK. The pharmacy purchasing department may be able to source some of these products from specialist manufacturers.…”

Antimicrobial resistance in vulvovaginitis

“…Nyirjesy et al [20] reported considerable success with topical paromomycin cream. Unfortunately, paromomycin is not widely available and its use has been associated with a high frequency of local vulvovaginal irritation and toxicity.…”