Successful Treatment of Four Patients With Recalcitrant Vaginal Trichomoniasis With a Combination of Zinc Sulfate Douche and Metronidazole Therapy

Abstract

BACKGROUND AND OBJECTIVES: There is no certain cure available for patients suffering from recalcitrant trichomoniasis. Zinc sulfate is reported to have antitrichomonal properties. We report our experience in treating four patients empirically with a combination of zinc sulfate douche and metronidazole. STUDY DESIGN: A retrospective case analysis. Patients who presented to the tertiary referral clinic with chronic recurrent trichomoniasis without evidence of reinfection were treated empirically with a combination of zinc sulfate douching (1%) followed by a metronidazole 500 mg suppository per vaginale twice daily and 200 to 400 mg three times a day orally. The douching and suppository were used prophylactically for 3 nights after menstruation for some months. RESULTS: Four patients who had a history of 4 months to 4 years of culture-positive symptomatic trichomoniasis and received a variety of therapies before referral were treated successfully. At the review of 2 to 5 months after therapy, all had remained asymptomatic and the results of clinical and laboratory examinations were normal. CONCLUSIONS: The exact role of zinc sulfate douching in the successful outcome is not certain, but the combination therapy requires only a moderate dose of metronidazole (1.6-2.2 g/day), avoiding the side effects of larger doses. The combination therapy therefore merits further evaluation.