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2.  Nifuratel Compared with Metronidazole in the Treatment of Trichomonal Vaginitis 
British Medical Journal  1970;2(5705):335-336.
Nifuratel (Magmilor) was compared with metronidazole (Flagyl) in the treatment of trichomonal vaginitis by a randomized double-blind trial. Only 18 out of 47 patients (38%) treated with nifuratel were found to be cured, whereas 42 out of 49 patients (85%) treated with metronidazole were cured. Severe reactions, necessitating withdrawal of treatment, occurred in three patients treated with nifuratel. There were no serious side-effects with metronidazole. The results of this trial indicate that nifuratel is not a satisfactory substitute for metronidazole in the treatment of trichomoniasis.
PMCID: PMC1700140  PMID: 4913962
3.  Bacterial Vaginosis, Atopobium vaginae and Nifuratel 
Current Clinical Pharmacology  2012;7(1):36-40.
As bacterial vaginosis (BV) is a potential cause of obstetric complications and gynecological disorders, there is substantial interest in establishing the most effective treatment. Standard treatment - metronidazole or clindamycin, by either vaginal or oral route – is followed by relapses in about 30% of cases, within a month from treatment completion. This inability to prevent recurrences reflects our lack of knowledge on the origins of BV. Atopobium vaginae has been recently reported to be associated with BV in around 80% of the cases and might be involved in the therapeutic failures. This review looks at the potential benefits of nifuratel against A. vaginae compared to the standard treatments with metronidazole and clindamycin. In vitro, nifuratel is able to inhibit the growth of A. vaginae, with a MIC range of 0.125-1 µg/mL; it is active against G. vaginalis and does not affect lactobacilli. Metronidazole is active against A. vaginae only at very high concentrations (8-256 µg/mL); it is partially active against G. vaginalis and also has no effect on lactobacilli. Clindamycin acts against A. vaginae with an MIC lower than 0.125 µg/mL and is active on G. vaginalis but it also affects lactobacilli, altering the vaginal environment. These observations suggest that nifuratel is probably the most valid therapeutic agent for BV treatment.
doi:10.2174/157488412799218824
PMCID: PMC3362959  PMID: 22082330
Antibiotic resistance; Atopobium vaginae; bacterial vaginosis; nifuratel; review.
4.  Sensitivity of Trichomonas vaginalis to metronidazole, tinidazole, and nifuratel in vitro. 
Prompted by the sensitivity of trichomonads to metronidazole and nifuratel in clinical practice, a study was conducted in 1971-1972 of 63 consecutive strains of Trichomonas vaginalis isolated from women with clinically refractory vaginal discharge. Their susceptibility to metronidazole, tinidazole, and nifuratel was tested, using a serial tube dilution technique. The minimum concentrations which in 48 hrs caused immobilization and lysis of trichomonads cultured in Diamond's medium was assessed. No differences in drug potency could be determined. The median trichomonistatic and trichomonicidal concentrations were 0-1 and 0-6 mug/ml. respectively when using an inoculum of 10,000 organisms per ml. An inoculum of 100,000 per ml. resulted in inhibitory concentrations of 1-0 and killing concentrations of 3-3 mug./ml. These levels are readily attained in blood and vaginal tissue after oral ingestion of the two imidazole derivatives. Thus, metronidazole has maintained its efficacy since it was first introduced more than a decade ago. The few therapeutic failures with metronidazole and tinidazole are considered to have been caused by pharmacokinetic deficiencies in the patients, or by re-infection.
PMCID: PMC1045320  PMID: 1087577
5.  Bacterial Vaginosis Assessed by Gram Stain and Diminished Colonization Resistance to Incident Gonococcal, Chlamydial, and Trichomonal Genital Infection 
The Journal of Infectious Diseases  2010;202(12):1907-1915.
Background. We sought to assess the relationship between bacterial vaginosis (BV) assessed by Gram stain and incident trichomonal, gonococcal, and/or chlamydial genital infection.
Methods. This longitudinal study included 3620 nonpregnant women aged 15–44 years who presented for routine care at 12 clinics in Birmingham, Alabama. Participants were assessed quarterly for 1 year. Vaginal smears were categorized by the Nugent Gram stain score (0–3, normal; 4–6, intermediate state; 7–10, BV). Pooled logistic regression was used to estimate the hazard ratios for the comparison of trichomonal, gonococcal, and chlamydial infection incidence in participants by Nugent score at the prior visit. Participants were censored at their first visit with a positive test result for trichomonal, gonococcal, and/or chlamydial infection.
Results. Of the 10,606 eligible visits, 37.96% were classified by BV and 13.3% by positive detection of trichomonal, gonococcal, and/or chlamydial infection. An intermediate state or BV at the prior visit was associated with a 1.5–2-fold increased risk for incident trichomonal, gonococcal, and/or chlamydial infection (adjusted hazard ratio [AHR] for intermediate state, 1.41 [95% confidence interval {CI}, 1.12–1.76]; AHR for BV, 1.73 [95% CI, 1.42–2.11]; P=.058 for trend). Estimates were similar for trichomonal-only, gonococcal-only, and chlamydialonly infection outcomes.
Conclusion. BV microbiota as gauged by Gram stain is associated with a significantly elevated risk for acquisition of trichomonal, gonococcal, and/or chlamydial genital infection.
doi:10.1086/657320
PMCID: PMC3053135  PMID: 21067371
6.  In Vitro Activity of Nifuratel on Vaginal Bacteria: Could It Be a Good Candidate for the Treatment of Bacterial Vaginosis?▿ 
Bacterial vaginosis is characterized by a shift of the physiological flora to a diverse spectrum of bacteria, where Gardnerella vaginalis and Atopobium vaginae are the most important markers. In this study, the antimicrobial activity of nifuratel against G. vaginalis, A. vaginae, and lactobacilli was compared with that of the two currently used antibiotics metronidazole and clindamycin. Results suggest that nifuratel has a better spectrum of activity, being highly active against G. vaginalis and A. vaginae without affecting lactobacilli.
doi:10.1128/AAC.01623-10
PMCID: PMC3088278  PMID: 21321147
7.  Antibacterial activity of nifuratel in urine and serum 
Journal of Clinical Pathology  1972;25(5):447-449.
The minimum inhibitory concentrations of nifuratel for 205 randomly selected isolates from urinary tract infections were tested by tube dilution. Of these, 177 (86·3%) were resistant to more than 6 μg/ml and 140 of 141 (99·3%) strains of Escherichia coli were resistant to more than 3 μg/ml. Urine levels of nifuratel were examined in two groups: one group had 400 mg given once and the other group had 2 g given over 24 hours. In both groups samples of urine were collected every hour for seven hours after the last dose. After one 400-mg dose the maximum urine level achieved by any subject was 2·0 μg/ml and the mean maximum level was 0·75 μg/ml. With the 2 g total dose, the maximum level noted was 4 μg/ml and the mean maximum level was 1·8 μg/ml. No measurable inhibition was noted in any of the blood samples removed at one and a half to two hours after the last dose.
PMCID: PMC477345  PMID: 4625698
9.  Treatment of candidal urinary tract infection with nifuratel. 
British Medical Journal  1976;2(6041):908-910.
Three patients with candidal urinary tract infections were successfully treated with oral nifuratel, a nitrofuran antimicrobial agent active against yeast and Trichomonas as well as urinary bacterial pathogens. The recommended dose is 400 mg thrice daily for a week. No side effects that could be attributed to the treatment were noted. Minimum ibhibitory concentration determinations for nifuratel against Candida strains of five species showed that 48 out of 59 organisms were inhibited by 50 mg/1 or less, the three strains of Candida species eliminated from our treated patients having MICs of nifuratel in the range of 10-50 mg/1.
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PMCID: PMC1688487  PMID: 974657
10.  Nifuratel for trichomonal vaginitis. 
British Medical Journal  1970;2(5712):792.
PMCID: PMC1700863  PMID: 5428755
11.  Nifuratel for trichomonal vaginitis. 
British Medical Journal  1970;2(5712):792.
PMCID: PMC1700821  PMID: 5428756
12.  Nifuratel for trichomonal vaginitis. 
British Medical Journal  1970;2(5711):731.
PMCID: PMC1700695  PMID: 5429662
13.  Nifuratel for trichomonal vaginitis. 
British Medical Journal  1970;2(5708):542.
PMCID: PMC1700368  PMID: 5428728
14.  Community based study of sexually transmitted diseases in rural women in the highlands of Papua New Guinea: prevalence and risk factors 
Sexually Transmitted Infections  1998;74(2):120-127.
OBJECTIVE: To estimate the prevalence of sexually transmitted diseases (STDs) and determine their risk factors/markers among a rural population of women in the highlands of Papua New Guinea. METHODS: Community based random cluster sample of women of reproductive age were interviewed and examined and had specimens collected for laboratory confirmation of chlamydial and trichomonal infection, gonorrhoea, syphilis, and bacterial vaginosis. RESULTS: Chlamydia trachomatis was detected in 26%, Trichomonas vaginalis in 46%, Neisseria gonorrhoeae in 1%, syphilis in 4%, pelvic inflammatory disease (PID) (diagnosed clinically) in 14%, and bacterial vaginosis in 9% of 201 women. 59% of the women had at least one STD. In a multivariate logistic regression analysis taking the clustered sampling into account, independent risk factors for chlamydial infection were age < or = 25 years, < four living children, visualization of yellow mucopurulent endocervical secretions on a white swab, and bacterial vaginosis. Being married to a man who did not have other wives was protective. For trichomonal infection, independent risk factors were having no formal education, infertility, more than one sexual partner in the previous 12 months, treatment for genital complaints in the previous 3 months, abnormal vaginal discharge detected on examination, and chlamydial infection. Similar levels of trichomonal infection were found in all age groups. Among married women, rates of infection correlated with their perception of their husband having had other sexual partners in the previous 3 months, and this relationship was significant for chlamydial infection among women over 25. CONCLUSION: STDs are a major problem in this population, with the risk factors varying by outcome. Current treatment regimens are inappropriate given the high prevalence of trichomonal infection, and the available services are inadequate. Effective interventions are required urgently to reduce this burden and to prevent the rapid transmission of HIV. 



PMCID: PMC1758105  PMID: 9634324
15.  The relationship between family planning methods, individual hygiene, and fertility with vaginal infections among the women referring to selected health centers in Isfahan city 
BACKGROUND:
With regard to the high commonality of vaginal infections among pregnancy-age women, especially gardnerella, candidiasis vaginitis, trichomonal vaginitis and chlamydia and by attending to this fact that these infections have a high cost, including the medical expenses and other services like missing working hours and bear a negative effect on the life quality of women as influential individuals in family and society, we decided to examine the commonality of some of these infections and their related factors among women referring to selected health centers in Isfahan City.
METHODS:
This research was of an analytical-descriptive type conducted on 266 samples referred to the midwifery unit of selected health centers in Isfahan City due to one of the common vaginal infections (gardnerella, candidiasis vaginitis, trichomonal vaginitis and chlamydia). The collection of data was carried out via conducting interview with women and filling out the researcher-made questionnaire with close-ended answers (38 questions) and open-ended answers (25 questions). Data analysis was done by descriptive and analytical statistics (variance analysis and chi-square test).
RESULTS:
The findings of the study showed a significant relationship (p = 0.04) between suffering from different kinds of vaginal infection and fertility factors (the treatment record of the spouse). But, there was no significant statistical relationship between suffering from these infections and delivery type, period regulation, seeing stains and the pregnancy prevention type. Meanwhile, a significant relationship was found between suffering from vaginitis and demographic and individual factors like women's job (p=0.001), their educational level (p = 0.006), body mass index (p = 0.01) and their weight (p = 0.02). However, no significant relationship was found between suffering from common vaginal infections and individual health factors.
CONCLUSIONS:
With regard to the research findings, knowledge of the factors related to vaginal infection, including the fertility factors, can be instrumental in preventing and reducing the suffering from these infections. Therefore, training related to mothers’ educational level and consulting with women for knowing the susceptibility factors like the effect of weight, attending to mothers’ professional issues and prevention methods by following individual and sexual health-related issues by men and women can reduce the rate of suffering from these infections and promote the health level of mothers and hence, the society's health status.
PMCID: PMC3203305  PMID: 22039384
Vaginal infections; fertility; individual hygiene
16.  The TvLEGU-1, a Legumain-Like Cysteine Proteinase, Plays a Key Role in Trichomonas vaginalis Cytoadherence 
BioMed Research International  2013;2013:561979.
The goal of this paper was to characterize a Trichomonas vaginalis cysteine proteinase (CP) legumain-1 (TvLEGU-1) and determine its potential role as a virulence factor during T. vaginalis infection. A 30-kDa band, which migrates in three protein spots (pI~6.3, ~6.5, and ~6.7) with a different type and level of phosphorylation, was identified as TvLEGU-1 by one- and two-dimensional Western blot (WB) assays, using a protease-rich trichomonad extract and polyclonal antibodies produced against the recombinant TvLEGU-1 (anti-TvLEGU-1r). Its identification was confirmed by mass spectrometry. Immunofluorescence, cell binding, and WB assays showed that TvLEGU-1 is upregulated by iron at the protein level, localized on the trichomonad surface and in lysosomes and Golgi complex, bound to the surface of HeLa cells, and was found in vaginal secretions. Additionally, the IgG and Fab fractions of the anti-TvLEGU-1r antibody inhibited trichomonal cytoadherence up to 45%. Moreover, the Aza-Peptidyl Michael Acceptor that inhibited legumain proteolytic activity in live parasites also reduced levels of trichomonal cytoadherence up to 80%. In conclusion, our data show that the proteolytic activity of TvLEGU-1 is necessary for trichomonal adherence. Thus, TvLEGU-1 is a novel virulence factor upregulated by iron. This is the first report that a legumain-like CP plays a role in a pathogen cytoadherence.
doi:10.1155/2013/561979
PMCID: PMC3581150  PMID: 23509742
17.  Ignored trichomonal infestation diagnosed by Papanicolaou smear. 
Genitourinary Medicine  1995;71(4):257-258.
OBJECTIVE--To compare the occurrence of Trichomonas vaginalis as demonstrated by culture and by Papanicolaou (PAP) smears in a sexually transmitted disease (STD) clinic. SETTING--The largest out-patient venereological clinic in Denmark. SUBJECT AND METHODS--As the prevalence of trichomonal infestation has decreased considerable in recent years direct microscopy of vaginal wet mounts is no longer performed routinely. Instead the screening diagnostic procedure is based on culture. We have retrospectively collected data on culture-negative women with Trichomonas vaginalis organisms present in cervical smears, taken on a routine basis to exclude atypical cells, and compared with the clinical findings. RESULTS--Since 1992 a total of 17 women were found to harbour Trichomonas vaginalis in cervical smear. A vaginal discharge was described in 10 women, six of whom had concomittant unspecific vaginitis. However, four women had unexplained vaginal discharge that could have been related to infestation with Trichomonas vaginalis. In addition one asymptomatic woman had a male partner with persistent urethritis. CONCLUSION--The prevalence of trichomoniasis is underestimated in women attending the clinic if the diagnosis is based on culture alone. PAP smears may be helpful in demonstrating characteristic trichomonal organisms. In general we do not recommend the PAP smear be used to diagnose STDs. However the finding of trichomanal organisms in smears should prompt a repeated culture and direct microscopy of vaginal wet mount.
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PMCID: PMC1195526  PMID: 7590721
18.  Monilial and Trichomonal Vaginitis—Topical Treatment with Povidone-Iodine Preparations 
California Medicine  1969;110(1):24-27.
A regimen of treatment for vaginitis combining the use of a povidone-iodine solution for swabbing, a povidone-iodine vaginal gel for application at night and a povidone-iodine douche for use in the morning, was evaluated in 93 courses of treatment in 87 patients with monilial or trichomonal vaginitis or a combination of both.
In monilial vaginitis, symptoms were cleared and negative laboratory results obtained in one to three weeks in all 74 courses of treatment. These results were obtained within one week in 52 cases and within two weeks in another 17.
In four of five patients with trichomonal vaginitis, symptoms were cleared within three weeks. In the fifth, negative laboratory results were obtained but a mild discharge persisted at the end of the fourth week.
In 14 courses for combined infections, symptoms were cleared within three weeks in 13, and the pathogens were absent in those patients within four weeks. In one patient the disease did not respond.
PMCID: PMC1503402  PMID: 5762464
19.  Trichomonas vaginalis adherence mediates differential gene expression in human vaginal epithelial cells 
Cellular microbiology  2005;7(6):887-897.
Summary
Trichomonas vaginalis, an ancient protist, colonizes the vaginal mucosa causing trichomonosis, a vaginitis that sometimes leads to severe health complications. Preparatory to colonization of the vagina is the adhesion to vaginal epithelial cells (VECs) by trichomonads. We hypothesized that VECs alter the gene expression to form a complex signalling cascade in response to trichomonal adherence. In order to identify the genes that are upregulated, we constructed a subtraction cDNA library after contact with parasites that is enriched for differentially expressed genes from the immortalized MS-74 VECs. Sixty cDNA clones were sequenced and to our knowledge for the first time, differentially regulated genes were identified in response to early trichomonal infection. The identified genes were found to encode functional proteins with specific functions associated with cell structure maintenance and extracellular matrix components, proinflammatory molecules and apoptosis. Semi-quantitative reverse transcription polymerase chain reaction (RT-PCR) confirmed expression of selected genes. Further, cyclooxygenase 2 (COX-2) protein expression was analysed using Western blot and immunofluorescence assays. Data suggest that p38 mitogen-activated protein (MAP) kinase and tyrosine kinases play a role in COX-2 induction. Finally, T. vaginalis and Tritrichomonas foetus but not Pentatrichomonas hominis induce expression of COX-2. This is a first attempt at elucidating the basis of interaction of trichomonads with host cells and the corresponding host responses triggered by the parasites.
doi:10.1111/j.1462-5822.2005.00522.x
PMCID: PMC2562669  PMID: 15888089
20.  CP30, a Cysteine Proteinase Involved in Trichomonas vaginalis Cytoadherence 
Infection and Immunity  2000;68(9):4907-4912.
We describe here the participation of a Trichomonas vaginalis 30-kDa proteinase (CP30) with affinity to the HeLa cell surface in attachment of this parasite to host epithelial cells. The CP30 band is a cysteine proteinase because its activity was inhibited by E-64, a thiol proteinase inhibitor. In two-dimensional substrate gel electrophoresis of total extracts of the trichomonad isolate CNCD 147, three spots with proteolytic activity were detected in the 30-kDa region, in the pI range from 4.5 to 5.5. Two of the spots (pI 4.5 and 5.0) bound to the surfaces of fixed HeLa cells corresponding to the CP30 band. The immunoglobulin G fraction of the rabbit anti-CP30 antiserum that recognized a 30-kDa band by Western blotting and immunoprecipitated CP30 specifically inhibited trichomonal cytoadherence to HeLa cell monolayers in a concentration-dependent manner and reacted with CP30 at the parasite surface. CP30 degraded proteins found on the female urogenital tract, including fibronectin, collagen IV, and hemoglobin. Interestingly, CP30 digested fibronectin and collagen IV only at pH levels between 4.5 and 5.0. Moreover, trichomonosis patients whose diagnosis was confirmed by in vitro culture possessed antibody to CP30 in both sera and vaginal washes, and CP30 activity was found in vaginal washes. Our results suggest that surface CP30 is a cysteine proteinase necessary for trichomonal adherence to human epithelial cells.
PMCID: PMC101697  PMID: 10948104
21.  Trichomoniasis in a Closed Community: Efficacy of Metronidazole 
British Medical Journal  1971;1(5742):207-209.
A retrospective survey of women treated in prison for trichomonal vaginitis with metronidazole showed that 488 of 496 (98·3%) were cured after one course of drugs. Five of the eight treatment failures were successfully treated by further courses of metronidazole.
A regimen of 400 mg metronidazole twice daily for seven days is simple and effective when taken in prescribed dosage. Metronidazole is still the drug of choice for trichomonal vaginitis. No toxic reactions were observed and there was no evidence that the drug has lost efficacy in the last ten years.
PMCID: PMC1794842  PMID: 5099972
22.  Iron and contact with host cells induce expression of adhesins on surface of Trichomonas vaginalis 
Molecular microbiology  2003;47(5):1207-1224.
Summary
The proteins AP65, AP51, AP33 and AP23 synthesized by Trichomonas vaginalis organisms in high iron play a role in adherence. Multigene families encode enzymes of the hydrogenosome organelles, which have identity to adhesins. This fact raises questions regarding the compartmentalization of the proteins outside the organelle and about the interactions of adhesins with host cells. Data here demonstrate the presence of the proteins outside the organelle under high-iron conditions. Fluorescence and immunocytochemical experiments show that high-iron-grown organisms coexpressed adhesins on the surface and intracellularly in contrast with low-iron parasites. Furthermore, the AP65 epitopes seen by rabbit anti-AP65 serum that blocks adherence and detects surface proteins were identified, and a mAb reacting to those epitopes recognized the trichomonal surface. Two-dimensional electrophoresis and immunoblot of adhesins from surface-labelled parasites provided evidence that all members of the multigene family were co-ordinately expressed and placed on the trichomonal surface. Similar two-dimensional analysis of proteins from purified hydrogenosomes obtained from iodinated trichomonads confirmed the specific surface labelling of proteins. Contact of trichomonads with vaginal epithelial cells increased the amount of surface-expressed adhesins. Moreover, we found a direct relationship between the levels of adherence and amount of adhesins bound to immortalized vaginal and ureter epithelial cells, further reinforcing specific associations. Finally, trichomonads of MR100, a drug-resistant isolate absent in hydrogenosome proteins and adhesins, were non-adherent. Overall, the results confirm an important role for iron and contact in the surface expression of adhesins of T. vaginalis organisms.
PMCID: PMC2562637  PMID: 12603729
23.  Differential susceptibility of fresh Trichomonas vaginalis isolates to complement in menstrual blood and cervical mucus. 
Genitourinary Medicine  1988;64(3):176-179.
The ability of complement in human menstrual blood and cervical mucus to kill Trichomonas vaginalis was compared with that of complement in serum, and 95 fresh trichomonal isolates obtained from vaginal wash material were evaluated for susceptibility to complement immediately after isolation. Only serum and menstrual blood with haemolytic activity produced total cytolysis of T vaginalis. The cytolytic abilities of these fluids were totally inactivated by treatment with heat or edetic acid (EDTA), which confirms the role of complement in cytolysis. Most cervical mucus samples had no detectable trichomonal cytotoxic properties. The cytotoxic activity in the remaining samples was not due to complement, as it was heat stable. Fresh isolates of T vaginalis and subpopulations of fresh isolates differed in their susceptibility or resistance to complement mediated lysis in serum. Resistance to complement did not remain stable after trichomonads were grown in vitro.
PMCID: PMC1194195  PMID: 3261708
24.  Analysis of human immunoglobulin-degrading cysteine proteinases of Trichomonas vaginalis. 
Infection and Immunity  1995;63(9):3388-3395.
Trichomonas vaginalis is a protozoan parasite that causes a widely distributed sexually transmitted disease (STD). Since immunoglobulin G (IgG) antibodies to specific trichomonad immunogens are found in serum and vaginal washes (VWs) from patients with trichomoniasis, a potential mechanism of immune evasion by this parasite might be the ability of T. vaginalis proteinases to degrade human immunoglobulins (Igs). Incubation of human IgG with lysates of T. vaginalis organisms resulted in time- and concentration-dependent degradation of the heavy chain. Secretory IgA was degraded similarly. Inhibitors of cysteine proteinases, when added to trichomonal lysates, abolished IgG and IgA degradation, while EDTA, a metalloproteinase inhibitor, did not. Substrate-gel electrophoresis with human IgG, IgM, or IgA copolymerized with acrylamide revealed several distinct cysteine proteinases in both lysates and culture supernatants from logarithmically growing parasites that degraded all classes of human antibodies. Trichomonal lysates and supernatants of numerous isolates tested all had Ig-degrading activity. Finally, proteolytic activity against IgG was detected in most (26 of 33; 78%) VWs from patients with trichomoniasis. In contrast, 18 of 28 (65%) VWs from women without trichomoniasis or from patients infected with other STDs had no detectable proteinases when tested in an identical manner. The other 10 of these 28 VWs (35%) had smaller amounts of detectable Ig-degrading proteinases. These differences in Ig-degrading proteinase activity between patients with and without trichomoniasis, regardless of coinfecting STDs, were statistically significant (P = 0.001). These results illustrate that T. vaginalis is capable of degrading human Igs.
PMCID: PMC173466  PMID: 7642267
25.  TRICHOMONAL VAGINITIS—The Problem of Chronic or Recurring Infection 
California Medicine  1958;89(3):191-194.
In general practice and in gynecology, vaginal trichomoniasis is a frequent and troublesome problem. However, the trichomonas vaginalis organism is frequently found in an apparently healthy vagina, indicating that symptoms, recurrences, or exacerbations may depend on local changes in secretions, probably due in part to emotional stress. Therapy must, therefore, include not only the topical use of an effective trichomonacidal drug, but also sympathetic and considerate listening by the physician.
The combination of furazolidone and nifuroxime in vaginal suppositories and vaginal insufflation powder was found to be an effective trichomonacidal compound. A total of 56 patients with trichomonal, monilial and nonspecific bacterial vaginitis was treated with this nitrofuran combination with good results.
In topical therapy, powders seem more effective, probably because a dry environment is unfavorable to the flagellates. The patient should be instructed to insert two vaginal suppositories daily for the first week, then to decrease the dosage gradually as indicated by the physician after clinical examination and microscopic examination of vaginal secretions each week. Of great importance is the fact that some patients may need long-term maintenance therapy—one or two suppositories weekly—especially if the emotional difficulties appear to be insurmountable.
PMCID: PMC1512478  PMID: 13573186

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