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1.  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.  Nifuratel for trichomonal vaginitis. 
British Medical Journal  1970;2(5712):792.
PMCID: PMC1700863  PMID: 5428755
4.  Nifuratel for trichomonal vaginitis. 
British Medical Journal  1970;2(5712):792.
PMCID: PMC1700821  PMID: 5428756
5.  Nifuratel for trichomonal vaginitis. 
British Medical Journal  1970;2(5711):731.
PMCID: PMC1700695  PMID: 5429662
6.  Nifuratel for trichomonal vaginitis. 
British Medical Journal  1970;2(5708):542.
PMCID: PMC1700368  PMID: 5428728
7.  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.
8.  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
9.  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
10.  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
11.  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
12.  Trichomonal vaginitis: evaluation of serological tests and identification of immunoreactive surface peptides. 
Genitourinary Medicine  1988;64(2):110-114.
An indirect haemagglutination assay (IHA) with polysaccharide and protein antigens of Trichomonas vaginalis and an enzyme linked immunosorbent assay (ELISA) were used to test for antibodies against T vaginalis in 58 women with trichonomal vaginitis and 48 with non-specific vaginitis. Eleven antibody positive sera were used in a radioimmunoprecipitation assay (RIPA) to identify surface peptides that elicited antibody responses in infected women. The serological tests were less sensitive than biological tests (smear examination and culture); antibodies were detected in 22 of the 58 women with trichomonal vaginitis by IHA using polysaccharide as antigen, in 27 by IHA using protein antigen, and in 36 by ELISA. The ELISA was also found to be of low specificity. Only two of the 11 sera tested by RIPA showed positive reactions with surface antigens, which were confirmed by autoradiography.
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PMCID: PMC1194168  PMID: 3384427
13.  Comparison of Resistant and Susceptible Strains of Trichomons vaginalis to Metronidazole Using PCR Method 
Background
Metronidazole is drug of choice recommended by WHO for treatment of trichomoniasis, however, some reports claims drug resistance in Trichomonas vaginalis isolates recently. The objective of this study was to determine the minimum lethal concentration (MLC) of metronidazole in resistant and sensitive strains, as well as genetic patterns of these stains by PCR method.
Methods
From February 2006 to March 2007, in a cross sectional study, clinical and wet mount examination of vaginal smear along with culture were performed on 683 women attending to public and private outpatient clinics in Hamadan. Trichomoniasis marked based on major clinical symptoms. Diagnosis confirmed using wet mount microscopically and culture in Diamond medium. A serial concentration of metronidazole was provided and all isolated Trichomonas strains (resistant and sensitive) tested by standard method. Finally, all sensitive and resistant strains examined by PCR technique.
Results
Only 15/683, (2.2%) of patients clinically diagnosed trichomonal vaginitis were positive for T. vaginalis by wet smear and culture. The minimum lethal concentration (MLC) for clinically sensitive isolates was 25 µg/ml; however, this concentration for resistant isolates was 200 µg/ml after 24 h and 100 µg/ml after 50 h. The results of PCR examination of DNA from sensitive and resistant isolates had same pattern. The lanes appeared by two primers were 98 bp and 261 bp for both clinically sensitive and resistant strains.
Conclusion
Resistance to metronidazole in T. vaginalis has not relation to genetic variations and might be related to some physiologic pathways of organism.
PMCID: PMC3469168  PMID: 23109958
Trichomonas vaginalis; Metronidazole; Resistance; PCR
14.  Trichomonal vaginitis refractory to treatment: case report. 
Genitourinary Medicine  1988;64(6):369-372.
A woman initially aged 25 was treated for seven years for symptomatic vaginal trichomoniasis. Throughout that period the patient received 5-nitroimidazoles at conventional and high dosages, antimicrobial agents to eliminate vaginal organisms capable of interfering with treatment, acidifying preparations, and vaccination with inactivated Lactobacillus acidophilus. Despite all the regimens used, the condition remained refractory to treatment.
PMCID: PMC1194269  PMID: 3147238
15.  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 (TV), gonococcal (GC) and/or chlamydial (CT) genital infection.
Methods
3,620 non-pregnant women aged 15-44 presenting for routine care at 12 clinics in Birmingham, Alabama participated in a longitudinal study. Participants were assessed quarterly for one year. Vaginal smears were categorized by Nugent's Gram stain score (0-3 designated normal, 4-6 intermediate state, 7-10 BV). Pooled logistic regression was used to estimate the hazard ratios (HR) for the comparison of TV/GC/CT incidence in participants by Nugent category at the prior visit. Participants were censored at their first TV/GC/CT-positive visit.
Results
Of the 10,606 visits, 37.96% were classified as BV and 13.3% as TV/GC/CT-positive. Intermediate state or BV at the prior visit were associated with a 1.5-2-fold increased risk for incident TV/GC/CT infection (adjusted HR(aHR):1.41, 95% CI:1.12-1.76; aHR: 1.73, 95% CI: 1.42-2.11, respectively, test for trend p=.058). Estimates were similar for TV-only, GC-only and CT-only outcomes.
Conclusion
BV microbiota gauged by Gram's stain is associated with a significantly elevated risk for acquisition of TV/GC/CT genital infection.
doi:10.1086/657320
PMCID: PMC3053135  PMID: 21067371
bacterial vaginosis (BV); vaginal microbiota; sexually transmitted infection (STI); Neisseria gonorrhoeae (GC); Chlamydia trachomatis (CT); Trichomonas vaginalis (TV)
16.  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
17.  Trichomonal vaginitis. A 24-hr regimen of nimorazole compared with a 7-day regimen of metronidazole. 
A 24-hr regimen of nimorazole (1 g. orally at 12-hrly intervals for three doses) was compared with metronidazole (200 mg. three times daily for 7 days) in the treatment of trichomonal vaginitis. The two treatment schedules were given to alternate patients, pregnant women being excluded. One hundred cases were treated on each schedule; roughly one-fifth of the patients in each group defaulted. There were no observed failures with either schedule. The reasons for these exceptionally good results are discussed.
PMCID: PMC1045112  PMID: 1092425
18.  Managing trichomonal vaginitis refractory to conventional treatment with metronidazole. 
Genitourinary Medicine  1988;64(1):25-29.
Three patients with vulvovaginitis caused by Trichomonas vaginalis, which was refractory to conventional treatment with metronidazole are described. The T vaginalis strain isolated from one patient was resistant to metronidazole (minimum inhibitory concentration (MIC) more than 100 mg/l) under aerobic conditions, although under anaerobic conditions it was as susceptible as a normal reference strain. The effect of the concomitant use of other medication and the influence of other vaginal pathogens on the efficacy of metronidazole are highlighted.
PMCID: PMC1194142  PMID: 3278971
19.  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
20.  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
22.  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
23.  Male circumcision and women's risk of incident chlamydial, gonococcal and trichomonal infections 
Sexually transmitted diseases  2008;35(7):689-695.
doi:10.1097/OLQ.0b013e31816b1fcc
PMCID: PMC2978019  PMID: 18418300
male circumcision; women; Chlamydia trachomatis; Neisseria gonorrhoeae; Trichomonas vaginalis
24.  In-Vitro Evaluation of Anti-Trichomonal Activities of Eugenia Uniflora Leaf 
Eugenia uniflora, used ethnomedically in some tropical countries as an anti-infective, has shown anti-malarial and anti-trypanocidal activities. Therefore using bioactivity guided fractionation, anti-trichomonal activity of E. uniflora leaf was investigated. Anti-trichomonal activities of leaf methanol extract and its fractions against Trichomonas gallinae as well as their cytotoxicities using an in vitro haemaglutination assay were determined. Anti-trichomonacidal activities of the extract improved on purification up to a stage. Subfractions E2–5 had LC50 and LC90 values of 4.77 – 5.28, 18.49 – 25.00 and 4.53 – 5.18, 18.32 – 19.07 µg/ml at 24 and 48 hrs, respectively that were better than those of metronidazole. Further purification of E2–5 led to loss of activity suggesting that the active components were probably working synergistically and additively. Demonstration of low haemaglutination titre values of 0.00 – 5.33 by methanolic extract and its partition fractions suggested their low toxicity profile. The established safety of the leaf indicated that its anti-trichomonal activity was not due to non-specific cytotoxicity, hence could be used in ethnomedicine as an anti-trichomonal agent.
PMCID: PMC3252693  PMID: 22238499
Eugenia uniflora; leaf extract; Trichomonas gallinae; in vitro
25.  Rare Case of Trichomonal Peritonitis 
Emerging Infectious Diseases  2011;17(7):1312-1313.
doi:10.3201/eid1707.100892
PMCID: PMC3381402  PMID: 21762600
Tritrichomonas foetus; Tritrichomonas suis; immunocompromised; peritonitis; parasite; human; letter

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