An imidazole derivative (flagyl) effective orally in vaginal trichomoniasis.

The very large number of chemical, antibiotic, hormonal, and other substances prepared as powders, creams, ointments, and solutions and applied by various means in the local treatment of vaginal trichomoniasis is a striking testimony to the general ineffectiveness of them all. Recurrence rates of 30-50 per cent. after the ensuing menstrual period are commonplace. Such recurrences are considered due to residual trichomonads not reached by the vaginal medication, particularly in the urethra and para-urethral glands, from which re-infection of the vagina may occur, and from re-infection from the male consort who may harbour T. vaginalis in the urethra and prostate or in the sub-preputial sac. What is required is an effective drug which may be given systemically and which may also be used, if necessary, for the male partner. The substances already tried have completely or almost completely disappointed. These have included arsenical and bismuth preparations, atebrin and other anti-malarial drugs, antibiotics (including penicillin, streptomycin, the broad-spectrum group, and the anti-fungal antibiotic trichomycin), and also aminitrozole-although claims had been advanced as to the usefulness of the latter two substances. A new substance developed in France, and known as Flagyl (8823 R.P.) a-, hydroxyethyl-2-methyl-5 nitro-imidazole, holds considerable promise in the treatment of this troublesome condition. It is available in 200-mg. tablets for oral use, and in ordinary doses appears to be a relatively non-toxic drug (Cosar and Julou, 1959). Durel, Roiron, Siboulet, and Borel (1959, 1960) have reported upon its successful use in all of twelve male patients with urethral trichomoniasis and in sixteen of nineteen women with vaginal trichomoniasis-although in the latter series, local treatment with the same preparation was usually administered concurrently. The