Local treatment of Trichomonas vaginitis.

There is general agreement that the treatment of trichomonas vaginitis is unsatisfactory. Medicaments administered by mouth or parenterally have proved ineffective, and although the immediate response to some remedies applied locally is satisfactory, there is a marked tendency to relapse. There seems little doubt that the preparations which seem effective do no more than temporarily suppress the signs of infection in many cases. It is sometimes necessary to maintain suppressive treatment for many months before cure can be presumed and in some cases there are frequent relapses despite prolonged treatment of all kinds. The value of local remedies must be assessed by the degree and speed with which the clinical effects of vaginal discharge, intertrigo, dyspareunia, and pelvic pain are abolished, and, in the course of observation and tests, by the proportion of cases in which the patients remain free from relapse. Assessment requires a considerable period of observation, and testing is complicated by the fact that many patients discontinue attendance when their symptoms are relieved, and that with outpatients there is no means of distinguishing between re-infection and relapse. The necessity for prolonged treatment in many cases renders it imperative that remedies should be well tolerated and that patients should not readily become sensitized to them. The standard preparation which has been used for a number of years is acetarsol. It has proved the most effective of the many remedies which have been tried and recommended, and in general it is well tolerated. It is, however, an arsenical preparation and cases of sensitization have been reported. Most of these, which occurred after prolonged treatment with acetarsol vaginal pessaries or powder used intravaginally,.were manifested by a generalized exfoliative dermatitis, pyrexia, and malaise (Kesten, 1938; Doyle, 1952). Some patients had been previously sensitized by arsenical compounds for the treatment of syphilis and showed immediate symptoms of sensitization on beginning a subsequent course of acetarsol vaginal pessaries (Campbell,