ABSTRACT
BACKGROUND There has been a great change in American physicians’ attitudes about Trichomonas vaginitis since the introduction of metronidazole into clinical practice in 1963. Before that, there was no effective treatment regimen, and practicing physicians faced the daunting task of ministering to a large number of women with an uncomfortable, persistent, and annoying vaginal discharge in which medications might temporarily relieve symptoms, but would not eradicate the problem. Although some women were able to eliminate the organism with local vaginal defense mechanisms, the majority had a persistent chronic infection. For these women, the mantra was similar to the one applied to genital herpes today: Trichomonas was forever. Metronidazole changed all that. The effectiveness of this treatment has remarkably reduced the incidence of the infection, and this has been seen in all Western industrialized countries. Currently, in the Cornell referral vulvovaginitis clinic, there is rarely more than one patient a year seen with a symptomatic T. vaginalis vaginitis. This probably relects the upper middle-class social status of this referral patient population. In contrast, using polymerase chain reaction (PCR) testing of low-income pregnant women, T. vaginalis was detected in 22 of 219 patients (10%)1. Similarly, a PCR T. vaginalis detection study of sexually active low-or middle-income adolescent women in Indiana, USA, identified infection initially in 16 of 268 (6%) of the participants; 57 of 245 (23.2%) of the study population with at least 3 months of follow-up had at least one infection2. In addition, this is a common sexually transmitted disease (STD) in third world countries that have a parallel high incidence of human immunodeficiency virus (HIV) infections. One study of men attending STD and dermatology clinics in Malawi found an incidence of 17%3. Physician awareness of this infection will be dependent upon the composition of their patient population.
