Trichomoniasis in a closed community: 100 per cent follow-up.

Abstract

The scepticism with which gynaecologists and venereo logists regarded the possible effectiveness of an oral trichomonacide was doubtless justified by the unsubstan tiated claims that had been put forward some years ago for a chemical compound which is now happily superseded by metronidazole ( flagyl ). This does, in fact, destroy the parasite in the great majority of cases of trichomonal vaginitis. Where it fails to do so there are several possible explanations. The patient might not have taken the pills at all, or might have taken them irregularly. She might have been reinfected after being cured. The drug might in some cases not have been adequately absorbed from the gastro-intestinal tract ; or, where there was no defect in absorption, the concentration of metronidazole in the blood might have been insufficient to destroy the trichomonads in the depth of the uterine cervical glands in which long standing inflammation had led to decreased vascularity. A final theoretical possibility is that some strains of Trichomonas vaginalis might have a natural or acquired resistance to the drug. I am informed (J. A. McFadzean and S. Squires, private communication) that there is little laboratory evidence of defective absorption and no evidence at all of drug-resistant trichomonads. Presumption of cure after treatment with metronidazole is arrived at after a series of negative reports of microscopical and cultural examinations of specimens taken at intervals throughout the three-months follow-up ; but some patients default long before the end of that time. It was thought that it would be of interest to ascertain the effects of oral metronidazole in a closed community in which all the patients could be kept under observation for as long as was considered desirable, and where the risk of reinfection was negligible. These conditions were found in Her Majesty's Prison, Holloway, where the 102 women who are the subjects of this report were treated. In order to save space I have listed the names of the early investigators of metronidazole only in the bibliography. I differ from those French, German, and Canadian workers who continue to give the drug in the form of vaginal suppositories as well as oral tablets. I have used the latter solely, believing that local treatment with this substance is likely to be no more successful than earlier topical applications, the use of which was followed so often by relapse. An actively trichomonicidal substance applied to the vaginal mucosa can never reach deep-seated foci of infection ; and metronidazole so exhibited can cause local irritation.