Persistent vaginitis caused by metronidazole-resistant trichomonas.

Persistent trichomonal vaginitis is usually considered the result of either patient noncompliance with therapy or reinfection. Drug-resistant trichomoniasis may also cause continued infection despite repeated courses of conventional metronidazole therapy. We report two cases of exceptionally persistent and prolonged infection despite repetitive and varied treatments, including parenteral metronidazole. An unconventional approach combining oral and topical therapy resulted in clinical and microbiologic cure in both cases.