LAUSR

RESULTS: Case 1 is a 46 y.o. woman with a 15-month history of persistent trichomoniasis. She underwent 10 treatments with oral TDZ over the course of one year without relief; the highest dose was 3g daily for 14 days. Subsequently she was treated with PARO, but stopped after two days due to minor bleeding and no improvement. CDC susceptibility testing was performed and showed very high levels of resistance to metronidazole and significant resistance to tinidazole. Upon confirmation of diagnosis, the patient was prescribed a combination regimen consisting of 1g of oral TDZ three times daily and 4g of a 6.25% PARO cream for 14 days. Cure was documented with negative trichomonas culture at 1 month and NAAT at 3 and 4 months. Case 2 is a 49 y.o woman with a 5-month trichomonas infection, treated with 4 treatments of oral MTZ and oral TDZ, with the highest dose of TDZ being 2 grams daily for a week. She was supposed to use combination high dose TDZ (1 g three times daily) and 4g of 6.25% PARO cream nightly for two weeks, but got confused and used each medication in sequence. When she returned, she tested positive again and was treated with combination TDZ and PARO. Trichomonas NAAT was negative at 1 and 4 months. CONCLUSIONS: The cases presented here demonstrated clinical resistance to monotherapy with high-dose oral TDZ and intravaginal PARO, but the combination effected a cure in both cases. This experience indicates an additive and perhaps a synergistic effect between TDZ and PARO. In vitro studies evaluating both medications and their interactions may help develop new options to address an uncommon scenario for which there exist few treatments.