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Re: Trich revisitedFrom: Terrence Jones (Terrence.Jones@kp.org)Wed Nov 1 14:44:38 2000
Rich, don't think an amnio is necessarily indicated, if trich vaginitis is only symptom (ie: no other s/s of chorio). Don't think the trich is 'coming' from up there, as it would have a difficult time traversing the membranes the way GBS does. More likely, the post-Rx wet smear missed residual organisms. To overcome this, the folks at SF State have studied the InPouch TV test, which also can screen for resistance, due to mutations in ferredoxin. If no resistance by MLC (minimum lethal conc) on InPouch culture, then repeat course of oral flagyl, and consider suppl with 1) hypertonic saline (per Roger Klam's suggestion): or 2)ZnSO4 + metronid supps, per Hoang (Sex Trans Dis 2/97, 24:116-9). If resistance demonstrated then titrate dose (oral Vs IV) to MLC, or consider nitrofuran (Furazolidone - Narcisi 5/96), provided She's not G6PD def; or aminoglyc (Paromomycin ( Nyirjesy 10/95, Lancet) - which, as Art mentioned a year or so ago, can be administered vaginally (Nyirjesy, Clin I! nf Dis '98, 26:986-88). Your lab should be able to get the InPouch kit from Biomed (San Jose) for app $95. tj.
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