Infection with Trichomonas vaginalis is common in women and also occurs in men. It is probably often transmitted by sexual intercourse. Often it causes no symptoms, but when it does treatment is necessary. For many years only topical treatment was available, and many different applications have been used in women. There is no clear evidence that any one of these is more effective than the others, and even a simple cleansing douche, such as a vinegar douche (2–3 tablespoonfuls to a quart of warm water) often relieves symptoms. However, in women the organism commonly inhabits the lower urinary tract and both protozoa and symptoms may persist despite topical vaginal treatment; in men organisms are harboured in the prostate and other inaccessible sites. The introduction of metronidazole (Flagyl - M&B), an effective systemic trichomonacide, was therefore an important advance. The drug is an imidazole, and is active by mouth.
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