# Persistent Trichomoniasis in Pregnancy: A Case Report Calling for Further Research to Alternative Antibiotic Treatment

## TL;DR

A pregnant woman with persistent trichomoniasis unresponsive to standard treatment highlights the need for safer antibiotic alternatives during pregnancy.

## Contribution

This case report highlights metronidazole resistance in pregnancy and calls for research into alternative treatments.

## Key findings

- A 39-year-old pregnant woman had persistent trichomoniasis unresponsive to multiple metronidazole courses.
- Recurrent symptoms suggested metronidazole resistance and uterine irritability.
- Current alternative treatments for resistance lack safety data in pregnancy.

## Abstract

Trichomoniasis is an STI caused by a microscopic parasite known as Trichomonas vaginalis. It is considered one of the most widespread nonviral STDs globally. Trichomoniasis during pregnancy can lead to complications such as early rupture of membranes and premature birth. The standard treatment for trichomoniasis in adults, including pregnant individuals, is metronidazole. Recurrent cases may occur due to factors such as incomplete treatment, reinfection, or metronidazole resistance. In cases of persistent trichomoniasis where noncompliance and reinfection have been ruled out, metronidazole resistance should be considered. We present the case of a 39-year-old woman, gravida 4, para 3, with persistent trichomoniasis unresponsive to multiple courses of metronidazole, suggesting potential metronidazole resistance. She experienced recurrent symptoms of threatened preterm labor, likely due to uterine irritability caused by trichomoniasis. While various treatment regimens are available for metronidazole resistance, their safety profiles have not been evaluated during pregnancy. Further research is essential to identify a safe and effective treatment for metronidazole-resistant trichomoniasis in pregnancy.