Am Fam Physician. 2005 Oct 15;72(8).
to the editor: Drs. Owen and Clenney presented a nicely organized review of the management of vaginitis in their American Family Physician article.1 They mention tinidazole (Tindamax) for the treatment of Trichomonas vaginalis. This drug has been approved by the U.S. Food and Drug Administration and is now available in the United States for the treatment of T. vaginalis. It is given in a single 2-g oral dose, similar to metronidazole (Flagyl), both of which interact with alcohol. Side effects of the two drugs are similar. Tinidazole is pregnancy category C and is contraindicated in women who are in the first trimester. Metronidazole is pregnancy category B. Tinidazole is considerably more expensive than generic metronidazole but may be effective in patients with metronidazole-resistant Trichomonas.2
In the discussion of diagnostic criteria for bacterial vaginosis, the authors1 correctly quote the Amsel criteria. The presence of a fishy odor would certainly be a positive whiff test, but the traditional way to do the whiff test is to check for a fishy odor after adding a few drops of 10 percent potassium hydroxide to the vaginal secretions.3 This raises the pH and causes a release of aromatic amines by the anaerobes, resulting in a distinctive amine, or fishy odor, that may not be evident on initial examination.
1. Owen MK, Clenney TL. Management of vaginitis. Am Fam Physician 2004;70:2125-32.
2. Tinidazole (Tindamax)—a new anti-protozoal drug. Med Lett Drugs Ther 2004;46:70-2.
3. Eschenbach DA, Hillier S, Critchlow C, Stevens C, DeRouen T, Holmes KK. Diagnosis and clinical manifestations of bacterial vaginosis. Am J Obstet Gynecol 1988;158:819-28.
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