Thank you for using Ask a Doctor Service from Doctor spring.

I can understand how bothersome this problem could be, and I will try to help you the best possible

From your description about the vaginal discharge and the vaginal swab microscopy report  it is quite typical of vaginal infection with a protozoan organism called trichomonasvaginalis. It usually presents with yellowish heavy foul smelling discharge. And you have been treated repeatedly with flagyl and clindamycin, this could have caused you develop resistance for these medications which is used to treat this protozoan infection. Due to resistance, these medicines may not be effective and will typically lead to treatment failure as it might have happened in your case. Usually with two standard course of treatment with flagyl the infection resolves, but you still persist to be symptomatic, the next level of therapy is to increase the dosage and duration of the flagyl, however this can cause certain side effects.

So you might need an alternative therapy to treat this infection. But before you opt for alternative treatment, you will have to confirm the resistance to metronidazole(flagyl) through culture susceptibility test which will be done in any medical laboratory. However, there are other reasons for treatment failure with flagyl such as not taking the medicine as prescribed regularly and repeated reinfection through your sexual partner if he is not treated concurrently. It is important to rule out these two factors before we think about treatment failure with flagyl. Alternative therapy consists of short term treatment with a similar drug called tinidazole. Tinidazole is generally an expensive alternative to metronidazole for the treatment of trichomoniasis. If the symptoms worsen and persist, then I would advise you to go for culture susceptibility test with flagyl and discuss with your doctor for alternative therapies. I would like to advise you to use condom to prevent re infection and also spread of infection when you have sexual contact in future.

Hope this helps. Feel free to ask if you have any further questions.

Thank you