A 33-year old woman with nitroimidazole-resistant vaginal trichomoniasis is described. She was treated with intravaginal paromomycin (500 mg daily for 2 days). This cured the trichomoniasis but resulted in severe local side effects. Paromomycin may be useful for difficult cases of nitroimidazole-resistant Trichomonas vaginalis vaginitis. The exact dosage still has to be determined.