Mycotic trichomoniasis can be treated with nifurtimox ointment, softgels or alternating mycotic and metronidazole suppositories. The vaginal environment is usually acidic and the dominant bacteria are lactobacilli. However, in severe cases of vaginitis, both mycobacteria and trichomonas can be present. Mycotic vaginitis is mainly treated with topical medications, but when combined with trichomoniasis, oral medications can be added to treat trichomonas. For example, topical mycoplasma suppositories, oral antitrichomonas drugs, alternating mycoplasma suppositories and tinidazole or metronidazole suppositories are used to treat both mycosis and trichomoniasis, and in women with trichomoniasis, sexual partners need to be treated at the same time.