Trichomonad urethritis

Trichomonas urethritis is one of the most common sexually transmitted diseases. The incidence of the disease ranges from 2 to 90%.

Often asymptomatic, which complicates timely diagnosis and the transition of the disease into a chronic form. Treatment is effective in 98% of cases. The prognosis is favorable.

Epidemiology

Trichomoniasis is one of the most common STIs in the world. On average, 170-180 million new cases are registered per year. Unlike other STIs, trichomoniasis usually occurs more frequently with age and an increase in the number of sexual partners. Unlike in women, trichomoniasis in men is usually asymptomatic.

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Causes trichomonad urethritis

The causative agent of trichomoniasis belongs to the genus Trichomonas, which are united in the class of flagellates. Of all the types of Trichomonas, Trichomonas vaginalis is considered pathogenic. Trichomonas are pear-shaped, their length is 10-20 microns. They reproduce by longitudinal division. At the anterior end of the cell there is a single nucleus and 3-5 free flagella.

In women, the habitat is the vagina, in men - the prostate and seminal vesicles. The urethra can be affected in both sexes.

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Pathogenesis

The usual route of transmission of trichomonads is sexual, primary infection occurs during sexual contact. Trichomonas vaginalis can cause a moderately expressed inflammatory reaction, especially in the presence of a large number of parasites. The products of the vital activity of these microorganisms have a toxic effect on the tissues of the host organism. Hyaluronidase secreted by trichomonads leads to significant loosening of tissues and freer penetration of toxic products of bacterial metabolism into the intercellular spaces.

Trichomonas infection can occur as a transient and asymptomatic carrier, which is observed in 20-36% of infected individuals.

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Symptoms trichomonad urethritis

The incubation period for urogenital trichomoniasis is on average 10 days, but sometimes it is reduced to 2-5 days or extended to 30-60 days. Trichomoniasis can proceed as an acute, subacute and chronic inflammation. At the onset of the disease, subjective symptoms of trichomonas urethritis come to the fore - paresthesia in the head of the penis (itching, burning, crawling sensation). Itching of the mucous membranes with true trichomoniasis occurs almost constantly.

During the first day of the disease, men develop scanty gray or whitish watery discharge. Sometimes hemospermia occurs. Patients complain of itching during urination and severe dysuria. Without treatment, acute symptoms of trichomonas urethritis subside after 3-4 weeks, and urethritis becomes sluggish. Chronic trichomonas urethritis is similar in clinical signs to chronic gonorrhea. Periods of sluggish urethritis alternate with exacerbations resembling an acute disease. Chronic urethritis usually worsens or becomes complicated after vigorous sexual intercourse, alcohol abuse, etc.

In trichomonas urethritis, the inflammatory process often spreads from the anterior to the posterior section of the urethra and prostate.

Trichomoniasis in women is associated with the presence of other STIs, including gonorrhea, chlamydia, and sexually transmitted viral infections. Trichomonas increases susceptibility to other viruses, including herpes, human papillomavirus (HPV), and HIV infection.

Complications and consequences

Complications of trichomonas urethritis are similar to complications of other non-gonococcal urethritis. Trichomonas ulcers and erosions of the genitals, which are very similar to hard chancre, deserve special attention. In some cases, ulcers have irregular undermined soft edges, purulent plaque on the bottom and are very similar to chancroid pyoderma. Erosions with a bright red bottom and irregular shape are more common.

Trichomonas can be a direct cause of epididymitis. Trichomonas urethritis in most patients begins and proceeds subacutely with a minor and short-term temperature reaction. Acute epididymitis occurs more often in people who have in the discharge from the urethra.

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Diagnostics trichomonad urethritis

Diagnostics involves microscopy of urine samples, scrapings from the urethra, immunochromatographic detection of antigens in the test material, hybridization test with DNA probes (MLPA), and PCR diagnostics.

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Treatment trichomonad urethritis

Oral metronidazole (Flagyl) remains the drug of choice for the treatment of trichomoniasis. In cases where first-line drugs are ineffective, other nitroimidazoles (tinidazole) or high-dose metronidazole may be used.

Recommended schemes

• Metronidazole 2 g orally in a single dose.
• Ornidazole 2 g orally in a single dose.

For pregnant women, metronidazole is recommended to be taken orally at a dosage of 2 g in a single dose. There is evidence of a possible increased risk of premature birth in women with trichomoniasis treated with metronidazole.

Although metronidazole crosses the placental barrier, data suggest a low risk to pregnant women. No evidence of teratogenic or mutagenic effects in children has been found.

Alternative scheme

• Metronidazole 500 mg orally twice daily for 7 days

Alcohol should be avoided during treatment with nitroimidazoles. Nitroimidazoles are the only class of antimicrobial agents proven effective against Trichomonas. In randomized clinical trials, recommended metronidazole regimens resulted in cure rates of approximately 84%-98%, and recommended tinidazole regimens resulted in cure rates of approximately 92%-100%.

Both sexual partners must be treated. It is necessary to abstain from sex until the drug treatment is completely finished and all symptoms disappear.

A follow-up examination is recommended 3 months after treatment.

Prevention

The basis of prevention is the use of condoms by men.

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Forecast

Recommended treatment regimens with metronidazole result in complete cure in 90-95% of cases.

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