Trichomonas urethritis

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

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

Epidemiology

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

[1], [2], [3], [4], [5], [6], [7], [8], [9],

Causes of the trichomonas urethritis

The causative agent of trichomoniasis belongs to the genus Trichomonas, united in the class of flagellates. Of all the types of Trichomonas pathogenic consider Trichomonas vaginalis Trichomonas have a pear shape, their length is 10-20 microns. Breed by longitudinal division. At the front 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 may be affected in both sexes.

[10], [11]

Pathogenesis

The usual route of transmission of Trichomonas - sexual, primary infection occurs during sexual contact. Trichomonas vaginalis can cause a moderately pronounced inflammatory reaction, especially in the presence of a large number of parasites. The waste products of these microorganisms have a toxic effect on the tissues of the host. The hyaluronidase secreted by trichomonads leads to a significant loosening of the tissues and more free penetration of the toxic metabolic products of bacteria into the intercellular spaces.

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

[12], [13], [14], [15]

Symptoms of the trichomonas urethritis

The incubation period for urogenital trichomoniasis averages 10 days, but sometimes shortens to 2-5 days or lengthens to 30-60 days. Trichomoniasis can occur in the type of acute, subacute and chronic inflammation. At the beginning of the disease, the subjective symptoms of Trichomonas urethritis - paresthesia in the area of the glans penis (itching, burning, goosebumps), come to the fore. Itching of the mucous membranes with true trichomoniasis occurs almost constantly.

On the first day of the disease, men appear scanty gray or whitish watery discharge. Sometimes hemospermia occurs. Patients complain of itching during urination and severe dysuria. Without treatment, after 3-4 weeks the acute symptoms of Trichomonas urethritis subside, the urethritis will become torpid. Chronic trichomonas urethritis on the clinical signs are similar to chronic gonorrhea. Periods of sluggish urethritis alternate with exacerbations resembling an acute disease. Chronic urethritis is usually exacerbated or complicated after violent sexual intercourse, alcohol abuse, etc.

In Trichomonas urethritis, the inflammatory process is often spread from the anterior to the posterior urethra and prostate.

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

Complications and consequences

Complications of trichomonas urethritis occur similarly to the complications of other nongococcal urethritis. Trichomonas ulcer and genital erosion deserve special attention, which are very similar to hard chancre. In some cases, the ulcers have irregular, undermined soft edges, purulent plaque on the bottom and are very similar to shankriform pyoderma. Often there are erosion with a bright red bottom, irregular shape.

Trichomonas can be a direct cause of epididymitis. Trichomonas urethritis in most patients begins and takes place subacutely with a slight and short-term temperature reaction. Acute epididymitis occurs more often in persons who have discharge in the urethra.

[16], [17], [18], [19], [20], [21], [22]

Diagnostics of the trichomonas urethritis

Diagnostics consists in microscopy of urine samples, scraping their urethra, immunochromatographic detection of antigens in the test material, hybridization test with DNA probes (MLPA), PCR diagnostics.

[23], [24], [25],

Treatment of the trichomonas urethritis

Oral metronidazole (Flagyl) remains the drug of choice for treating trichomoniasis. In cases where the first line of drugs is ineffective, other nitroimidazoles (tinidazole) or high doses of metronidazole can be used.

Recommended schemes

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

For pregnant women, it is recommended to take metronidazole in a dosage of 2 g orally in a single dose. There is evidence of the possibility of increasing the risk of preterm birth in women with trichomoniasis who were treated with metronidazole.

Although metronidazole crosses the placental barrier, data suggest a low risk for pregnant women. No evidence of teratogenic or mutagenic effects in children was detected.

Alternative scheme

• Metronidazole 500 mg orally twice a day for 7 days

During treatment with nitroimidazoles, alcohol should be avoided. Nitroimidazoles are the only class of antimicrobial drugs that have proven to be effective against Trichomonas. In randomized clinical trials, the recommended metronidazole regimens resulted in a cure in approximately 84% -98% of cases, the recommended tinidazole regimens resulted in a cure in approximately 92% -100% of cases.

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

3 months after treatment, re-examination is recommended.

Prevention

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

[26], [27], [28], [29], [30]

Forecast

Recommended treatment regimens with metronidazole lead to complete recovery in 90-95% of cases.

[31], [32], [33], [34]