Trichomoniasis in women

Trichomoniasis is an infectious disease caused by urogenital Trichomonas (Trichomonas vaginalis), which parasitizes the organs of the genitourinary system of a person. In the structure of vector-borne diseases it is 10-30%. Trichomonas infection increases the risk of HIV transmission in men and women, their role in the complication of pregnancy, the development of infertility, postoperative infections and cervical neoplasia has been proved.

Epidemiology

The frequency of trichomonas infection in the structure of urethrogenic STIs is about 10%.

Causes of the trichomoniasis in women

The causative agent of trichomoniasis is Trichomonas vaginalis, which is a single-celled pear-shaped microorganism of 8 to 24 microns in size with flagella and an undulating membrane providing the ability to actively move.

Sexual transmission is considered dominant, it is possible to infect newborn girls while passing the birth canal of a sick mother, as well as indirect sexual and domestic way through gloves, oilcloth, ship and other toilet items. Factors contributing to trichomonas infestation include changes in the pH of the vagina and hormonal disorders. The greatest danger is presented by patients with a slow inflammatory process.

Trichomonas mainly localized in places covered with a flat epithelium. In women, they mostly affect the vagina with the development of trichomonas vulvovaginitis. If they get into the urethra or cervical canal, they can spread along the length of the mucous membrane and through the intercellular spaces onto the subepithelial layer, where they cause an inflammatory reaction. In women, the vestibular and paraurethral glands are also involved in the inflammatory process. Sometimes the presence of trichomonads in the genitourinary organs is not accompanied by any symptoms. Without treatment, the process can continue indefinitely.

[1], [2], [3], [4], [5], [6]

Risk factors

• Prostitution.
• Numerous and occasional sexual relations.
• Homosexuality.
• Rare use of barrier methods of contraception and spermicides.

[7], [8], [9], [10], [11], [12], [13], [14], [15]

Symptoms of the trichomoniasis in women

The incubation period lasts from a few days to two months.

Trichomoniasis is characterized by multichannel involvement of various parts of the genitourinary system, prolonged course and a tendency to relapse. The most common are colpitis, urethritis, cervicitis. Patients usually complain about copious leucorrhoea, pain, itching in the area of the external genitalia and dysuric phenomena.

Forms

The following classification of trichomoniasis is currently used:

• fresh:
  • acute,
  • subacute,
  • Torpid (low-symptomatic, duration of which does not exceed 2 months);
• chronic (torpid course when the duration of the disease is more than 2 months);
• trichomonadonation.

[16]

Complications and consequences

• Abscess of Bartholin glands.
• Metroendometrit.
• Salpine oophoritis.
• Parametrite.
• Pelvioperitonitis.
• Pregnant women have premature discharge of amniotic fluid and childbirth.

[17], [18],

Diagnostics of the trichomoniasis in women

On examination, the focal flora of the vulva, the walls of the vagina and the cervix of the uterus, foamy secretions, the pH of the vaginal contents> 4,5.

Laboratory methods of research:

• The microscopic method is the main one. At a microscopy of a native (wet) preparation mobile trichomonads are found out. In some cases, it is possible to use smears stained with methylene blue or Romanovsky-Giemsa. When viewing dyed smears, false positive results are possible.
• Culture method - sowing on selective media for detecting mobile trichomonads. They are used to supplement the microscopic method and as the main one for the detection of trichomonads in children and in men.
• Molecular biological methods (PCR) are actively studied. Perhaps their practical application.
• Immunoluminescent methods (UIF) are not recommended for use.

Screening

Examination of patients with complaints of itching, burning, dyspareunia, dysuric phenomena, foamy yellow discharge.

[19], [20]

The procedure of the doctor with the established diagnosis of trichomoniasis

1. Tell the patient about the diagnosis.
2. Providing information on the behavior of the patient during treatment.
3. Gathering of a sexual anamnesis.
4. Identification and examination of sexual contacts are carried out depending on the clinical manifestations of the disease and the estimated duration of infection - from 3 days to 6 months.
5. Identification and examination of household contacts conduct:
   • children (girls) living together on the same living space;
   • in the case of detection of trichomoniasis in a child (girl) attending a preschool, inspect and, if necessary, examine the children and employees of the group.
6. In the case of detection of trichomoniasis in a woman in labor or a woman in a hospital, a newborn girl is examined.
7. Carrying out of epidemiological measures among contact persons (sanation of epidemiological center):
   • inspection and examination of contact persons;
   • ascertaining laboratory data;
   • the decision on the need for treatment, its scope and timing of follow-up.
8. In case of residence of contact persons in other territories, a dress-card is sent to the territorial HLC.
9. In the absence of results from treatment it is recommended to consider the following possible reasons:
   • false positive result of the study;
   • non-compliance with treatment regimen, inadequate therapy;
   • repeated contact with an untreated partner;
   • infection from a new partner;
   • infection with other microorganisms.

Patient education

Training of patients should be directed to the implementation of measures for the prevention of sexually transmitted infections and the prevention of infection of sexual partners.

Treatment of the trichomoniasis in women

For the treatment of trichomoniasis, women usually use metronidazole (Flagyl) or tinidazole, at a dosage of 2 grams orally once. With extreme caution should be used during pregnancy, especially in the first trimester.

In randomized clinical trials, the recommended regimens of metronidazole therapy in 90-95% lead to complete cure. However, in 4-5% of cases, Trichomonases are resistant to Metronidazole.