Trichomonas vaginitis is one of the most common sexually transmitted infections, and affects 60-70% of women who have sex.
Etiology and pathogenesis. The causative agent of trichomoniasis is vaginal trichomonas (Trichomonas vaginalis) —the simplest microorganism of the oval form; It has from 3 to 5 flagella and an undulating membrane with which it moves. Food is provided by endosmosis and phagocytosis.
Trichomonas is unstable in the environment and easily dies when heated above 40 ° C, dried, and exposed to disinfectant solutions. Trichomonas often are companions of other sexually transmitted infections (gonorrhea, chlamydia, viral infections, etc.) and (or) causing inflammation of the genital organs (yeast, mycoplasma, ureaplasma). Trichomoniasis is considered as a mixed protozoan-bacterial infection.
Trichomonas can reduce sperm motility, which is one of the causes of infertility. The main route of infection with genital trichomoniasis. The contagiousness of the pathogen is close to 100%. The household route of infection, especially in girls, when using shared underwear, bedding, as well as intranatally during the passage of the fetus through the infected birth canal of the mother, is also not excluded.
Trichomonas are mainly in the vagina, but can affect the cervical canal, urethra, bladder, excretory ducts of the large glands of the vestibule.
Trichomonas can penetrate the uterus and fallopian tubes even into the abdominal cavity, carrying pathogenic microflora on its surface.
Despite the specific immunological reactions to the introduction of Trichomonas, immunity after suffering trichomoniasis does not develop. Classification. There are fresh trichomoniasis (the duration of the disease is up to 2 months), chronic (sluggish forms with a prescription of the disease more than 2 months or of unspecified prescription) and trichomonadal disease, when the pathogens do not cause inflammation in the genital tract, but can be transmitted to the partner during sexual contact. Fresh trichomoniasis can be acute, subacute, or torpid (low sympathetic). Urogenital trichomoniasis is also divided into uncomplicated and complicated.
Clinical symptoms. The incubation period for trichomoniasis ranges from 3-5 to 30 days. The clinical picture is due, on the one hand, to the virulence of the pathogen, and on the other, to the reactivity of the microorganism.
Diagnostics help thoroughly collected history (contacts with patients with trichomoniasis) and the data of objective examination. A gynecological examination reveals hyperemia, edema of the mucous membrane of the vagina and the vaginal portion of the cervix, “foamy pus-like whites on the walls of the vagina. With colposcopy, hereditary hemorrhages and cervical erosion are detected. In the subacute form of the disease, signs of inflammation are mild, while in the chronic form, they are practically absent.
Microscopy of vaginal smears identify the pathogen. It is better to use a native rather than a colored preparation, since the possibility of detecting the movement of Trichomonas under a microscope increases the probability of their detection. In some cases, fluorescent microscopy is used. In recent years, for the diagnosis of trichomoniasis are increasingly using the PCR method. 1 week before taking the material, patients should not use anti-cyst drugs, stop local procedures. Successful diagnosis involves a combination of different methods, multiple repetition of tests.
Treatment should be carried out to both sexual partners (spouses), even if Trichomonas is found only in one of them. During the period of therapy and subsequent control, sex life is prohibited or recommended to use condoms. The treatment should also involve trichromono-carriers.
In acute and subacute trichomoniasis, therapy is reduced to the prescription of one of the specific anti-trichomonas drugs – ornidazole, tinidazole, metronidazole. In the absence of the effect of treatment, a drug change or a dose doubling is recommended. When trichomonas vulvovaginitis in children ornidazole is the drug of choice.
In chronic forms of trichomoniasis, poorly amenable to conventional therapy, the vaccine “SolkoTrihovak” 4 is effective, including special strains of lactobacilli isolated from the vagina of women infected with trichomoniasis. As a result of the introduction of the vaccine, antibodies are formed that destroy Trichomonas and other pathogens of inflammation that have antigens that are common with lactobacilli. When this happens, normalization of the vaginal microflora occurs and a long-lasting immunity is created, which prevents recurrences.
The criteria for cure for trichomoniasis are the disappearance of clinical manifestations and the absence of Trichomonas in the discharge from the genital tract and urine.
Prevention of trichomoniasis is reduced to the timely identification and treatment of patients and trichomonadal bearers, personal hygiene, the exclusion of casual sex.