Trichomoniasis (trichomoniasis) is a genital infection that causes inflammation of the organs of the urogenital system. Manifested signs of colpitis, urethritis, cystitis, proctitis. Often combined with other genital infections: chlamydia, gonorrhea, mycoplasma, candidiasis, etc. In the acute stage, there is abundant vaginal discharge, itching and burning in women and painful urination in men. In the absence of adequate treatment, it becomes chronic, and in the future may be the cause of prostatitis, infertility, complicated pregnancy and childbirth, pediatric pathology and mortality.
Trichomoniasis (or trichomoniasis) urogenital disease is a disease of the human urinary system only. The causative agent of trichomoniasis - vaginal (vaginal) trichomonas, sexually transmitted.
Trichomoniasis targets in men are the urethra, prostate, testicles and their appendages, seminal vesicles, and in women - the vagina, the vaginal part of the cervical canal, the urethra. Trichomonas vaginalis in women is found more often due to more pronounced manifestations of trichomoniasis and more frequent visits to the doctor for preventive purposes. Trichomoniasis mainly affects women of reproductive age from 16 to 35 years. During childbirth, infection with trichomoniasis of a newborn from a sick mother occurs in about 5% of cases. In newborns, trichomoniasis occurs in a mild form due to the nature of the epithelium and is able to self-cure.
In men, usually, the presence of Trichomonas does not cause obvious symptoms of trichomoniasis, they are often carriers of Trichomonas and, without experiencing obvious indisposition, transmit the infection to their sexual partners. Trichomoniasis can be one of the causes of non-gonococcal urethritis, chronic prostatitis and epididymitis (inflammation of the epididymis), contribute to the development of male infertility due to reduced mobility and viability of sperm.
Trichomoniasis infection occurs mainly through sexual contact. Everyday way - through contaminated bedclothes, towels, swimsuits, trichomoniasis is extremely rarely transmitted.
The number of diseases associated with trichomoniasis is large. Trichomoniasis is often detected with other STI pathogens (gonococci, chlamydia, ureaplasmas, Candida, and herpes viruses). Currently, trichomonads are believed to contribute to the development of diabetes, mastopathy, allergies, and even cancer.
The causative agents of trichomoniasis - trichomonas (the simplest type, family flagellates) - unicellular anaerobic organisms - parasites, widely distributed in nature. In the human body 3 types of trichomonads parasitize: vaginal (the largest, active, pathogenic), oral and intestinal. Thanks flagella Trichomonas very active and mobile. Trichomonas are asexual and omnivorous, multiply rapidly under optimal conditions - in the absence of oxygen and at t = 35-37 ° C.
Trichomonas are fixed in the cells of the mucous membrane of the urogenital tract and cause an inflammatory process there. The waste products of Trichomonas poison the human body, reduce its immunity.
Trichomonas can live in the genitals and even in the bloodstream, which penetrate the lymphatic pathways, the intercellular spaces with the help of the enzyme hyaluronidase. Trichomonas are extremely adapted to the existence in the human body: they can change shape, mask themselves as plasma cells (platelets, lymphocytes) - which makes it difficult to diagnose trichomoniasis; “Cling” to other microbes and in this way dodge the body’s immune attack.
Microorganisms (gonococci, ureaplasmas, chlamydia, Candida, mushrooms, herpes viruses, cytomegalovirus), getting inside Trichomonas, there are protected from the effects of drugs and the human immune system. Motile Trichomonas can spread other microbes through the genitourinary system and blood vessels. By damaging the epithelium, Trichomonas reduces its protective function, and facilitates the penetration of microbes and sexually transmitted viruses (including HIV).
Although modern venereology has effective drug treatment for most genital infections, getting rid of trichomoniasis is completely extremely difficult, even today. The fact is that the non-protein shell of Trichomonas does not react to the action of antibiotics and can be destroyed only by special anti-protozoal drugs.
Usually the incubation period of trichomoniasis lasts from 2 days to 2 months. If trichomoniasis occurs in an erased form, the first symptoms may appear several months after infection with a decrease in immunity or exacerbation of other chronic infections.
Trichomoniasis (depending on the severity of symptoms and duration) can occur in acute, adjusting, chronic forms and as trichomonasal carrier.
The clinical manifestations of trichomoniasis in men and women are different. Trichomoniasis in women occurs with more pronounced symptoms, and male trichomoniasis usually exists in the form of trichomoniasis.
The symptoms of trichomoniasis in women are aggravated before the onset of menses.
In childhood trichomoniasis occurs infrequently, as a rule, in girls. Infection occurs non-sexually from sick mothers through household items, underwear. Trichomoniasis in girls is manifested in the form of vulvovaginitis, in the acute course of which the symptoms are similar to the adult form of the disease.
Trichomoniasis in men occurs in the form of trichomonas urethritis (the urethra is affected) and is accompanied by mucopurulent discharge, slight itching, burning right after sexual intercourse or urination. When examining observed solid infiltrates, stricture of the urethra. Trichomoniasis can affect the prostate gland and epididymis, cause prostatitis (in 40% of cases) and epididymitis. Very rarely in men with trichomoniasis, erosions and ulcers of the mucous membrane, inflammation of the midline suture are observed.
The nature and amount of discharge depends on the stage of the inflammatory process: in chronic trichomoniasis, a small amount of mucous secretions is noted. Over time, they may subside, but recovery does not occur.
Fresh trichomoniasis, in the absence of treatment, becomes chronic (if more than 2 months have passed from the moment of infection) or to trichomonasal carriage. Chronic trichomoniasis can occur for years with little symptoms (
4% is accompanied by dysuria and slight pain,
Trichomoniasis is isolated as a form of trichomoniasis, in which the pathogen is detected laboratory, but the manifestations of the disease are absent. This division is conditional, since different forms of trichomoniasis can transform into each other. Eraded forms of trichomoniasis play a large role in the spread of the disease. The pathogen inhabiting the urogenital system is a source of infection of the partner during sexual intercourse and its own re-infection.
Trichomoniasis is dangerous because of its complications, because it increases the risk of transmission of other infections (including HIV), pregnancy pathologies (premature birth, stillbirth), the development of infertility (male and female), cervical cancer, chronic diseases of the genitourinary system. If there are similar symptoms and even in the absence of them, it is necessary to be examined for trichomoniasis, and possibly other STIs. This is important for women planning pregnancy, for sexual partners - trichomonadal carriers and patients with trichomoniasis; for all, leading an active sex life.
Self-treatment of trichomoniasis can lead to the opposite result: Trichomonas go into a more aggressive form, begin to multiply more actively, the disease becomes hidden or atypical forms. To diagnose and treat trichomoniasis in this case is much more difficult.
Diagnosis of trichomoniasis is the detection of the pathogen using various methods.
On the basis of complaints of patients and inspection, one can suspect the presence of Trichomonas. When viewed in women with trichomoniasis, there are signs of inflammation - swelling and hyperemia of the vulva and vagina. When conducting colposcopy, a symptom of “strawberry cervix” can be observed: redness of the mucous membrane with punctate and focal hemorrhages on the cervix. There is epithelial dysplasia, sometimes atypical epithelial cells may appear.
Reliably trichomoniasis is detected using laboratory methods:
Trichomoniasis in men is more difficult to diagnose, due to the absence of symptoms, moreover, trichomonads with this course of the disease are in an atypical amoeboid form. Before planning for pregnancy, both a man and a woman must undergo a full examination for STIs, including trichomoniasis.
Treatment of trichomoniasis is carried out by venereologists, gynecologists and urologists. It must be carried out in any form of the disease, regardless of the presence or absence of manifestations. Treatment of trichomoniasis should be carried out simultaneously for sexual partners (even with negative analyzes of one of them). The treatment of trichomoniasis in only one of the sexual partners turns out to be ineffective, because it can be reinfected after treatment. The production of antibodies against the causative agent of trichomoniasis does not form a strong immunity, after treatment, you can get sick again with repeated infection.
Treatment of trichomoniasis must be combined with treatment of other STIs that often accompany the disease.
The need for treatment of trichomoniasis in a pregnant woman is determined by the doctor, it can be prescribed only in the second trimester of pregnancy. Due to the insensitivity of trichomonads to antibiotics, antiparasitic therapy is prescribed in the treatment of trichomoniasis: they use drugs of the 5-nitroimidazole group. These include tinidazole, metronidazole, ornidazole, nimorazole, ternidazole. In the treatment of trichomoniasis, it is forbidden to drink alcohol even in small quantities, since all drugs, with the exception of ornidazole, cause antabus-like syndrome (affect the body's alcohol exchange). If trichomoniasis occurs in an uncomplicated acute (subacute) form, the treatment is ingestion of antiprotozoal drugs. With a complicated and chronic course of trichomoniasis, stimulating therapy is prescribed in advance. Symptomatic and local treatment is applied according to indications. Only topical treatment of trichomoniasis (ointment, suppository) will be ineffective. In the presence of a mixed infection (chlamydia, ureaplasma, gonococcus, cytomegalovirus, candida), an antibiotic is prescribed in conjunction with an antiparasitic drug.
Trichomoniasis is considered cured when the pathogen is not detected during the diagnosis and no clinical symptoms are observed. Sex life during treatment is excluded. It is necessary to inform your sexual partner about the presence of trichomoniasis and other STDs, about the need for examination and treatment.
The result of the treatment of trichomoniasis depends on the normalization of the microflora of the urogenital system and the organism as a whole. Women with this purpose use a vaccine against inactivated acidophilic lactobacilli. Perhaps the appointment of immunomodulatory drugs.
Sometimes there is resistance of trichomonads to a specific drug of the 5-nitroimidazole group (usually partial), but changing the dose, the duration of taking or changing the drug of the same group give a positive result in the treatment of trichomoniasis. To avoid the development of resistance of trichomonads to antiparasitic drugs, undergoing a course of therapy, it is necessary to strictly follow all recommendations of the doctor.