Trichomoniasis is a sexual infection that causes inflammation of the genitourinary system. It is manifested by signs of colpitis, urethritis, cystitis, proctitis. It is 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 soreness during urination – in men. In the absence of adequate treatment, it turns into a chronic form and in the future can cause prostatitis, infertility, complicated pregnancy and childbirth, childhood pathology and mortality.
Trichomoniasis urogenital is a disease exclusively of the human genitourinary system. The causative agent of trichomoniasis is vaginal (vaginal) trichomonas, sexually transmitted.
The target organs 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. Vaginal trichomonas in women is found more often due to more pronounced manifestations of trichomoniasis and more frequent visits to the doctor for preventive purposes. Basically, disease affects women of reproductive age from 16 to 35 years. During childbirth, infection of a newborn from a sick mother occurs in about 5% of cases. In newborns, disease occurs in a mild form due to the peculiarities of the structure of the epithelium and is able to heal itself.
In men, usually, the presence of trichomonads does not cause obvious symptoms of trichomoniasis, they are often carriers of trichomonads and, without experiencing obvious malaise, 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 a decrease in sperm motility and viability.
Infection with trichomoniasis mainly occurs during sexual intercourse. Disease is transmitted extremely rarely through contaminated linen, towels, swimsuits by the patient.
The number of diseases associated with trichomoniasis is large. Trichomoniasis is often detected with other STI pathogens (gonococci, chlamydia, ureaplasmas, Candida fungi, herpes viruses). Currently, it is believed that trichomonads contribute to the development of diabetes, mastopathy, allergies and even oncological diseases.
The causative agents – Trichomonas (Protozoan type, Flagellate family) are single–celled anaerobic parasitic organisms, widely distributed in nature. There are 3 types of trichomonas parasitizing in the human body: vaginal (the largest, active, pathogenic), oral and intestinal. Thanks to the flagella, trichomonas are very active and mobile. Trichomonas are asexual and omnivorous, they multiply rapidly under optimal conditions – in the absence of oxygen and at t = 35-37 ° C.
Trichomonads are fixed in the cells of the mucous membrane of the genitourinary tract and cause an inflammatory process there. The waste products of trichomonads poison the human body, reduce its immunity.
Trichomonads can live in the genitals and even in the bloodstream, where they penetrate through the lymphatic pathways, intercellular spaces with the help of the enzyme hyaluronidase. Trichomonads are extremely adapted to exist in the human body: they can change shape, disguise themselves as blood plasma cells (platelets, lymphocytes) – which makes it difficult to diagnose trichomoniasis; “cling” to other microbes and in this way evade the immune attack of the body.
Microorganisms (gonococci, ureaplasmas, chlamydia, Candida fungi, herpes viruses, cytomegalovirus), getting inside trichomonads, find protection from the effects of drugs and the human immune system there. Mobile trichomonads can carry other microbes through the genitourinary system and through blood vessels. By damaging the epithelium, trichomonads reduce its protective function, and facilitate the penetration of sexually transmitted microbes and viruses (including HIV).
Although modern venereology has effective medical methods of treating most sexual infections, it is extremely difficult to get rid completely, even today. The fact is that the non-protein shell of trichomonas does not react to the action of antibiotics and can only be destroyed by special antiprotozoal drugs.
Usually the incubation period of trichomoniasis lasts from 2 days to 2 months. If trichomoniasis occurs in an erased form, then the first symptoms may appear a few 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, sub-acute, chronic forms and as trichomoniasis.
Clinical manifestations in men and women are different. Trichomoniasis in women occurs with more pronounced symptoms, male trichomoniasis usually exists in the form of trichomonadism.
Trichomoniasis in women manifests itself in the form of urethritis, vulvovaginitis, bartholinitis, cervicitis. The acute stage of trichomoniasis has the following manifestations:
- significant foamy discharge of yellow, green color, with an unpleasant odor;
- redness and irritation of the genital mucosa (itching, burning), dermatitis of the inner thighs;
- damage to the genital mucosa (erosions, ulcers);
- discomfort during urination, dysuria;
- unpleasant sensations during sexual contact;
- sometimes pain in the lower abdomen.
Symptoms of this disease in women increase before the onset of menstruation.
In childhood, disease is observed infrequently, usually in girls. Infection occurs asexually from sick mothers through household items, underwear. Trichomoniasis in girls manifests itself 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, mild itching, burning immediately after sexual intercourse or urination. During the examination, solid infiltrates and urethral stricture are observed. Trichomoniasis can affect the prostate gland and appendages of the testicles, cause prostatitis (in 40% of cases) and epididymitis. Very rarely, with trichomoniasis in men, erosions and ulcers of the mucous membrane, inflammation of the median suture are observed.
The nature and amount of discharge depends on the stage of the inflammatory process: in chronic trichomoniasis, there is an insignificant amount of mucous secretions. Over time, they may subside, but recovery does not occur.
Fresh trichomoniasis, in the absence of treatment, turns into a chronic form (if more than 2 months have passed since infection) or into trichomoniasis. Chronic trichomoniasis can occur for years with little symptoms (~ 4% are accompanied by dysuria and slight pain, ~ 5-8% have sexual disorders).
Trichomoniasis is isolated as a form of trichomoniasis, in which the pathogen is detected in the laboratory, but there are no manifestations of the disease. This division is conditional, since different forms of trichomoniasis can pass into each other. Erased forms of trichomoniasis play an important role in the spread of the disease. The pathogen living in the genitourinary system is a source of infection of the partner during sexual intercourse and its own re-infection.
Trichomoniasis is dangerous due to 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. In the presence of 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 – trichomoniasis carriers and patients with trichomoniasis; for everyone leading an active sexual life.
Self-treatment of trichomoniasis can lead to the opposite result: trichomonas turn into a more aggressive form, begin to multiply more actively, while the disease acquires hidden or atypical forms. It can be much more difficult to diagnose and treat trichomoniasis in this case.
Diagnosis of trichomoniasis consists in detecting the pathogen using various methods.
Based on the complaints of patients and examination, it is possible to suspect the presence of trichomonas. When examined, women with trichomoniasis have signs of inflammation — swelling and hyperemia of the vulva and vagina. During colposcopy, a symptom of “strawberry cervix” may be observed: redness of the mucous membrane with spot and focal hemorrhages on the cervix. Epithelial dysplasia is noted, sometimes the appearance of atypical epithelial cells is possible.
Disease is reliably detected using laboratory methods:
- microscopy of the test material (in women – smears from the vagina and urethra, in men – smears from the urethra);
- culture (microbiological) method using artificial nutrient media;
- immunological method;
- PCR diagnostics.
Trichomoniasis in men is more difficult to diagnose, due to the lack of symptoms, in addition, trichomonas with this course of the disease are in an atypical amoeboid form. Before planning a pregnancy, both a man and a woman should undergo a full examination for STIs, including trichomoniasis.
Treatment is carried out by venereologists, gynecologists and urologists. It must be carried out in all forms 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 tests of one of them). Treatment of trichomoniasis in only one of the sexual partners is ineffective, because re-infection may occur after treatment. The production of antibodies against the causative agent of trichomoniasis does not form a stable immunity, after treatment, you can get sick again with repeated infection.
Treatment of trichomoniasis must be combined with the treatment of other STIs that often accompany the disease.
The need for treatment in a pregnant woman is determined by a 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: drugs of the 5-nitroimidazole group are used. These include tinidazole, metronidazole, ornidazole, nimorazole, ternidazole. In the treatment of disease, it is forbidden to drink alcohol even in small quantities, since all drugs with the exception of ornidazole cause an antabuse-like syndrome (affect the metabolism of alcohol in the body). If trichomoniasis occurs in an uncomplicated acute (subacute) form, treatment consists in ingestion of antiprotozoal drugs. In the complicated and chronic course of trichomoniasis, stimulating therapy is pre-prescribed. Symptomatic and local treatment is used according to indications. Only local treatment (ointments, candles) will be ineffective. In the presence of a mixed infection (chlamydia, ureaplasma, gonococci, cytomegalovirus, candida), an antibiotic is prescribed together with an antiparasitic drug.
Disease is considered cured when the pathogen is not detected during diagnosis, and no clinical symptoms are observed. Sexual activity 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 treatment depends on the normalization of the microflora of the genitourinary system and the body as a whole. In women, a vaccine against inactivated acidophilic lactobacilli is used for this purpose. It is possible to prescribe immunomodulatory drugs.
Sometimes there is resistance to a certain drug of the 5-nitroimidazole group (usually partial), but changing the dose, duration of administration or replacing the drug of the same group gives a positive result in the treatment of trichomoniasis. In order to avoid the development of resistance to antiparasitic drugs, while undergoing therapy, it is necessary to strictly follow all the recommendations of the doctor.