Trichomoniasis in women is a specific inflammatory lesion of the organs of the urogenital tract due to infection with vaginal trichomonas. In acute cases, infection is manifested by copious fetid foamy discharge from the vagina, itching in the vulva, cuts and pains in the vagina and urethra, frequent urination. With torpid and chronic course, the symptoms are limited by a slight increase in the number of vaginal whites. Gynecological examination, bacteriological and serological studies are used to make a diagnosis. Conservative etiotropic treatment with the appointment of nitroimidazole derivatives.
Trichomoniasis is the most common sexually transmitted urogenital infection, diagnosed in 65-80% of patients with STIs. Every year, up to 170 million people are infected in the world, of which more than half are women, mainly of reproductive age. It is extremely rare that trichomoniasis is detected in girls before the onset of menarche. In various countries, vaginal trichomonas infected from 2 to 40% of the population. Infection is particularly dangerous due to the presence of latent carrier and the development of various complications – from severe inflammatory diseases of the genitourinary organs to infertility, miscarriage, premature and complicated childbirth.
Urogenital trichomoniasis causes Trichomonas vaginalis – the simplest single-celled organism affecting the multilayered squamous epithelium. The optimal conditions for the reproduction of trichomonas are high humidity, a temperature of about 36-37 ° C, an acidic environment with a pH of 5.9-6.5. In women, the pathogen usually parasitizes the vaginal mucosa and the vaginal part of the cervix, in the excretory ducts of the bartholin glands, urethral canal, skin passages, bladder. In rare cases, trichomonas cause inflammation of the uterus and its appendages. There are three ways of infection with trichomoniasis:
- Sexual. Most often, infection occurs during unprotected sex with a partner who is ill with trichomoniasis or is an asymptomatic carrier of infection.
- Household. Extremely rarely, the pathogen is transmitted through contaminated personal hygiene items, non-sterile medical instruments, gloves, etc.
- Contact. Newborn girls can become infected from their mother when passing through infected birth canal.
Predisposing factors play an important role in infection and rapid manifestation of the disease. The risk of developing trichomoniasis is increased in women who are promiscuous in choosing sexual partners, abuse psychoactive substances, and practice unprotected sex.
Pathology belongs to the category of multi-focal. The primary infectious focus is usually located on the mucous membrane of the vagina. The microorganism from the surface of the epithelium quickly penetrates through the intercellular spaces into the submucosal connective tissue. An inflammatory reaction develops in the affected area, which is clinically manifested by signs of specific colpitis. As they multiply, trichomonads spread downward and upward to nearby organs, causing secondary vulvitis, bartholinitis, cervicitis, endometritis, salpingitis, urethritis, cystitis, pyelonephritis.
The rate of spread of trichomonads is determined by the massiveness of infection, the immune status of the patient, the degree of protective reaction of vaginal secretions, the state of the epithelium, the presence of concomitant microflora. In 89.5% of cases, the pathogen is associated with candidiasis and other microorganisms that cause STIs – gonococci, chlamydia, ureaplasmas, mycoplasmas.
The clinical classification of trichomoniasis in women takes into account the prescription of infection, the nature of the development of the disease and the severity of the clinical picture. Accordingly, fresh (with a disease duration of up to 2 months) and chronic trichomoniasis are isolated. Specialists in the field of gynecology distinguish three main forms of fresh trichomoniasis:
- Acute – with a sudden onset and vivid clinical symptoms.
- Subacute – with less pronounced symptoms.
- Torpid – with scant clinical signs of infection.
The transition of the disease to the chronic phase is indicated by the presence of symptoms for two or more months. Depending on the presence of complications , the following types of chronic trichomoniasis are distinguished:
- Uncomplicated – with the development of the inflammatory process in the lower parts of the urogenital system.
- Complicated – involving the internal genitalia (uterus and appendages) in the process.
A separate form of trichomoniasis is an asymptomatic carrier, which is observed in almost a third of those infected. Infection with some strains of Trichomonas vaginalis is not accompanied by the appearance of symptoms of the disease, while the woman remains a source of infection for sexual partners. The asymptomatic form can manifest clinically with a change in the immune or hormonal status of the carrier.
Symptoms of trichomoniasis in women
During the incubation period, which lasts on average from 5 to 14 days, there are no symptoms. With acute manifestation of the infectious process, the patient complains of itching in the area of the external genitalia, frequent painful urination, pain and pain in the vagina and urethra, dyspareunia. The genitals are swollen, abundant foamy yellowish- or greenish-white whites with a fetid smell and an admixture of blood are released from the vagina. The temperature has been raised to subfebrile digits. Sleep and general well-being are disturbed. Some women report pain in the lower abdomen.
In the subacute course of trichomoniasis, patients notice a slight increase in the amount of vaginal discharge, the rest of the symptoms are usually blurred. The torpid form of the disease proceeds almost asymptomatically and turns into chronic trichomoniasis or trichomoniasis. The spread of the inflammatory process to other organs of the urogenital system is manifested by the development of an appropriate clinical picture – pain in the lower abdomen and lower back, mucopurulent discharge, menstrual cycle disorders and reproductive function.
Trichomoniasis in women is most often complicated by purulent-inflammatory diseases of the genital organs: bartholin gland abscess, endometritis, adnexitis, tubovarial abscess, parametritis, pelvioperitonitis. Due to the formation of adhesions in the pelvis, infertility may develop. According to the observations of specialists, such patients are at risk for the development of cervical neoplasia. In patients with trichomoniasis, pregnancy is often interrupted spontaneously, amniotic fluid is poured out prematurely. Childbirth usually proceeds pathologically, and the child may become infected with trichomoniasis when passing through the birth canal.
When making a diagnosis, it is necessary to take into account clinical symptoms, epidemiological history, physical and laboratory studies. Usually the survey plan includes:
- Examination on a chair in mirrors. During gynecological examination, the mucous membrane of the vagina and cervix looks reddened. In the posterior arch of the vagina, abundant foamy discharge is determined. There is swelling of the vulva and urethra.
- Microscopy and seeding on flora. Trichomonas in a smear from the mucous membrane of the vagina or urethra can be detected under a conventional or phase-contrast microscope. Seeding of native material allows you to confirm the presence of the pathogen with an accuracy of up to 95%.
- Serological and molecular genetic analyses. Antibodies to the pathogen or fragments of its genetic material are detected using RIF, ELISA, PCR.
Gynecological ultrasound, tomography and other instrumental diagnostic methods play an auxiliary role and allow us to assess the degree of involvement of pelvic organs in the inflammatory process. Differential diagnosis is carried out with candidiasis, nonspecific and gonorrheal vulvovaginitis. If necessary, the patient is prescribed a consultation with a dermatovenerologist.
Treatment of trichomoniasis in women
Treatment is carried out on an outpatient basis, the patient is recommended sexual rest and abstinence from alcohol. Etiotropic therapy is indicated for a sexual partner. The pathogen is highly sensitive to metronidazole and other nitroimidase derivatives, which not only act directly on the trichomonad, but also stimulate the production of interferon. Course combination therapy is used with simultaneous administration of drugs inside and topically (in the form of vaginal tablets, candles, creams). If trichomoniasis is detected in a pregnant woman, only local treatment is carried out. With a long course, an antitrichomonas vaccine is administered simultaneously with etiotropic therapy, stimulating the formation of humoral and secretory antibodies. The drug enhances the effect of antiprotozoal treatment, protects against damage to the cells of the multilayer epithelium and prevents reinfection. Immunomodulators may be prescribed as additional medications.
To confirm the complete cure of trichomoniasis, bacteriological control is performed. The material from the vagina, urethral canal and rectum is examined 7-10 days after the end of the course of therapy and during the next three menstrual cycles (on the fifth day from the beginning of menstruation). To increase the probability of detection of trichomonads, alimentary, physical or biological provocation can be carried out. It is important to take into account that almost 90% of patients have chronic trichomoniasis associated with other infections. Therefore, after timely detection of concomitant microflora and determination of its sensitivity, appropriate etiotropic treatment should be prescribed.
Prognosis and prevention
The prognosis is favorable. When prescribing therapeutic doses of metronidazole, patients are completely cured of trichomoniasis in 90-95% of cases, even resistant forms of the disease can be treated with nitroimidazoles of the second generation. To prevent infection, it is necessary to refrain from sexual contact with casual partners, use condoms, and observe personal hygiene rules. Timely referral to a gynecologist about the appearance of characteristic clinical symptoms after unprotected sex allows you to start therapy in time and prevent the development of serious complications.