TRICHOMONOSIS

TRICHOMONOSIS is a parasitic disease of the organs of the genitourinary system, caused by the simplest - vaginal trichomonas.

In most cases, the disease is transmitted sexually. The urethra can be affected in men, the vagina, the cervical canal, the urethra and the pararethral passages in women. Less often Trichomonas penetrate the Bartholin glands and bladder, even less often - and the uterine cavity, extremely rarely - in the fallopian tubes. The spread of the disease is promoted by promiscuous sexual intercourse, especially in high-risk groups (alcoholics, drug addicts, prostitutes). Out-of-the-box infection is rare, for example, through the hands of medical staff, toilet items (sponges, sponges, towels, night pots, bed linens, etc.), which the patient used a short time before. Newborn girls can become infected during labor during passage through the birth canal of a mother with a trichomoniasis.

Vaginal trichomonas are extremely sensitive to many environmental factors (high temperature, drying, changes in osmotic pressure, the effect of disinfectant solutions) and does not form cysts or any stable forms. Nutrition of trichomonads occurs by the absorption of cells, including microorganisms, some of which, in particular gonococci, can remain viable inside the trichomonads and manifest their pathogenic effect after the death of the latter. This explains the relapse of gonorrhea, which sometimes occurs after antibiotic therapy of trichomoniasis in patients with mixed trichomonas-gonorrhea infection. Immunity with trichomoniasis is absent, so repeated infection is possible.

Trichomoniasis in men. The incubation period lasts more often 5-15 days. Usually the disease begins with urethritis. Fresh trichomonadal urethritis is clinically little different from urethritis of any other etiology. Abundant foamy whitish-yellow discharge after 1 to 2 weeks decreases, the disease takes an asymptomatic course. Itching and burning with mild urination. In acute form, when the inflammatory process proceeds with purulent discharge from the urethra, dysuria, trichomoniasis urethritis can simulate acute gonorrhea, which is often combined. With subacute trichomonadal urethritis, subjective symptoms are minor, discharge from the urethra is meager, white or grayish-yellow in color. For the asymptomatic form of trichomoniasis urethritis is often characterized by a complete absence of symptoms. With chronic trichomoniasis urethritis, the posterior urethra is often affected - total urethritis develops. At exacerbations of inflammatory process in such cases the expressed dysuria arises.

The diagnosis is based on the clinical picture, the epidemiological history and the results of laboratory studies. In all cases, the diagnosis should be confirmed by the detection of vaginal trichomonads in the test material. It is necessary to examine the discharge from the urethra, the secret of the prostate gland, seminal vesicles, urine. With balanoposthitis, scrape from the erosive surface of the glans penis is examined. The frequency of detection of the pathogen increases after a preliminary massage of the prostate gland, seminal vesicles. For bacterioscopic examination of smears, the material taken is applied in a thin uniform layer on two slides, one is stained with methylene blue or brilliant green, and the other by Gram.

Treatment of trichomoniasis is carried out in both spouses (partners) both in the presence of clinical manifestations of the disease, and in trichomonadonositelstve. Sexual life during the period of treatment is prohibited. Treatment of men with trichomoniasis is carried out in urological offices of polyclinics, in skin and venereal dispensaries. Treatment of acute trichomoniasis can be limited to the appointment of anti-trichomonias funds - trichomonaside, metronidazole. It is advisable to simultaneously use antibiotics of a wide spectrum of action, since trichomoniasis is often combined with a bacterial infection. If trichomoniasis urethritis acquires a chronic course, in addition, instillations in the urethra are indicated for 5-10% oily or aqueous suspension of wasarsol, which is administered daily for 7-10 days for 10 ml for 10-15 minutes. After instillation, the patient should not urinate for 2 hours. Treatment of trichomoniasis of the prostate gland, seminal vesicles, testis and its epididymis is carried out with the same anti-trichomoniasis drugs in combination with all measures recommended for non-specific prostatitis, vesicles, orchitis, epididymitis. Control studies - after 7 -10 days, 1 and 2 months after the end of treatment. Criteria for cure are the disappearance of clinical symptoms, the absence of vaginal Trichomonas and leukocytes in the first portion of urine, in smears from the urethra, in the secretion of the prostate and seminal vesicles.

The prognosis in most patients is favorable. However, even after the complete eradication of trichomonias infection, chronic urethritis often remains, urethral stricture may occur, and in trichomonadic epididymoortitis, especially bilateral, infertility . Preventive measures are the same as in gonorrhea.

Trichomoniasis in women suffering from gynecological diseases, according to different authors, is found in 40-80% of cases. Especially often it occurs in patients with gonorrhea (40 - 80%), which is explained by the common pathways of infection.

With Trichomonas colpitis, the urethra, the paraurethral passages, the glands of the vestibule, the bladder can be simultaneously affected. With acute and subacute colpitis, abundant, liquid, yellow, foamy discharge from the genital tract, often corroding character with an unpleasant odor, sharp itching in the area of ​​the external genitalia, burning, soreness in sexual intercourse, unpleasant sensations (feeling of heaviness) in the lower abdomen are noted. The mucous membrane of the vagina is sharply hyperemic, edematous, sometimes with pinpoint hemorrhages, it bleeds easily. When malosymptomatic in form, the symptoms of the disease are poorly expressed, complaints of excreta from the genital tract, occasional itching, predominate; Hyperemia of the mucous membrane may be absent, allocation abundant, purulent, foamy.

For chronic colpitis characterized by a prolonged course with periodically appearing pruritus in the region of the external genitalia; Poor, pus-like discharge from the genital tract. The mucous membrane of the vagina may not be altered. With trihomonadonositelnost complaints and local inflammatory changes are absent, and in the smears are determined vaginal Trichomonas. For the defeat of the urethra and bladder, complaints of rubbing and frequent urination are common.

The disease often takes a prolonged course with periods of exacerbations and remissions.

All women with trichomonads are subject to treatment, regardless of the presence or absence of inflammatory changes in the genitourinary organs. For treatment use antitrihomonadnye funds.

Local treatment: use gramicidin , furazolidone , furatsilin , fitontsidy. Instead of metronidazole, girls 8-10 years old for 7 days in the vagina inject 1-2 ml of a 2.5% suspension of nitazole (after a preliminary syringing with 1% sodium hydrogen carbonate solution). At the age of up to 3 years in the vagina it is recommended to administer 1 ml of 1% aqueous solution of methylene blue daily for 7 days.

Freestands are considered cured, when repeated repeated studies can not detect trichomonads during the three menstrual cycles (the study is carried out on the 1st, 2nd and 3rd day after the end of menstruation).

Preventive measures are the same as in gonorrhea. Children suffering from trichomoniasis are not admitted to the children's team until they recover. Women suffering from trichomoniasis are suspended from work in children's institutions.