Sexually transmitted diseases – trichomoniasis and the consequences associated with it
Trichomoniasis is a sexually transmitted infection that is characterized by an increased risk of contracting other sexually transmitted diseases such as chlamydia, gonorrhea, HIV and is associated with cervical carcinogenesis. Another characteristic of trichomoniasis is that it increases the risk of postpartum and postoperative complications and infertility. In women, infection with Trichomonas vaginalis causes symptomatic vaginitis, while in men it is asymptomatic, which facilitates transmission and easy spread of the infection.
Trichomoniasis is a sexually transmitted disease caused by single-celled protozoan Trichomonas vaginalis. Trichomonas is the size of white blood cells and have whips (flagella) with which they move. Transmission of trichomoniasis is exclusively sexual, being very rarely transmitted through the use of common toiletries and very poor hygiene. The parasite can also be passed to the fetus at birth, where it can cause vaginitis, urethritis, or respiratory infections.
T. vaginalis can be found in the vagina, cervix, large vestibular (Bartholin) glands, and paraurethral (Skenian) glands in women. Its presence in the vagina leads to alkalization of the environment and a pH above 4.5, which increases the risk of developing other sexually transmitted diseases. In the external environment, Trichomonas is extremely unstable – they are destroyed at very high or low temperatures, under the influence of sunlight, in an acidic environment.
The risk of infection with T. vaginalis increases in patients with multiple sexual partners, frequent change of sexual partners, sexual contact with an infected partner, previous or current sexually transmitted infection, non-use of condoms during intercourse, and use of intravenous drugs.
From a pathophysiological point of view, the parasite penetrates into the epithelial cells of the mucous membranes of the genital tract and releases cytotoxic substances. By binding to host plasma proteins, it avoids recognition by the alternative complement pathway. The production of polymorphonuclear leukocytes increases as a result of the production of chemotactic cytokines by the parasite.
Symptomatically, trichomoniasis appears after an incubation period of 4 to 28 days. Infection in women can occur in three forms: acute, chronic, and asymptomatic. The characteristic of the acute form is that it proceeds with the appearance of yellow-green frothy discharge from the vagina, which has an unpleasant odor. Patients complain of pain and burning during urination, pain during intercourse, redness, and itching in the vulva, pelvic pain, etc. There may be bleeding after intercourse.
The infection manifests itself most often as macular colpitis, so named because of the observation of a characteristic, “strawberry”, macular rash when viewed with a colposcope. In addition to colpitis, trichomoniasis can also be manifested by cervicitis, which is characterized by purulent discharge in the endocervical canal and endocervical bleeding. In the chronic form, the symptoms are less pronounced and macular colpitis is more widespread.
The diagnosis of trichomoniasis is made on the basis of the clinical picture, microbiological examination, and colposcopy. Macular colpitis is a specific symptom that is visualized during colposcopy and the application of Lugol’s solution. When measuring pH, an alkaline reaction of the environment in the vagina is established. Trichomoniasis is also characterized by a positive amine test when using 10% KOH – the release of an unpleasant odor after applying 10% KOH to vaginal discharge.
The secret is taken for cultural study. PCR tests for trichomoniasis are highly specific. In terms of differential diagnosis, trichomoniasis can be confused with other sexually transmitted diseases, inflammatory diseases of the pelvic organs, urethritis, vaginitis, etc.
Complications that may result from T.vaginalis infection are infertility, postoperative complications, cervical intraepithelial neoplasia, etc. During pregnancy, trichomoniasis can lead to the birth of a small fetus, premature birth, premature rupture of the amniotic sac, and respiratory infections of the fetus.
Trichomoniasis is a completely curable infection. Treatment is mainly systemic but may be combined with topical therapy and vaccination. Systemically administered a single dose of metronidazole 2 g, a single dose of tinidazole 2 g, or a 7-day course of metronidazole 500 mg 2 times a day. Metronidazole and tinidazole act by reducing the 5-nitro group of anaerobic microorganisms.
Systemic therapy can be combined with topical application of these drugs. There is also a vaccine for T.vaginalis – which is a lyophilized inactivated strain. It is applied 3 times, 1 ampoule in 2 weeks.
Treatment should be carried out on all partners who have had contact with an infected person. During therapy, sexual contact is prohibited.