Contents
Trichomoniasis is an infectious lesion of the urinary tract, which is caused by special parasitic organisms – trichomonads (Trichomonas vaginalis). Millions of episodes of infection are recorded annually (according to WHO, the incidence in the world exceeds 170 million cases / year), while it is difficult to determine more accurate numbers, since the disease often occurs with a minimum of manifestations. Trichomoniasis in men is asymptomatic in almost 80% of cases.
Causes
Human parasites are three types of Trichomonas: oral, intestinal, urogenital. It is the latter, which differs in its characteristics from the other two and is adapted to living in the genitourinary organs, and is the cause of the disease. An interesting feature of this unicellular parasite, it is also called vaginal Trichomonas, is a tendency to “capture” (the so-called phagocytosis) of other pathogenic organisms, in particular gonococci. Outside the human body, Trichomonas die in the absence of moisture, drying, they cannot withstand heating above 40 degrees, the action of antiseptics, soap solutions and the sun. In distilled water, they die in seconds. Since Trichomonas, unlike some other microorganisms, “do not know how” to create special forms with a protective shell, otherwise cysts, infection through water, for example, a pool, is impossible.
You can become infected with trichomoniasis from a patient or a parasite carrier, in the vast majority of episodes through sexual contact (while genital-oral transmission has not been proven, a single episode of infection during anal contact). Contact-household infection, through sharing personal hygiene items, towels, through the toilet seat or medical instruments with the patient, also remains unproven at the moment. Infants can become infected from the mother during childbirth (extremely rare).
Risk Factors
Risk factors for infection include: • the presence in the present or past of other diseases, transmitted mainly through sexual contact; • frequent change of sexual partners; • the presence of an infection in a sexual partner; • refusal to use condoms; • injecting drug use.
Types and symptoms of trichomoniasis
On the territory of the Russian Federation, pathology is divided into fresh (up to 2 months lasting, in acute, subacute or asymptomatic form) and chronic trichomoniasis (with a duration exceeding two months and with mild manifestations).
There is also the term “trichomonas carrier”, when there are no signs of pathology, but there are parasites in the body. This condition is very common in men (almost 80% of all identified patients) and is the cause of the active spread of infection (i.e., even in the absence of symptoms, a person can infect his partner).
The incubation period after infection varies from five to 15 days (usually two weeks). In men, signs of trichomoniasis, as a rule, are absent altogether. Sometimes the disease occurs in the form of urethritis (inflammatory lesions of the urethra). In the latter case are typical: • itching in the urethra; • some urination disorders; • rarely, slight pain in the urethra, testicles, in the lower abdomen; • turbidity of urine; • a large amount of foamy (containing air bubbles) discharge of a mucopurulent nature (after two weeks, this manifestation may subside, remaining only in the form of scanty morning urethral discharge).
Sometimes men develop balanitis (the inflammatory process affects the head of the penis) or balanoposthitis (with spread to the foreskin). Patients may complain of red spots, sores, erosion on the surface of the head, foreskin, itching / burning sensation. Symptoms are often intermittent and tend to resolve on their own over time. At the same time, if the treatment of trichomoniasis is not carried out or is implemented improperly, then complications may develop or the process becomes chronic.
Methods for diagnosing and detecting a disease
Diagnosis requires an examination by a specialist and a laboratory examination. Basic laboratory methods: • examination of a microscopic smear (low sensitivity, common for diagnosing a disease in women, but not recommended in men); • cultural method, otherwise bacteriological inoculation on a nutrient medium, includes studies of prostate juice, urine / semen tests (is the main method for diagnosing pathology in men, although it requires a lot of time and labor costs); • immunofluorescence reaction – highly sensitive, specific, but expensive and requires high qualification of personnel (otherwise false results may be recorded); • polymerase chain reaction – widely used in the Russian Federation, Europe, but not recommended in the US in routine practice (sensitivity / specificity of this method is comparable to a culture study, which makes it possible to use PCR diagnostics as an alternative).
It is important to note that with trichomonas carriers, microscopy and urinalysis may not show the presence of the pathogen. Therefore, if a problem is suspected and it is difficult to make a diagnosis, a culture study of prostate juice is mandatory.
The detection of infection in one of the sexual partners is an indication for the treatment of both (examination of the second partner in such a situation before the end of treatment is not mandatory).
Trichomoniasis treatment
The only proven effective treatments for trichomoniasis are representatives of a number of nitroimidazoles (such as ornidazole, tinidazole, metronidazole), which are taken orally in the form of tablets. A specific treatment regimen for trichomoniasis is strictly selected by the attending physician, taking into account the tolerance of drugs to patients and the presence of comorbidities in the latter.
Both a single dose of the drug in an increased dose (about 2 g) and 5-7-day courses with a double daily intake of smaller dosages (about 0,5 grams) are possible. A single dose reduces the risk of developing some side infections, such as candidiasis, but with a prolonged and / or complicated infection, a longer course is usually used.
The drugs act strictly in the zone of localization of the pathogen (genitourinary tract), are excreted in the urine after only a few days – a week, while maintaining an effective concentration necessary for treatment in this period. All drugs are quite safe when properly selected scheme. While taking nitroimidazoles, the use of alcohol is excluded (depending on the specific drug for up to one three days after the end of the last tablet). Recovery occurs in 95% of cases.
Unfortunately, in recent years, the uncontrolled use of such drugs has led to an increase in the resistance of the pathogen to them (a similar problem was recorded mainly when taking metronidazole). In such a situation, the doctor may increase the dosage of the drug or prescribe an additional examination to determine the sensitivity of the pathogenic microorganism. A number of studies have shown the effectiveness of tinidazole in the treatment of metronidazole-resistant trichomoniasis infection. In the case of a severe course of the disease, they resort to inpatient treatment with intravenous administration of drugs.
After about 2 weeks from the end of the therapeutic course, a control of cure is mandatory. The disappearance of symptoms absolutely does not indicate the cessation of the disease – laboratory confirmation of the absence of Trichomonas in both partners is necessary. Local treatment in the form of lotions, douching did not show effectiveness, although it can be prescribed in addition to the main scheme. It is important to carry out therapy together with a sexual partner to exclude reinfection in the future, and exclude sexual contacts for the duration of treatment.
In case of allergic reactions to drugs of the nitroimidazole group, consultation with an allergist and, possibly, the appointment of desensitizing agents is required.
Additionally, medications that increase the body’s defenses (introduction of aloe, the vitreous body, the use of cycloferon, galavit, etc.), physiotherapy and vitamin therapy, instillation of the urethra (introduction of drug solutions into it – silver nitrate, furallin, antibiotics and etc.). The effectiveness of such measures remains insufficiently clinically proven.
The use of traditional medicine in addition to the main course of therapy is possible only after the permission of the attending physician. Such techniques include: • taking freshly squeezed garlic juice three times a day; • the use of honey; • application in the form of lotions or lubrication with aloe juice near the urethral region; • drinking aloe juice, chamomile decoction, eucalyptus infusion; • introduction into the urethra of an aqueous infusion of lilac flowers, bird cherry, calendula leaves and celandine.
A feature of Trichomonas infection is that it rarely occurs in isolation. In almost 85% of cases, the disease is combined with other infectious pathologies: mycoplasmosis, chlamydia, gonorrhea, ureaplasmosis, candidiasis. In this case, the doctor also prescribes specific medications to treat such concomitant problems (antibacterial, antifungal, and the like).
Previously, it was believed that due to the phagocytosis of other microorganisms by Trichomonas, it is first necessary to treat trichomoniasis and only then comorbidities. Today, it has been accurately proven that the survival rate of “swallowed” microorganisms inside the parasite is low: three hours for mycoplasma and ureaplasma, 6 hours for gonococci, chlamydia are not phagocytosed at all. Thus, simultaneous therapy of all detected infections is possible, which significantly reduces the duration of the course of treatment, according to scientists from the English research center. However, I oppose the studies of British scientists, the forum participants (the section of the forum on the treatment of chlamydia), argue the opposite – Trichomonas infection absorbs chlamydia and complicates their treatment. That is why many successful episodes of chlamydia treatment, voiced on the forum, had a consistent treatment of first trichomoniasis, and then chlamydia.
Complications
It has been scientifically proven that trichomoniasis significantly facilitates HIV infection, and also contributes to the spread of the latter: annually in women alone, more than 700 cases of HIV infection are caused by concomitant trichomonas infection. In the general population, this risk increases by 2 times in patients with trichomoniasis compared with healthy ones. In addition, with this pathology, the risk of infection with other sexually transmitted infections, for example, gonococcal, chlamydial, etc., is significantly increased.
In men, a complication of untreated trichomoniasis can be: • most often – prostatitis (inflammatory pathology of the prostate gland), the symptoms of urethritis are added to the symptoms characteristic of this complication, the disease is classified as trichomonas prostatitis; • vesiculitis (inflammation extends to the seminal vesicles); • strictures (narrowing of the diameter due to changes in the cicatricial nature of the mucous membrane) of the urethra; • epididymitis, the so-called inflammation of the epididymis, and when the process spreads to the testicle itself – orchiepididymitis; • infertility (due to impaired production and viability of spermatozoa).
Prophylaxis against trichomonas
With a recurrent form of trichomoniasis, the use of the Swiss vaccine Solkotrikhovak in women has shown some effectiveness. In men, the appointment of this vaccine is meaningless, since its protective mechanism is based on the immunological action of vaginal lactobacilli, antibodies to which in men arise immediately after the first sexual contact in life.
As a result, prevention of the disease in men comes down to: • limiting the number of sexual partners; • use of condoms; • exclusion of casual sexual relations; • timely detection and adequate treatment of trichomoniasis in a partner; • careful observance of rules of personal hygiene.