Trichomoniasis refers to the infectious damage to the urogenital tract organs, which is caused by special parasitic organisms – trichomonas (Trichomonas vaginalis). Millions of episodes of infection are recorded annually (according to WHO, the incidence in the world exceeds 170 million cases per year), while more accurate figures are unavailable, since the disease often proceeds with a minimum of manifestations. Trichomoniasis in men is asymptomatic in almost 80% of cases.
Human parasites include three types of trichomonas: oral, intestinal, and urogenital. It is the latter agent, which differs in its characteristics from the other two and is adapted to live in the urogenital organs, that causes the disease. An interesting feature of this unicellular parasite (it is also called vaginal trichomonas) is a tendency to “capture” (so-called phagocytosis) other pathogens, in particular, gonococci. Outside the human body trichomonas die without moisture, dried, they cannot withstand heating above 40 degrees, the effects of antiseptics, soap solutions and sun light. In distilled water, they will die in a matter of seconds. Since trichomonas, unlike some other microorganisms, “do not know how” to create special forms protected with a shell, also known as cysts, it is impossible to get contaminated through water, for example, in the pool.
It is possible to get infected with trichomoniasis from a sick or parasitic carrier, in the overwhelming number of episodes, sexually (genital-oral transmission is not proven, a single episode of anal contamination reported).
Infection through non-sexual contact, for example, by joint use of hygiene items, towels, via the toilet seat or medical instruments, is currently unproved as well. Infants can get infected from the mother during childbirth (very rarely).
Contamination risk factors include the following:
• other past or present predominantly sexually transmitted diseases;
• frequent change of sexual partners;
• infected sexual partner;
• refusal to use condoms;
• use of injecting drugs.
Types and Symptoms of Trichomoniasis
The pathology is divided into recent (lasting up to 2 months, in acute, subacute or paucisymptomatic form) and chronic trichomoniasis (exceeding two months, slightly manifested).
There is also the term “trichomonas carriage”, with no signs of pathology, despite the presence of the parasites in the body. This condition is very common in men (almost in 80% of all identified patients) and this makes the infection spread fast (i.e. a person can infect his partner even in the absence of symptoms).
The incubation period after the contamination varies from five to 15 days (usually, two weeks). In men, signs of trichomoniasis, as a rule, are absent altogether. Sometimes, the disease proceeds in the form of a urethritis (inflammatory lesion of the urethra). The following manifestations are typical of the latter case:
• itching in the urethra;
• some urination disorders;
• rarely a small soreness in the urethra, testicles, in the lower abdomen;
• clouding of urine;
• profuse foamy (containing air bubbles), mucopurulent discharge (after two weeks, this manifestation can subside, remaining only in the form of morning scant urethral discharge).
Sometimes, the patients develop balanitis (the inflammatory process affecting the balanus) or balanoposthitis (spreading to the prepuce). Patients may complain of red spots, sores, and erosion on the surface of the balanus or prepuce, and/or itching/burning sensation.
Symptoms are often non-persistent, and may be eliminated spontaneously over time. However, if the treatment of trichomoniasis is not performed or improperly performed, complications or chronization of the process is possible.
Methods of Diagnostics and Detection
To make a diagnosis, it is required that the doctor conduct an examination and laboratory examination. Basic in vitro techniques include the following:
• swab sample microscopy (low sensitive, used to detect the disease in women, while in men it is not recommended);
• culture-based method, also known as bacterial inoculation, includes studies of prostate fluid, urine/sperm analysis (it is the main method of diagnosing pathology in men, although it is very time- and labor-consuming)
• Immunofluorescence assay (highly sensitive, specific, but expensive and requires high qualification of the personnel (otherwise false results can be recorded));
• polymerase chain reaction is widely applicable in the Russian Federation, Europe, however, not recommended in the US in routine practice (the sensitivity/specificity of this method is comparable to the culture test, which makes it possible to use PCR diagnostics as an alternative).
It is important to note that in the case of trichomonas carriage, neither microscopy nor urinalysis may indicate the presence of the pathogen. Therefore, when the issue is suspected, and it is difficult to make diagnose, the culture test of the prostate fluid is mandatory.
If the infection is detected in one of the sexual partners, then treatment of both partners should be prescribed (to examine the second partner before the treatment is completed is not mandatory).
Treatment of Trichomoniasis
The only proven effective treatment for trichomoniasis are nitroimidazoles (such as ornidazole, tinidazole, metronidazole), which are orally taken in the form of tablets. The specific treatment regimen for trichomoniasis is selected only by the attending physician, taking into account the patients’ tolerance to the drugs and concomitant pathologies.
Both a single increased dose of the drug (about 2 g), and 5 to 7-day courses with a twice daily intake of smaller dosages (about 0.5 grams) are possible. A single dose reduces the risk of developing some side infections, for example candidiasis, however, for a long and/or complicated infection, a longer course is usually taken.
The drugs are active only in the area of localization of the pathogen (urogenital tract); they are excreted in urine just after a few days to a week, keeping the effective concentration necessary for the treatment over the period. All preparations are safe enough if the regimen is selected properly. During administration of nitroimidazoles, alcohol consumption is forbidden (depending on an individual drug, for up to three days after the last pill is taken). The patients make a complete recovery in 95% of cases.
Unfortunately, currently, uncontrolled use of such drugs has led to increased resistance of the pathogen (a similar problem was recorded mainly with the use of metronidazole). In such a situation, the doctor may increase the dosage of the drug or prescribe an additional examination to define sensitivity of the pathogenic microorganism. A number of studies have shown the effectiveness of tinidazole in the treatment of metronidazole-resistant trichomoniasis infection. A severe course of the disease may require inpatient treatment with intravenous administration of drugs.
After about 2 weeks from the end of the therapeutic course, a follow-up is necessarily performed. Subsidence of the clinical signs is not always indicative of the cessation of the recovery, a laboratory confirmation of the absence of trichomonads in both partners is necessary.
Local treatment in the form of lotions and syringing did not prove to be efficient, although it can be prescribed in addition to the main regimen.
It is important to undergo treatment together with a sexual partner to exclude reinfection in the future, as well as to abstain from sexual contacts during treatment.
Allergy to the drugs of the nitroimidazole group requires consultation of an allergist and, possibly, prescribing desensitizing agents.
Also, the drugs that increase the body's defenses (aloe, vitreous, Cycloferon, Galavite, etc.), physiotherapy and vitamin therapy, instillation to the urethra (introduction of solutions of medicines – silver nitrate, furacilin, antibiotics and other). Effectiveness of such interventions remains insufficiently clinically proven.
The use of traditional medicine in addition to the main course of therapy is possible only if permitted by the attending physician. Such remedies include:
• fresh squeezed garlic juice three times a day;
• application of or lubrication with aloe juice the periurethral area;
• drinking of aloe juice, decoction of chamomile, infusion of eucalyptus;
• aqueous infusion of lilac flowers, bird cherry, marigold leaves and celandine into the urethra.
A specific feature of trichomonas infection is that it rarely occurs in isolation. Almost in 85% of cases, the disease is combined with other infectious pathologies such as mycoplasmosis, chlamydia, gonorrhea, ureaplasmosis, candidiasis. In this case, the doctor shall prescribe administration of specific medicines to treat the accompanying problems (antibacterial, antifungal, and similar drugs).
It was previously thought that due to phagocytosis of other microorganisms by trichomonas, first, trichomoniasis, and only after that, the accompanying pathologies should be treated. Today, it is conclusively established that survival of the “swallowed” microorganisms in the parasite is low: for mycoplasma and ureaplasma – 3 hours, for gonococci – 6 hours, while chlamydia are not phagocyted at all. Thus, simultaneous treatment of all detected infections is possible, which will reduce the duration of the therapy significantly, as the scientists from the English research center believe. However, opposing to the research of English scientists, the forum participants (forum section discussing the treatment of chlamydia) argue the converse: a trichomonas infection does absorb chlamydia and makes the treatment difficult. That is why many episodes of successful treatment of chlamydia, claimed at the forum, involved a consistent treatment of trichomoniasis, and then chlamydia
It is well documented that trichomoniasis significantly facilitates HIV infection, as well as contributes to the spread of the HI virus: annually more than 700 recorded cases of HIV infection in women are due to concomitant trichomonas infection. For the general population, this risk increases by a factor of 2 in patients with trichomoniasis in comparison with healthy individuals. In addition, this pathology significantly increases the risk of contamination with other sexual infections, for example, gonococcal, chlamydial, etc.
In men, untreated trichomoniasis could induce the following complications:
• in most cases, prostatitis (an inflammatory pathology of the prostate gland), symptoms of urethritis are accomplished by characteristic signs of the complication; the disease is classified as trichomonadal prostatitis;
• vesiculitis (the inflammation spreads to the seminal vesicles);
• strictures (narrowing of the diameter due to cicatrical changes of the mucous membrane) of the urethra;
• epididymitis, which denotes the inflammation of the epididymis, and when the process spreads to the testicle, orchiepididymitis;
• infertility (due to the impaired production and viability of spermatozoa).
Prophylaxis of trichomoniasis
For the recurrent form of trichomoniasis, Swiss vaccine SolcoTrichovac proved to be in some way of use. In men, prescribing this vaccine is useless, because its protective mechanism is based on the immunological action of vaginal lactobacilli, male antibodies to which will form immediately after the first ever sexual contact.
Therefore, prophylaxis of the disease in men is reduced to the following:
• reducing the number of sexual partners;
• use of condoms;
• abstaining from casual sex;
• timely detection and adequate treatment of trichomoniasis in a partner;
• careful observation of personal hygiene rules.
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