Trichomonas infection and how the menstrual cycle changes. What are the symptoms of trichomoniasis? Symptoms in women

is a parasitic disease known since ancient times, sexually transmitted and causing inflammation of the mucous membrane of the genitourinary organs of women and men.
The disease is caused by a special type of microorganism called protozoa. There are many types of protozoan microorganisms found in nature. Some of them live in water and soil, others are parasites in animals and humans.

Who are Trichomonas, types of Trichomonas

Protozoa– single-celled organisms, unlike other single-celled organisms, are capable of movement due to the presence of flagella and independent existence outside the infected organism. In their structure, the simplest are similar to ordinary cells, the totality of which makes up an entire organism. The difference is that protozoa, despite the simplicity of their structure, exist as a separate integral organism.
The name trichomoniasis comes from the simplest organisms called trichomonas, which cause specific local pathological phenomena.
Trichomonas, which parasitize the human body, are of three types:
Trcihomonas elongata - lives in the oral cavity.
Trichomonas hominis - lives in the human intestine, feeds on various bacteria, red blood cells (blood cells).
Trichomonas vaginalis – found in the lower genitourinary tract:

• Urethra
• Vagina
• Prostate

The first two species (Trichomonas hominis, Trichomonas elongata) do not cause any harm to humans. The third type, which is also the most pathogenic, exhibits the greatest activity and causes local discomfort, as well as inflammatory processes.

Routes of infection with Trichomonas

Trichomoniasis is a very common disease. There is no place on earth where this microorganism does not exist. According to some data, trichomoniasis occurs in both men and women, young and mature, who are sexually active. The disease is transmitted primarily sexually, that is, through unprotected sex. Detailed and clear information about trichomoniasis

Trichomonas colpitis (vaginitis)
Colpitis– inflammation of the superficial layers of the vaginal mucosa. The term colpitis is borrowed from the Greek language. There is also a second name characterizing inflammation of the vaginal mucosa, of Latin origin - vaginitis
Acute trichomonas colpitis is characterized by:

• Unbearable itching, burning in the vaginal area, around the labia. Itching is explained by the irritating effect of trichomonas on the vaginal walls and foamy discharge (secretion).
• Redness and scratching of the skin in the perineal area, labia majora and minora. Appear due to itching in these areas.
• Foamy discharge with a characteristic unpleasant odor. The volume of discharge depends on the phase of the disease. From copious leucorrhoea (discharge) of yellow color, with an acute progressive course, to scanty discharge of gray color, with a chronic, sluggish process. Foaminess and an abundance of secretion appears as a result of vital activity in parallel with Trichomonas, a special type of bacteria that produces gas.

With good, high immunity, the disease can occur in a latent chronic form. In this case, one or another symptom may be absent, or all symptoms may be mild or absent. Inflammatory changes are also minor. The chronic process may periodically worsen. Most often this occurs in the period before the start of a new menstrual cycle, a few days before the onset of menstruation. The exacerbation is associated with a decrease in the amount of estrogens, which are actively involved in the renewal of the surface cells of the vaginal mucosa; in addition, they contribute to the acidification of the internal vaginal environment, and Trichomonas feed on glycogen with the help of which, during the activity of lactobacilli, the internal environment of the vagina becomes acidic.

Trichomoniasis in the menopausal period.
In menopausal women, the incidence of trichomoniasis varies widely. Lack of estrogen causes atrophy (decreased functions, thinning of the walls) of the mucous membrane of the vaginal walls. Accordingly, the microflora of the inner surface of the vagina is disrupted, local immunity is reduced, and favorable conditions are created for the growth and development of not only Trichomonas, but also many pathogenic microorganisms. The main clinical symptoms are expressed as:

• Mucopurulent discharge, sometimes streaked with blood
• Itching in the area of ​​the vaginal vestibule
• Rarely, minor bleeding after sexual intercourse

Pregnancy and trichomoniasis

As a rule, trichomoniasis causes inflammatory changes at the local level, that is, at the level of the genital organs. Thereby negatively affecting the course and course of pregnancy. Can cause complications such as: spontaneous abortion and premature birth. The essence of abortion is that Trichomonas cause inflammatory changes, during which special substances called prostaglandins are released into the blood. Prostaglandins cause increased contractions of the uterine muscles, thereby promoting the expulsion of the fetus from the uterine cavity.

Disorders of the central nervous system (CNS)
Inflammatory damage to the mucous membrane, the addition of a secondary purulent infection and profuse foul-smelling vaginal discharge affect the quality of sexual intercourse. Sexual intercourse becomes painful and impossible. A long-term chronic course of the disease can ultimately cause frigidity not only due to pain, but also emotional discomfort, causing in some cases a disturbance in the psycho-emotional state of a woman.

Microscopic method
For diagnosis confirming the presence of trichomonas in the genital tract, it is necessary to take smears from the vaginal mucosa. It is preferable to take swabs from three different places:
Among women

• Posterior vaginal vault
• Cervical canal
• Urethra

In men, the following is examined:

• Scraping from the urethra
• Prostate fluid
• Sperm

To obtain prostate fluid, a gentle massage of the prostate gland is usually used.
Laboratory tests should be carried out no later than 30 minutes after taking smears, since Trichomonas are very unstable in the external environment and die quickly.
The taken material is placed on a glass slide, a 0.9% sodium chloride solution is dropped, covered with a coverslip and placed under a microscope. In some cases, to better identify trichomonas, smears are pre-stained. Microscopic examination is the most rapid method for diagnosing trichomoniasis and makes it possible to make a diagnosis only 15-20 after taking the starting material.

Cultivation of Trichomonas
As one of the three modern methods for determining a pathological pathogen, it has a number of advantages, such as:

• Allows you to determine the initial amount of Trichomonas in the test material. Indirectly reflects the degree of the inflammatory process.
• It reveals which drugs Trichomonas are sensitive to, which is very important when prescribing the correct and optimal treatment. It also allows you to adjust treatment that has already begun.

Cultivation is carried out by inoculating the contents of smears from the vagina and urethra onto special artificial nutrient media. In this case, Trichomonas find themselves in a favorable environment and begin to multiply intensively. The grown colonies are then subjected to microscopic examination.

PCR method in the diagnosis of trichomoniasis
A very valuable method for detecting Trichomonas. The advantage of this method is that in the chronic course of the disease the pathogen is very difficult to detect using conventional microscopic methods. In addition, any biological fluid of the body is suitable for research, be it blood, saliva, scraping of the urethral or vaginal mucosa.
The method is based on the fact that Trichomonas DNA, that is, genetic material, can be easily detected in the material being studied. Analysis accuracy is 100%. Results appear the very next day, which allows you to start effective treatment in a timely manner.

Treatment of trichomoniasis

To fully recover from trichomoniasis, the following conditions must be met:

1. It is necessary to treat both sexual partners at the same time
2. During the course of treatment, any sexual contact is excluded
3. Use special anti-trichomonas drugs (metronidazole, tinidazole)
4. In parallel with treatment, hygiene rules for caring for the genitourinary organs are observed:

• Daily washing of the genitals using antiseptics (a weak solution of potassium permanganate, furatsilin solution) or detergents, that is, ordinary toilet soap.
• All movements when washing are carried out from front to back, that is, from the side of the vagina to the anus. This is necessary in order to avoid infection in the urethra.
• Individual use of toiletries (soap, washcloths, towels).
• Daily change of underwear

1. Mandatory treatment of other concurrent diseases of the genitourinary organs of infectious and inflammatory origin.

Below are several treatment regimens for trichomoniasis using anti-trichomoniasis drugs.

Scheme using metronidazole (Trichopol)
On the first day, take 1 tablet 4 times orally with water.
From the second to the seventh day inclusive, take 1 tablet 3 times a day, also taken orally with water.

Metronidazole– antiprotozoal, antimicrobial drug.

Mechanism of action consists of an inhibitory effect on the genetic apparatus of bacteria. In this case, all biological processes of the cell gradually cease and the microorganism dies.

Contraindication pregnancy and hypersensitivity to the drug.

Tinidazole regimen
Take 4 tablets of 500 mg each at once. Or
For 7 days, 1/3 tablet 2 times a day

Tinidazole
The drug is from the same group as metronidazole with a similar mechanism of action and side effects.
Contraindications –

• hematopoietic disorders
• pregnancy and lactation
• hypersensitivity to the drug

Scheme using Klion - D
Klion – D- a combination drug that contains equal parts of metronidazole and miconazole (an antifungal drug). The drug is very effective for mixed infections of the genitourinary system of bacterial and fungal origin.
Prescribed in the form of vaginal suppositories, 1 piece at night for 10 days.

Monitoring the effectiveness of treatment antitrichomonas drugs are carried out as follows:

• For 2-3 months after treatment, smears of the contents of the vagina and urethra are taken for microscopic examination for the presence of vaginal trichomonas
• Smears should be taken 1-3 days after menstruation

Prevention of trichomoniasis

Preventive measures imply an integrated approach aimed at protecting against possible infection not only with trichomoniasis, but also with all sexually transmitted diseases, be it gonorrhea, chlamydia, syphilis and many others.

• Prevention should begin with educational activities about a healthy lifestyle, the importance of contraceptive methods, and routes of transmission of infections that cause inflammatory diseases of the genital tract. These measures are primarily aimed at preventing the occurrence of infectious inflammatory diseases of the genitourinary organs in categories of people of adolescence. Medical workers, teachers in schools, professors in lyceums and universities are required to carry out educational activities in this direction among high school students, university students, and vocational schools.

• Categories of young and middle-aged people who are sexually active should be careful when choosing a sexual partner. Promiscuous sexual intercourse is not encouraged. The ideal option is an intimate relationship with one sexual partner. The use of condoms plays an important role as a means of preventing the occurrence of unwanted pregnancy and the transmission of Trichomonas infection during sexual intercourse.

• Preventive control by a gynecologist at least once a year, with taking smears from the urethra, posterior vaginal fornix, and cervical canal. The contents from these places are subjected to microscopy, thereby determining the presence of a possible infection and at the same time determining the degree of cleanliness of the vagina.

• Treatment of concomitant diseases of the genitourinary organs caused by other types of pathogenic microorganisms that reduce local immunity and increase the risk of Trichomonas infection.

• An incomparably significant role in the spread of Trichomonas vaginalis is played by the simultaneous use of toiletries (washcloth, towel) by two or more people, one of whom suffers from trichomoniasis. Therefore, it is necessary for each person to have their own body care products and use them individually.

• When preparing for pregnancy, both women and men should be tested for the possible presence of a latent urinary tract infection. And also consult your doctor about this. When planning a pregnancy, it is necessary to cure all possible foci of infection in the woman’s body.

What are the possible consequences of trichomoniasis?

Most often, trichomoniasis causes complications during pregnancy:

• premature birth;
• low birth weight of the baby;
• transmission of infection to the child when he passes through the birth canal.

In addition, there is evidence that trichomoniasis increases the risk of contracting some dangerous infections, in particular the human immunodeficiency virus (HIV), which causes AIDS.

How to eat properly if you have trichomoniasis?

Dietary habits are more related not to the disease itself, but to the use of anti-trichomoniasis drugs that have antibacterial activity. As with any antibiotics, the diet must be complete, otherwise nausea, indigestion and other side effects may occur. You need to have a hearty breakfast, preferably porridge.

It is useful to take pancreatic enzyme preparations during the course of treatment, for example Mezim-Forte. You can also take medications containing bifidobacteria, since antibiotics can cause dysbacteriosis. For more detailed advice, contact your healthcare provider.

Do not drink alcohol within 24 hours of taking it metronidazole and within 72 hours after administration tinidazole. These drugs can cause a reaction to ethyl alcohol, like a “coding” for alcoholism. Nausea, vomiting and other unpleasant symptoms occur.

Is it possible to have sex with trichomoniasis?

During treatment of trichomoniasis, sex is completely contraindicated for two reasons:

• Trichomoniasis is a sexually transmitted infection. This means there is a risk of infecting your partner.
• Sexual intercourse reduces the effectiveness of treatment.

Does a condom protect against trichomoniasis?

Condoms are one of the simplest, most accessible and effective means of protection against unwanted pregnancy and sexually transmitted infections. But they do not completely protect against either one or the other.

Condoms only prevent trichomoniasis by 90%. With constant contact with one sick partner, the likelihood of transmission of infection increases even more.

Do not forget that during sexual intercourse the condom can break and slip off the penis.

Is trichomoniasis transmitted during oral sex?

Theoretically, such a possibility exists, it may even develop trichomoniasis sore throat. In practice, this happens extremely rarely. But it’s still not worth the risk.

How is trichomoniasis coded in the ICD?

Trichomoniasis has several codes in the International Classification of Diseases, 10th revision:

The sexually transmitted disease trichomoniasis is not always heard of. However, doctors classify it as one of the most common sexually transmitted diseases (STDs). Thus, more than 3 million new cases are recorded annually in the United States.

The causative agents of infection are neither bacteria nor viruses, but belong to the category of protozoan flagellates. At the same time, they are often combined with other pathogenic microorganisms. Usually with gonococci, chlamydia, candida, mycoplasma.

In women, the vagina is most often affected, and in men, the urethra. This feature means that trichomoniasis is a sexually transmitted disease. There are several known types of Trichomonas:

• Trichomonas tenax (elongata) live in the oral cavity, carious teeth.
• Trichomonas hominis (abdominalis) is found in the intestines.
• Trichomonas vaginalis is the only pathogenic member of the family that can cause sexually transmitted infections in men and women.

Clinically, trichomoniasis (trichomoniasis) is an infectious process. This venereal disease is characterized by a number of features:

• Highly infectious. On the surface of T. vaginalis there are special receptors that bind it to the epithelial cell within a few minutes.
• Significant virulence. Trichomonas destroy red blood cells and reduce the activity of tissue immunity.
• Resistance to the immune response: killer macrophages cannot cope with the pathogen and die, provoking a subacute inflammatory process.
• Tendency to chronicity.

Trichomoniasis has a high frequency of chronicity.

Clinical manifestations are often mild or absent.

Causes of the disease

The only way to become infected with trichomoniasis is to acquire pathogens from an asymptomatic carrier or a sick person. In almost 99.9% of cases, infection occurs through unprotected sexual contact.

So it’s not a problem to figure out how to specifically become infected with trichomoniasis. Trichomonas are found in semen, prostate juice, and vaginal discharge. Pathogenic Trichomonas vaginalis is not detected in saliva. For the disease to occur, a minute’s contact between the mucous membranes of the genital organs of a man and a woman is sufficient. Even without ejaculation. So it is the sexual transmission of trichomoniasis that is considered clinically significant. Therefore, the disease almost never occurs in boys, virgins and menopausal women.

The pathogenesis of trichomoniasis has been well studied. Once on the epithelium of the urethra or vagina, the microbes “stick” to the cell and release pseudopodia. And with their help they begin to suck out the substances they need from her. To get iron, they absorb red blood cells and phagocytose them. As a result, the cells weaken and become susceptible to other infections. The appearance of an unpleasant odor during trichomoniasis indicates the addition of third-party flora (gardnerella, candida and other microbes).

Outside the human body they dry out quickly, so infection through household contact is rare. However, there is a possibility of transmission of infection through objects and surfaces contaminated with a large number of microbes:

• Bidet.
• Toilet seat.
• Washcloth.
• A damp towel.

So in a public bath or sauna you need to use only personal hygiene products.

This begs the question, is it possible to get sick while swimming in the same body of water (swimming pool, pond, river). Such transmission routes are rejected by medicine. Doctors also exclude the possibility of developing trichomoniasis outside the genital organs, even in people with immunodeficiencies. Skin lesions of the genital organs in men and women are described as isolated cases. That is, the likelihood of contracting trichomoniasis during oral sex or through a kiss is quite low. But in order for the infection to become very widespread, saliva is not needed: the sexual tract is enough. The highest chance of getting sick is in people who are sexually active. At risk:

• Women and men 16-39 years old.
• Sex workers.
• People who are not too picky in choosing sexual partners.
• Neglecting barrier contraception.
• Avoiding periodic medical examinations.

The problem is that inflammation with trichomoniasis is invisible. A person can be infected for several years without even knowing it. Accordingly, his sexual partners get sick. And when symptoms appear, they cannot understand how it happened, where their trichomoniasis comes from. In a sexually active couple, it is generally impossible to determine who infected whom first. The only exception is sex with a virgin. If after the first contact a woman develops trichomoniasis, then there is no question about the source of infection. We already know where the disease comes from and how it is transmitted.

How does trichomoniasis manifest?

Unfortunately, the clinical picture does not allow us to accurately determine the presence of trichomonas inflammation. That's why he's insidious trichomoniasis: symptoms diseases are not specific.

Those who are sick simply show signs of some kind of infectious process in the genital organs. The first symptoms appear in different people at different times, the average duration of the incubation period is 5-7 days with fluctuations from 3 to 14 days. There are then three possible options for the process:

• Acute with vivid symptoms.
• Chronic, manifestations are weak.
• Asymptomatic carriage.

In men, the urethra is the first to be affected, and signs of anterior urethritis occur:

• Itching and burning in the head area.
• Increased discomfort at the beginning of urination.
• Scanty discharge from the urethra, like a morning drop.
• Discomfort during ejaculation.

• The back of the urethra is affected, the burning does not subside throughout the entire act of urination.
• Prostate. Prostatitis can manifest as pain in the perineum and impaired urine flow.
• Seminal vesicles. Inflammation is accompanied by pain during ejaculation.
• Epididymis. Pain and swelling in the scrotum.
• Bladder. Signs of cystitis appear.

In 60-70% of men, the process does not manifest itself at all or occurs with sluggish symptoms. As for women, the vaginal mucosa is primarily affected. The day on which symptoms appear depends on the severity of the infection. After the end of the incubation period, vaginitis appears:

• Itching and burning in the vagina.
• Scanty discharge. At first, the leucorrhoea is mucous in nature, but soon it can become purulent and profuse.
• When other flora joins, an unpleasant odor appears.

Abundant leucorrhoea leads to maceration of the skin and causes rashes in the groin and perineum. After a few days, due to their mobility, the pathogens spread to the cervix, cervical canal, endometrium, glands of the vestibule of the vagina and the female urethra. And from there - into the bladder. During anal sex, intestinal trichomoniasis cannot be ruled out.

Symptoms:

• The urge to go big becomes more frequent.
• The feces are liquid and unformed.
• Pain and discomfort in the anus.
• An admixture of mucus and blood in the stool.

Whether chronic or asymptomatic trichomoniasis can manifest itself after a few years is difficult to answer. Probably, with a decrease in immunity, this option cannot be excluded.

Types of Trichomonas

We have already mentioned above that vaginal trichomoniasis can be caused by only one type of microorganism. This is T. vaginalis or Trichomonas vaginalis.

Only these pathogens have tropism for the epithelium of the vagina, urethra or other organs of the human genitourinary system.

No other pathogens cause urogenital trichomoniasis are not capable. If symptoms of inflammation appear in the intestines or mouth and trichomonas are detected during examination, their belonging to T. vaginalis is doubtful. The oral cavity can be contaminated with Trichomonas tenax (elongata), the intestinal microbe - Trichomonas tenax (elongata). Both of these microorganisms are non-pathogenic and do not lead to disease even in conditions of severely weakened immunity.

Difference from other diseases

In clinical practice, special forms of trichomoniasis or, which is the same thing, trichomoniasis pose serious difficulties. These are combined and mixed lesions.

Combined trichomonas infection involves simultaneous damage to several organs. In the second case, they mean a mixture of Trichomonas with other pathogenic microorganisms:

• Gonococci (very common).
• Chlamydia.
• Candida.
• Gardnerells.

Each of the pathogens is capable of causing urethritis and/or vaginitis, and the treatment required is different. Therefore, the problem of how to determine the type of infection is of great clinical importance.

Gonorrhea or gonorrhea are a common companion to trichomoniasis, but they are not the same thing. Mixed is very common because Trichomonas can ingest gonococci and then release them. Because of this feature, suspicion of gonorrhoea always requires examination for trichomoniasis.

Externally, it is impossible to distinguish the acute forms of these infections. The next common mix is ​​trichomoniasis and chlamydia.

Gardnerella is a common cause of “rotten fish” odor. This symptom is sometimes attributed to Trichomonas or chlamydia. But in fact, these pathogens weaken tissue immunity, which Gardnerella takes advantage of.

Treatment options

Answering the question of how to cure trichomoniasis is both simple and difficult at the same time. On the one hand, not many drugs are effective against pathogens. Because of this, the treatment regimen seems simple. On the other hand, such a superficial approach does not take into account the peculiarities of the treatment of chronic trichomoniasis, frequent mixtures with gonorrhea and chlamydia. Such errors sometimes make one wonder whether the disease can be completely cured? Yes, it is being treated.

But the only sure way to cure trichomoniasis forever is to contact a qualified urologist or venereologist. This doctor treats trichomoniasis in both men and women.

Only a specialist knows how to treat the disease and which regimen will be most effective. He will tell you how many days it takes to treat trichomoniasis and what to do to prevent the infection from returning. Determine which, for how long and in what doses to take medications for the complete destruction of Trichomonas and accompanying pathogenic flora.

Without medical help, without adequate treatment, trichomoniasis can never go away on its own. And the spontaneous disappearance of symptoms is not a victory of the immune system, but the transition of the infection to a chronic form.

What drugs are used for treatment?

Treatment of trichomoniasis is medicinal and is implemented in two directions: local and systemic. In the first case, vaginal suppositories and tablets with anti-Trichomonas components are used. In the second, treatment drugs are taken orally or administered parenterally.

Only simultaneous treatment of both spouses or sexual partners will be effective. Nitroimidazole derivatives are used as the main drugs for trichomoniasis: trichopolum (metronidazole), tinidazole (fasizhin), ornidazole, imidazole. Conventional antibiotics are not effective.

Treatment of simple monoinfection

Early detection allows you to limit yourself to metronidazole. This is a good drug, available in the form of tablets, solutions for intravenous infusion, vaginal suppositories for local treatment. There are several regimens for taking metronidazole or trichopolum:

• Once in an amount of 2-2.4 grams.
• 500 mg 2 times a day for 5 days.
• Individual course.

Alternative schemes are as follows:

• Ornidazole or tinidazole 500 mg twice a day for 5 days.
• Ornidazole once 1-1.5 g.
• Tinidazole 1.5-2.0 g once.

It has been proven that the best effect is guaranteed by regimens that involve taking medications over several days.

Treatment of complicated trichomoniasis

The high frequency of advanced cases does not allow prescribing simple regimens to all patients. In the presence of complicated and common forms, the following are used:

• Metronidazole 500 mg orally three times a day for 7 days.
• Metronidazole orally 2.0 g once a day, 5 days.
• Ornidazole 500 mg 2 times a day, 5 days.
• Tinidazole 2 grams once a day, 3 days.

You must take tablets for trichomoniasis strictly as prescribed by your doctor. Since uncontrolled use of these medications sometimes has a toxic effect.

There are difficult cases when effective initiation of treatment requires intravenous infusions of drugs from the nitroimidazole group. The development of scars and adhesions is an indication for the use of enzyme preparations (longidase, lidase).

Treatment of mixed infection

Antitrichomonas drugs are enhanced by antibiotics and other drugs in the presence of concomitant pathogenic flora:

• Macrolides – azithromycin, josamycin (Vilprafen). Effective against chlamydia, gonorrhea, mycoplasma, syphilis.
• Fluoroquinolones – lomefloxacin (Maxaquin). Indicated for gonorrhea, chlamydia, ureaplasma.
• Tetracyclines – doxycycline. Destroys chlamydia, gonococci, Treponema pallidum.
• Sulfonamides - biseptol. Microbial resistance to them is often found.
• Penicillins – amoxicillin. Useful for syphilis.
• Uroseptics – nifuratel (Makmiror). Prescribed for gardnerellosis, chlamydia, mycoplasma, candidiasis and trichomoniasis.
• Monural (fosfomycin) is effective for nonspecific infections.

The only universal remedy is Macmiror.

In addition to antibacterial and antifungal effects, this remedy simultaneously destroys Trichomonas. It does not affect lactobacilli. How to take medications should be discussed with your doctor. The dose often depends on body weight, and each has contraindications.

Local treatment

Does not eliminate trichomonas from the internal genital organs. Therefore, local therapy must be combined with systemic drugs. For local treatment of trichomoniasis, creams, suppositories, vaginal tablets and douching are used in women. For men - instillation of solutions into the urethra.

Applicable:

• Complex products, for example, Terzhinan with ternidazole, neomycin, nystatin and hormone.
• Uroseptics – furagin.
• Antiseptics – chlorhexidine.

Any attempts at self-medication, for example, douching with vinegar, will only increase the irritating effect of microbes and aggravate the course of the disease.

Trichomoniasis during pregnancy

Many cases of trichomoniasis are detected during pregnancy registration. For the fetus, the infection is dangerous due to malnutrition, impaired maturation of the placenta, and early rupture of the amniotic sac. Developmental anomalies are very rare, but treatment should be carried out at any stage of pregnancy.

A typical regimen for the eradication of trichomonas in pregnant women is metronidazole 2.0 orally once. You need to be examined in preparation for conception: doctors categorically do not recommend getting pregnant with untreated trichomoniasis. But after a course of therapy, conception and pregnancy proceed without problems.

Analysis for trichomoniasis

A test for trichomoniasis must be taken when the first complaints appear. And sometimes even a few days after unprotected sex. Laboratory diagnosis of trichomoniasis is based on tests:

• Urine.
• Urethral smear.
• Blood from a finger.

Methods for detecting trichomoniasis include:

• Microscopy of urine and smear tests.
• Sowing the smear on nutrient media.
• PCR of blood or smear material.

You need to take tests again at the end of the course of therapy to confirm recovery.

The gold standard now is PCR diagnostics: the analysis is done in one day and gives 99.9% accuracy.

A rapid test using a drop of blood is suitable for screening examination. But his positive result still needs to be double-checked.

Consequences of the disease

The main thing that makes trichomoniasis dangerous is the development of adhesions in the genitals after several years of carriage. Such complications can make a person infertile. If a pregnant woman gets sick and gives birth, it is terribly dangerous for the fetus. Since he may die, or be hypotrophic, or be born with congenital trichomoniasis.

Trichomoniasis (or trichomoniasis) urogenital is a disease exclusively of the human genitourinary system. The causative agent of trichomoniasis is Trichomonas vaginalis, which is sexually transmitted.

Next, we will consider what kind of disease this is, what are the causes, modes of transmission and symptoms in adults, and also why it is important to carry out a correct diagnosis and start treatment at an early stage so that serious consequences do not arise.

What is trichomoniasis?

Trichomoniasis is a sexually transmitted disease caused by human infection with vaginal trichomonas (Trichomonas vaginalis).

Trichomoniasis affects the human genitourinary system and is caused by a specific pathogen – Trichomonas vaginalis. It belongs to the group of protozoal infections and is characterized by the ability to persist for a long time inside the genitourinary organs, even under unfavorable conditions and the action of various drugs.

Trichomonas infection is present in 30–70% of the total female population, and in almost half of those affected, the characteristic symptoms of the disease are absent or mildly expressed.

The main route of transmission of trichomoniasis - sexual contact and household contact - is not considered in any way, although there is a point of view that infection is possible through freshly used bath accessories, on which fresh discharge of a patient with trichomoniasis could remain.

• In men, pathogens are found in the urethra, prostate gland and seminal vesicles, and from secretions - in semen and prostate secretions.
• In infected women - in the vagina and Bartholin glands, cervical canal, urethra. Neisseria and chlamydia are often found inside Trichomonas; in these cases, gonorrhea accompanies trichomoniasis, complicating the diagnosis and treatment of the disease.

Features of the pathogen

Incubation period, that is, the time from the moment of infection to the appearance of the first symptoms of the disease ranges from 1 day to 1 month, on average - from 5 to 15 days.

Trichomonas:

• quickly lose viability outside the human body. A prerequisite for life is the presence of moisture; when dried, they quickly die.
• Not resistant to high temperatures (over 40°C), direct sunlight, or antiseptics.

Forms of trichomoniasis:

1. Fresh – up to two months.
2. Chronic. It is characterized, as a rule, by a torpid course lasting more than two months.
3. Carriage of Trichomonas infection. When trichomonas are detected in the laboratory, there are no clinical symptoms of the disease.

Causes of trichomoniasis

In fact, 90% of the population are carriers of Trichomonas, but in most people it does not manifest itself in any way.

How can you become infected with trichomoniasis?

• unprotected sexual contact;
• a large number of sexual partners;
• previously suffered or not fully cured sexually transmitted diseases.

The development of trichomonas in the body is facilitated by hormonal imbalances, metabolic disorders, and a decrease in the body’s immune response. Immunity to trichomoniasis is not developed, so you can become infected again.

Factors contributing to the development of urogenital trichomoniasis:

• endocrine system disorders;
• metabolic disorders;
• hypovitaminosis;
• bacterial contamination of the vagina, accompanied by a change in its acidity;
• menstruation and postmenstrual period.

First signs

Trichomoniasis, like gonorrhea, is almost impossible to recognize on your own, except for frequent discharge from the genitals. A transparent, large drop is the only symptom inherent in everyone with trichomoniasis.

Indirect signs of trichomoniasis:

• pain when urinating (as with gonorrhea);
• strong periodic burning sensation;
• pain in the lumbar part of the body.

In the acute phase of trichomoniasis, symptoms begin to appear quite pronounced in the form of:

• temperature rise;
• increase in ESR;
• development of leukocytosis.

Symptoms of trichomoniasis in adults

Typically, the incubation period for trichomoniasis lasts from 2 days to 2 months. If trichomoniasis occurs in an erased form, then the first symptoms may appear several months after infection with decreased immunity or exacerbation of other chronic infections.

Trichomoniasis (depending on the severity of symptoms and duration) can occur in acute, acute, chronic forms and as trichomonas carriers.

The onset of an acute inflammatory process is predominantly characterized by the appearance of vaginal discharge, as well as discharge from the urethra. It is the discharge arising from the genital tract that is the main and most common symptom, and such discharge is noted in about 75% of cases.

The main symptoms of trichomoniasis are discharge from the urethra or vagina, the entry point of infection. Among women, this symptom is observed in approximately 8 out of 10, and in men – in half of cases of trichomoniasis.

Among women

With the development of trichomoniasis, women experience characteristic complaints:

• discharge from the genitals (abundant, often serous-purulent, foamy - characteristic of trichomoniasis);
• itching, burning, pain when urinating;
• swelling and hyperemia (redness);
• occurrence in the folds of the vaginal mucosa;
• pain upon examination, when pressing on the urethra - the appearance of discharge;
• macerated skin;

Genital warts often occur simultaneously.

If the disease affects the cervix (endocervicitis), then swelling of the cervix occurs, accompanied by copious discharge. Erosion often occurs.

In men

After the urogenital trichomonas has entered the male body, its vital activity provokes the development of the so-called trichomonas. This infectious and inflammatory disease is accompanied by a number of clinical symptoms:

• A burning sensation during urination or after intimacy;
• Mucopurulent discharge from the urethral canal, accompanied by discomfort and unpleasant odor;
• Formation of compaction (strictures) in the urethral area;
• Signs of inflammatory damage to the testicles and their appendages, as well as the prostate gland.

The infected person may be unaware that he is the source of the spread of infection, and transmit Trichomonas to sexual partners or family members.

Therefore, if a man has even the slightest signs of a urogenital infection, he needs to contact a urologist and get tested not only for trichomoniasis, but also for other STIs.

As a rule, the symptoms of the acute form of trichomoniasis appear for about 1-2 weeks, after which the clinical manifestations either decrease or disappear, or transition to the chronic form of the disease.

Complications

Complications of trichomoniasis:

• Acute or chronic inflammatory lesions of the genital area in women and men: endometritis, salpingoophoritis, urethritis, etc.
• During pregnancy, the risk of miscarriage, premature birth, infection of the fetus, and the development of purulent-septic complications of the postpartum period increases.
• Male and female infertility.
• Increased risk of contracting other sexually transmitted infections. It has been proven that the presence of trichomoniasis in women doubles the risk of infection with type 2 herpes viruses and human papillomavirus infection, as well.

Diagnostics

Laboratory diagnostic methods are used:

• microscopic examination of native smears from the vagina, urethra and cervix (reliable only with rapid microscopy of freshly taken smears);
• microscopic examination of Gram-stained smears;
• cultural method (seeding mucus and urethral contents on nutrient media, but requires 4 to 7 days);
• PCR (polymerase chain reaction) - isolation of Trichomonas DNA from urethral or vaginal discharge (very expensive analysis).

In most cases, trichomoniasis is accompanied by the following infections:

• gonorrhea;
• chlamydia;
• mycoplasmosis;
• fungal infections (thrush in women).

This information should be taken into account when prescribing the appropriate course of therapy.

Treatment of trichomoniasis

How to treat trichomoniasis? Treatment requires compliance with several basic principles, these include the following:

• treatment of the disease in a simultaneous manner, that is, it implies treatment of both sexual partners;
• prohibition on sexual activity during treatment of the disease;
• elimination of factors that provoke a decrease in the body’s resistance, which implies the need to cure concomitant diseases, hypovitaminosis and other similar varieties;
• the use of anti-Trichomonas drugs in combination with local and general hygiene procedures.

Medicines for trichomoniasis

Before using any drug, be sure to consult your doctor, as... there are contraindications.

Drugs	Instructions
Metronidazole (Trichopol)	On the first day, take 1 tablet 4 times orally, with water. From the second to the seventh day inclusive, take 1 tablet 3 times a day, also orally with water.
Metronidazole	Antiprotozoal, antimicrobial drug. The mechanism of action is an inhibitory effect on the genetic apparatus of bacteria. In this case, all biological processes of the cell gradually stop and the microorganism dies. Contraindications are: pregnancy hypersensitivity to the drug.
Tinidazole	Take 4 tablets of 500 mg each at once, or 1/3 tablet 2 times a day for 7 days. Contraindications: hematopoietic disorders, pregnancy and lactation period, hypersensitivity to the drug
Klion – D	A combined drug that contains equal parts of metronidazole and miconazole (an antifungal drug). Prescribed in the form of vaginal suppositories, 1 piece at night for 10 days.

There is an approved treatment regimen for chronic trichomoniasis, as well as recurrent and various localizations:

• a single daily dose of 2.0 g of Metronidazole for 7-10 days or 500 mg 3 times a day for the same number of days,
• Tinidazole - 2.0 g once daily for 3 days.
• Highly effective with good tolerability and a small number of possible side effects is Ornidazole, or Ornizol, in a dose of 0.5 g - 2 times a day for 10 days.

Immunomodulatory agents are also used, which also suppress the development of concomitant infections, for example, fungal infections - 3 irrigations of the vagina and cervical area with a 0.04% solution of the drug Gepon in a dose of 5 ml - 1 irrigation each with a 2-3 day interval.

In addition, to reduce the harmful effects of antimicrobial drugs on the intestinal microflora, it is recommended to take medications containing bifidobacteria.

After taking Metronidazole, absolutely prohibited to use alcohol within 24 hours.

If the patient takes Tinidazole, then the duration of abstinence from alcohol is at least 72 hours. If these restrictions are not observed, a person risks experiencing adverse reactions such as dizziness, nausea and vomiting.

Trichomoniasis is considered cured when the pathogen is not detected during diagnosis and clinical symptoms are not observed. Sexual activity is prohibited during treatment. It is necessary to inform your sexual partner about the presence of trichomoniasis and other STDs, about the need for examination and treatment.

The result of treatment for trichomoniasis depends on the normalization of the microflora of the genitourinary system and the body as a whole. In women, a vaccine against inactivated lactobacillus acidophilus is used for this purpose. It is possible to prescribe immunomodulatory drugs.

Prevention

Prevention of trichomoniasis comes down to following the rules to prevent infection with sexually transmitted diseases. Basic recommendations:

• use condoms;
• be careful when choosing partners;
• avoid casual sexual relationships;
• Do not share towels, washcloths or other hygiene items.

Please also note that trichomoniasis is easily transmitted during sexual intercourse, so if there is a suspicion of an infection, both partners should be examined at once.

This is all about trichomoniasis in women and men: what kind of disease it is, its causes, what are the first symptoms and signs, features of treatment. Do not be ill!

After the incubation period ends, that is, about a month after infection, the first symptoms of trichomoniasis can be detected in the patient. During the course of the disease, inflammatory processes can occur in an acute form, which is characterized by the identification of such signs as severe pain and profuse purulent-whitish discharge from the genitals.

Determination of clinical signs of the disease

How does trichomoniasis manifest during the primary stage of infection? In most cases, the infection initially proceeds torpidly, depriving the doctor of the opportunity to promptly identify the pathogen and determine its type. In addition, the patient himself may not detect the disease at all, but at the same time inflammatory processes are already beginning to form in the organs of the genitourinary system. A latent carrier of trichomoniasis can cause infection to their sexual partners.

In the acute stage of the disease, the following clinical symptoms are detected: discharge of unpleasant-smelling greenish mucus from the urethral canal, vagina or glans penis. How to identify Trichomonas at this stage? The intensity of the discharge can determine the degree of inflammation - they are the most common sign of trichomoniasis, which can be detected in 80% of those who seek medical help. Among women this statistical indicator is significantly higher, among the male part of infected people it is lower.

Gender differences in symptoms when identifying a pathogen

How to determine trichomoniasis in a woman? It is necessary to pay attention to the following manifestations of a bacterial infection discovered during a gynecological examination: redness of the surface of the genital organs, swelling of the perineum, mucous discharge from the vagina, the presence of erosive ulcers on the mucous surface of the genitals, foamy or watery discharge, with an unpleasant fishy odor (with colpitis). Trichomoniasis is often accompanied by a burning sensation during urination, itching and short-term pain in the groin.

How does Trichomonas manifest itself in men? Infection in men can be detected by the following symptoms: burning and sharp pain when urinating, dysuria, white or foamy discharge from the urethra, and possibly blood in the stool or urine.

Diagnostic methods for determining bacteria

The fundamental data in determining the type and diagnostic identification of a microorganism are the results of laboratory tests, for which various biological fluids and scrapings from epithelial tissue are taken from the patient for examination. How to detect Trichomonas using IRA, PCR or ELISA? For analysis, biomaterial is taken from women from the urethra, rectum or vagina. And in men - only from the urethra. A urine centrifuge test is very effective in identifying bacteria.

In medical practice, several methods for detecting a pathogen are described:

• The cultural method is characterized by high accuracy of detection of trichomonas, is effective, but requires a lot of time.
• Microscopic examination of native preparations - identification of the pathogen by immediate examination of the obtained smears under a microscope.
• Microscopic analysis - aimed at identifying the pathogen using specific staining of preparations.
• PCR is a fast method that is highly sensitive and helps to detect the DNA of the pathogen even if other diagnostic methods did not detect anything or could not determine the type of infection.
• Immunological studies - help to demonstrate labeled antibodies.

Each method has its own advantages and disadvantages, therefore, before identifying trichomoniasis using any of them, be prepared for the fact that none of the tests will give a 100% accurate result.

Trichomoniasis is a unique disease in the full sense of the word. On the one hand, it occurs three times more often than syphilis, chlamydia and HIV. But, on the other hand, it often remains without due attention, both from doctors and from the patients themselves.

Often a woman undergoes long-term treatment for ureaplasmosis-mycoplasmosis, chlamydia, candidiasis, dysbacteriosis, or simply “leukocytosis in smears,” which exhausts her body and suppresses its defenses, but complaints about periodic unpleasant discharge that causes discomfort continue. When communicating with such a woman, information suddenly appears that trichomonas were sometimes found in smears, which either disappear or appear again. Has the woman's partner been tested? From the answers of many women, you learn that most often sexual partners remain aloof from any examinations. And, on the contrary, where it is not rational to examine a partner, he is sent for dozens of tests and given unreasonable treatment.
Trichomoniasis is a typical infection transmitted only through sexual contact, which means it is a minor venereal disease. If a person is diagnosed with Trichomonas and the diagnosis of trichomoniasis is confirmed correctly, it is necessary to understand that the infection occurred through sexual contact, so the sexual partner(s) must be examined and treated. Most cases of trichomoniasis in men are not diagnosed! Unprotected sexual relations should be stopped during the treatment period. Most often, both partners need treatment at the same time.

Prevalence of trichomoniasis
In the world, according to WHO, trichomoniasis affects 170-180 million people annually, which significantly exceeds the incidence of gonorrhea and chlamydia. In the USA, up to 10 million people are infected with Trichomonas, and in Europe – 11 million people. More than 150 million people are infected in developing countries. These figures may be significantly higher (according to other sources, more than 270 million people are infected in the world). In fact, this is the only sexually transmitted disease that is not subject to registration and reporting in the vast majority of countries in the world.
The prevalence of the disease depends on the socio-economic conditions of the population and the availability of timely, high-quality medical care, good hygiene, and the level of education of people. For example, in the United States, black residents are more often infected with trichomoniasis. Around the world, the incidence of trichomoniasis among adolescents is increasing because many of them are sexually active.
Trichomonas infection occurs in 29-84% of women (depending on the region), and half of these women have no complaints or signs of the disease. Women who have casual sex suffer from trichomoniasis 3.5 times more often than women who have one sexual partner.
Regarding trichomoniasis in men, there are many gaps in the medical literature: trichomonas infection in men has hardly been studied. The last serious publications on this topic were about 50 years ago.

Trichomonas infection
To date, more than 50 varieties of Trichomonas are known. Three species of Trichomonas live in the human body (T. intestinalis, T. elongate, T. vaginalis). Many serious studies have been carried out on the possibility of causing Trichomonas infection by these representatives of protozoa, including on female volunteers. It turned out that only Trichomonas vaginalis can be the causative agent of trichomoniasis. The species of Trichomonas living freely in reservoirs has nothing to do with the disease trichomoniasis.
Can Trichomonas infection be transmitted through non-sexual contact? There is a lot of false and speculative information on this topic. Trichomonas quickly lose their viability outside the human body. These protozoa die instantly in a 2% soap solution and very quickly when dried. It is extremely rare (less than 1% of cases) that Trichomonas can be transmitted through contact of the genitals with the wet secretions of an infected person (using washcloths, wet towels, dirty linen).
The pathogen can be viable for 24 hours in urine, semen, water and wet underwear. If there is wet discharge from an infected person on the toilet seat, then it is theoretically possible for the pathogen to be transmitted to a healthy woman, but it is practically unlikely that the woman will not notice the discharge on the toilet seat.
Trichomoniasis is more common in men and women who have a large number of sexual partners. It is also more common in combination with other pathogens.
If a healthy man has contact with a woman with trichomoniasis, he has a 70% chance of contracting this infection. If a healthy woman has contact with a sick man, the risk of infection is 80-100%. No other sexually transmitted infection has such a high level of pathogen transmission. Considering that trichomoniasis occurs latently for several days (the incubation period in some cases can last more than a month, but on average is 4-28 days), then the risk of transmission of trichomonas is extremely high. In men, trichomoniasis occurs without symptoms more often than in women, and this also needs to be remembered.

Signs of trichomoniasis
Up to 60% of women may have no signs of Trichomonas infection. Many women are carriers of trichomonas, which in combination with other microorganisms can lead to acute inflammation of the appendages after a certain period of time. Most often, women complain of copious amounts of gray-yellow (purulent), sometimes foamy vaginal discharge with an unpleasant odor, as well as painful and frequent urination, itching and burning in the external genital area. In some cases, swelling of the labia, vaginal walls and cervix may be observed.
This infection often occurs in combination with gonorrhea and/or chlamydia (only in 10.5% of cases, trichomoniasis occurs as a monoinfection, that is, one harmful pathogen), which can lead to long-term inflammation of the pelvic organs and infertility.
In men, Trichomonas infection can cause inflammation in the urethra. In 50% of cases of all urethritis, Trichomonas is the only causative agent of this disease, which can result in the formation of adhesions in the urethra, which can subsequently lead to male infertility. Trichomoniasis is often associated with chronic prostatitis (20% of cases).
In pregnant women, trichomonas infection may be one of the risk factors for the development of premature birth and premature rupture of membranes. Trichomoniasis is also associated with low birth weight babies. During childbirth, in some cases, trichomonas infection can be transmitted to the child.

Trichomoniasis and other infections
The connection between trichomoniasis and other dangerous sexually transmitted infections has been noticed for a long time. Trichomonas infection is known to double the risk of long-term (persistent) viral infections caused by the human papillomavirus (HPV). In women, HPV is associated with the development of precancerous conditions and cervical cancer, so it is safe to say that trichomoniasis increases the risk of developing these pathological conditions of the cervix. Self-cleansing of the body from HPV types that are involved in the development of cervical cancer in healthy women occurs within 1-2 years (in 90% of cases) - an average of 180 days. In women with trichomoniasis, the body’s self-cleansing of HPV is extended by 2.5 times.
Women with Trichomonas infection are at twice the risk of contracting the herpes simplex virus (HSV) than healthy women.
There is reliable evidence that the presence of trichomoniasis increases the risk of HIV infection. It is important to understand that the degree of infection with sexually transmitted viral infections depends largely on the condition of the mucous membrane of the urogenital system. Healthy epithelial cells have a greater resistance to the viral agent, so people who do not have other sexually transmitted infections become infected with viral infections (HIV infection, hepatitis, herpes, etc.) not so often, despite sexual contact with a sick person. Conversely, the level of infection increases significantly if the mucous membranes are damaged, especially with the formation of ulcers, because ulcers are an open gate for any virus. Trichomonas lead to damage to epithelial cells, so the protective forces of the mucous membranes are sharply reduced. Trichomoniasis is called a cofactor in HIV transmission.

Diagnosis of trichomoniasis
Examination of the external genitalia, vagina and cervix of a woman is not a reliable diagnostic method, although discharge in the presence of trichomoniasis has a specific unpleasant odor, foaminess, or may be profuse, greenish-purulent in color. In the chronic course of Trichomonas infection, changes occur in the mucous membranes of the cervix and vagina - pinpoint reddening of the epithelium occurs, which are small hemorrhages in the tissues of the squamous epithelium. Therefore, upon examination, the color of the cervix resembles strawberries (spot colpitis), which is called the “strawberry sign.”
In men, there are even fewer signs of trichomoniasis, so in addition to a physical examination, it is important to conduct a number of laboratory tests.
All diagnostic methods can be divided into three groups – old, new and newest. Each diagnostic method has its own advantages and disadvantages. These methods are evaluated in terms of sensitivity (fewer false negatives) and specificity (fewer false positives) for identifying the infectious agent. The table below shows the sensitivity and specificity of available methods for diagnosing trichomoniasis.

Method name	Time spending	Sensitivity (%)	Specificity (%)
Old methods:
Native smear
Painted smear
Cytological smear
Liquid-based cytological smear
Cultivation on agar
New methods:
Cultivation in broth
Smell test
Latest methods:
Rapid antigen test
	Several hours or days
Non-amplification VPIII test
Nucleic Acid Amplification Test (NAAT)	Few hours
Amplification test (TMA)	Few hours

Not all of these methods are used in post-Soviet laboratories.
The sensitivity of the test often depends on the material that was taken for analysis. Preference should be given to vaginal discharge and scraping in women, and discharge and scraping from the urethra in men.
A smear of the discharge using a potassium solution can help identify the foul (fishy) odor that may occur with trichomoniasis, but is used very rarely in modern practice.

Microscopic examination of secretions(fresh native smears and stained smears) allows you to detect Trichomonas, as well as the presence of a large number of altered lymphocytes. The more lymphocytes, the more pronounced the infectious process. Often with trichomoniasis other types of microorganisms are found - coccobacilli.
Cytological smears (Papanicolaou) or liquid cytological smears are a good diagnostic method. Quite often, laboratory doctors do not indicate the presence of Trichomonas, but in the conclusion they write: “Atypical epithelial cells have been identified. Rule out trichomonas infection." This is an excellent tip for the attending physician and should be taken into account.
If the test results are negative, Trichomonas can be detected using cultivation discharge from the urethra, vagina, prostate secretion and sperm. The cultural method is of great value for recognizing atypical forms for the purpose of diagnosing trichomoniasis and for monitoring treatment; it is also considered the “gold standard” of diagnosis.
Serological methods diagnostics are becoming very popular, but they should complement, and not replace, other methods for diagnosing trichomoniasis. Trichomonas have an extremely large number of proteins on the surface of the shell (antigens), so the determination of antibodies to them is more of an experimental diagnostic method than a reliable practical method.
Having such a wide choice in diagnosing trichomoniasis, most cases of this disease remain undiagnosed in people visiting medical institutions. Most of these institutions do not have clear examination algorithms. Typically, doctors send patients for several tests at once, or only for serological tests. Test results often contradict each other, doctors do not know how to interpret them, so some prescribe treatment at random, others do not prescribe anything at all, and still others ignore the examination and treatment of their partner.

Rational approach to diagnosing trichomoniasis
Progressive medicine is guided by the principle of rationality: how to accurately diagnose a disease with the least amount of time and money. This principle takes into account not only the sensitivity and specificity of different diagnostic methods, but also the cost of each method, speed of implementation and necessarily safety for the person undergoing examination (the less invasive the test, that is, the less needles, systems, devices, drugs, etc. are introduced into the body .p, the safer the test).
To diagnose trichomoniasis, there is also a rational examination algorithm that allows you to avoid unnecessary expenses (no matter from whose pocket), unnecessary errors in diagnosis, unnecessary stress for a person and an unnecessary waste of time (someone else’s life too).

Rules for a rational approach in diagnosing trichomoniasis the following:
1. Physical examination of the patient (gynecological in women) and collection of material for research - a native (fresh or wet) smear from the vagina in women and from the urethra in men. Why a native smear, despite its low sensitivity? Because this is the cheapest diagnostic method, as well as the fastest: examination of the discharge under a microscope must be carried out in a matter of minutes. If trichomonas are detected in the native smear, additional examination is not necessary. Of course, it is necessary to take into account complaints and inspection results.
2. If the result of the native smear is negative, a rapid antigen detection test or one of the amplification tests can be performed. Such tests are more expensive, but the result can be obtained within 10-30 minutes or several hours (in some laboratories within several days). If the result is positive, treatment can be prescribed.
3. If the result of rapid diagnostics is negative, most doctors recommend using cultivation if there are complaints and signs of trichomonas infection.
Using more diagnostic methods to diagnose trichomoniasis is not recommended.
Of course, each doctor may have his own principles for diagnosing trichomoniasis, but the passion for reinsurance should not dominate the examination and treatment.

Treatment of trichomoniasis
Until 1960, when 5-nitroimidalol (metronidazole) came onto the market, treatment for trichomoniasis was more often unsuccessful than successful. A little later, other drugs from the group of 5-nitroimidazoles appeared on the market - ornidazole, tinidazole, secnidazole, which began to be used in the treatment of trichomonas infection.
Modern post-Soviet regimens include long-term use of tablet drugs metronidazole (Trichopol), and in very high doses. In addition to this drug, doctors prescribe another additional drug from the same group of nitroimidazoles, even the same metronidazole, but under a different name (from a different manufacturer). Plus antibiotics, antifungal drugs, a whole list of vitamins and dietary supplements, suppositories, baths, douching, “rinsing” the urethra, bladder, uterus and even microenemas. Most people cannot withstand such treatment regimens, because already on the second day of taking the medications, many experience nausea, vomiting, liver pain, indigestion and many other side effects. Women are more resilient than men, so they persistently “finish off” the prescribed course, only to then drag themselves into a months-long struggle with other emerging health problems.
It has been proven that the treatment of trichomoniasis has never required and does not require doubling, tripling, or multiple increases in both the dose and time of taking medications, or even a combination of any medications in general.
The most popular and fairly effective method of treating trichomonas infection for more than 30 years has been the use of metronidazole orally. Local treatment in the form of vaginal tablets and suppositories may be insufficient, since Trichomonas affects not only the vaginal mucosa, but also the Bartholin glands and urethra.
Numerous studies have shown that the use of a single dose of the drug has the same rate of complete cure as the use of other regimens (3-5-7 days of treatment), so doctors are increasingly using a loading dose of metronidazole to treat trichomoniasis. The impact single dose of metronidazole (Trichopol) is 2 grams - and no more. You can take 250 mg (1 tablet) of trichopolum twice a day for 5 days.
Many of our doctors do not know that if Trichomonas are sensitive to metronidazole, then 2 grams of the drug is quite enough for recovery. If trichomonas are not sensitive to metronidazole, then after prescribing even super-doses, there will be no effect in treatment, but the patient will experience many serious complications due to treatment. Therefore, such overreaction in the treatment of trichomoniasis is based on too outdated Soviet schemes.
Many infections in modern medicine are successfully treated with shocking single doses of drugs that are easily tolerated and are as effective as long-term courses of treatment, but have fewer side effects. Complete cure is observed in 90-95% of cases after using a single dose of metronidazole.
Within 48 hours after using metronidazole, a person should not drink alcohol due to the possible development of an antabuse (disulfiram, teturam) reaction, which manifests itself in the form of rapid heartbeat, malaise, nausea, and vomiting. Metronidazole also causes a feeling of dry mouth and often stains the urine like meat slop.

Relapses of trichomoniasis
Why doesn’t recovery occur in all people without exception? For the first time, resistance (resistance) of Trichomonas to metronidazole was discovered in 1962 - several years after the appearance of the drug. For a long period of time there was no alternative drug, the prescription of large doses of metronidazole or repeated courses did not lead to recovery, and this caused doctors some fear and purely professional hostility towards this pathogen (just as many doctors are now extremely aggressively fighting ureaplasma or chlamydia).
If the desired recovery does not occur, you need to answer several questions:
1. Has the sexual partner(s) been examined for the presence of trichomonas in his body?
2. Was the partner treated at the same time?
3. Was sexual activity limited during the treatment period and were preventive measures (condoms) used?
4. Does the patient have a resistant strain of trichomonas or is it re-infected from a partner(s)?
Resistance of trichomonas to metronidazole is not common. If it is suspected (from the moment of treatment until the moment of detection of trichomonas, the person has not had sexual intercourse again, for example), tinidazole is prescribed - a second-generation nitroimidazole, in the form of a single dose (2 grams). It is also effective in treating amoebiasis. Less commonly, repeated courses of metronidazole are prescribed, usually in a slightly higher dose and for 5-14 days.
People tend to hide important information from doctors when it comes to their intimate life, even if there is a serious danger to the person's health. In the transmission of sexually transmitted infections, a chain of relationships always occurs: pathogen-woman-pathogen-man-pathogen-woman-pathogen-male-pathogen, etc. Therefore, it is very important to interrupt this chain of transmission of the infectious agent in a timely manner. Relapses of trichomonas infection, like other sexually transmitted infections, are most often not a manifestation of ineffective treatment. The main reason for the appearance of repeated cases of trichomoniasis is the existence of the same strong chain of transmission of infection.

Treatment of trichomoniasis in pregnant women
There are now many contradictions regarding the treatment of pregnant women who are carriers of Trichomonas. Clinical studies in a number of major treatment centers around the world have shown that treatment of trichomoniasis with metronidazole does not reduce the incidence of preterm birth in women with asymptomatic trichomoniasis. Modern recommendations state that a pregnant woman, regardless of whether she has complaints and signs of trichomoniasis, should undergo treatment for this infection.
However, in 2001, a publication appeared in scientific and medical circles that claimed that women who were treated for trichomoniasis with metronidazole had a higher rate of preterm birth than those who were not treated. Therefore, other recommendations suggested the opposite: in pregnant women without complaints, there is no need to diagnose trichomoniasis.
A more detailed study of the American clinical study on which this article was published showed that doctors used 8 grams of metronidazole to treat trichomoniasis, when the standard safe dose for pregnant women is 2 grams, treatment was prescribed with a delay of 4 weeks after the diagnosis of trichomoniasis. usually in the second trimester of pregnancy. The study was not completed because doctors felt that using metronidazole to prevent preterm birth was ineffective and had side effects.
Most doctors are still of the opinion that trichomoniasis in a pregnant woman should be diagnosed and treated on time, because it is necessary to take into account other negative consequences of trichomonas infection, primarily its relationship in the transmission of a number of serious sexually transmitted infections. Metronidazole is not a teratogen, that is, it does not cause developmental defects or embryo death. This is a completely safe drug and can be used if necessary in the first half of pregnancy.

Treatment of sexual partner
Should my male partner be treated if he has no signs of trichomonas infection? Correct answer: yes, the man should undergo examination and treatment immediately. During treatment, unprotected sexual intercourse should be avoided.
Taking into account the high cost and time of the examination, isn’t it easier for the sexual partner to simultaneously prescribe a loading dose of the medicine in absentia? Most doctors do this, although this contradicts the doctor’s duties not to prescribe treatment in absentia, but only after collecting complaints, examining and examining the person. And what often happens is this: a woman comes home after visiting the doctor and tells her man that he must take these pills because she is being treated for some kind of infection, and these are the treatment regimens. Whether the man takes these pills or not is unknown. He may not even ask about the name of the disease. Therefore, the seriousness of the diagnosis of trichomoniasis, which is a sexually transmitted disease, and not a cold or something else, is lost and is not properly perceived by sexual partners.

Monitoring the effectiveness of treatment
Many people are interested in the question of how to know that a person has recovered and is no longer contagious. As implausible as it may sound, trichomoniasis is a self-healing disease (like HPV infection and chlamydia). In people who are not treated, trichomoniasis usually lasts up to 4 months in men and up to 5 years in women. In women, trichomonas are found on average within 12 weeks. About one third of women will still seek help due to signs of trichomonas infection. In almost a third of women, trichomoniasis will resolve on its own without treatment. But even in such a semi-optimistic picture of getting rid of sexually transmitted infections, there are several “buts”.
Firstly, we can talk about possible self-healing only if the infected person has no sexual intercourse for a long period. Secondly, it is always important to remember that the healing process depends on the body’s defenses and a person’s lifestyle. Thirdly, in the presence of other sexually transmitted infections, spontaneous recovery is almost impossible. And fourthly, Trichomonas infection can be long-term or persistent in some cases. Therefore, it is always better to undergo treatment than to rely on the power and help of nature.
Resistance of trichomonas to metronidazole is observed in only 5% of people, but there are no clear recommendations when exactly it is necessary to undergo a follow-up examination. Most doctors suggest using PCR or TMA for control diagnosis two weeks after treatment, since a native smear and culture may be negative for several weeks or even months after treatment. This is explained by the fact that to isolate the culture, a certain concentration of trichomonas in the material is necessary, and after treatment the number of trichomonas can be significantly reduced. The number of trichomonas in a smear may also be low and therefore not noticed when viewed. Many doctors recommend performing PCR or TMA several times in a row over 3-6 months (once a month).
At the time of signs of acute infection, sexual intercourse is often accompanied by severe discomfort and pain, so it is not advisable until the inflammation subsides. Unprotected sexual intercourse, that is, without condoms, taking into account that the sexual partner is healthy, is recommended only after confirmation of complete recovery, usually no earlier than two weeks after completion of treatment (before receiving the results of a control test). Some doctors recommend using condoms for 3 to 6 weeks. Planning pregnancy during the period of treatment and recovery monitoring is not advisable.