TRICHOMONIASIS (trichomoniasis; a synonym trichomoniasis) — the inflammatory disease of urinogenital human organs caused by vulval trichomonads.
The activator is opened in 1836 for A. Donne at a research of vulval contents. To A. Donne considered trichomonads harmless inhabitants of generative organs. P. P. Lazarevich (1870) for the first time established pathogenetic connection of a trichomonad with an inflammation of a mucous membrane of a vagina and neck of uterus, and also paid attention that the mecotic infection of urinogenital bodies, in addition to local inflammatory changes in fabrics, can exert impact on the general condition of an organism. In 1926. The international commission on the zoological nomenclature approved the name Trichomonas vaginalis offered in 1838 to Erenbergom (Page G. Ehren-berg). Capek (A. Sarek, 1927) described a mecotic urethritis at men; he for the first time pointed to a sexual way of transfer of a disease and need of treatment of both spouses. In a crust, time of T. it is qualified as a disease, sexually transmitted, along with gonorrhea and syphilis therefore in the USSR sick T. are under dispensary observation, in relation to them the same measures of prevention, as are applied at gonorrhea. However it is not included in the list of veins. the diseases provided by the International classification of diseases, injuries and causes of death of the IX review therefore in legal sense is not a venereal disease.
T. it is often combined with gonorrhea (see) or candidiasis (see).
Etiology. Trichomonads treat type of protozoa, a class of the flagellates (see) parasitizing at the person and at nek-ry animals (monkeys, cows, horses, cats, etc.). Breed by division, have big mobility thanks to existence of four flagellums and an undulating membrane. Optimal conditions of development of a trichomonad: pH of the environment 5,9 — 6,5, t ° 35 — 37 °. She quickly perishes at
a temperature St. 40 °, drying, in hypo - and hypertensive, and also in disinfecting solutions.
At the person several kinds of trichomonads are revealed (vulval, oral and intestinal), however the disease is caused only by a vulval trichomonad. The vulval trichomonad — the largest (length it usually makes 7 — 30 microns), an ovoidny form, on its wider part is available 4 flagellums (see fig. to St. «Flagellates», t. 8, Art. 42). In the forefront of a trichomonad are located a kernel with a kernel and blefaroblast, consisting of 4 granules. Passes through a body of a trichomonad aksostil, effluent in the form of an edge. At electronic microscopic examination also parabasal device, lysosomes, ribosomes, digestive vacuoles are found. Food of trichomonads occurs by an endosmose, the absorption of cells, including microorganisms separate from to-rykh, in particular gonokokk, can keep viability in trichomonads and show the pathogenic action after death of the last. The recurrence of gonorrhea arising sometimes after antibacterial therapy of T is explained by it. at patients with the mixed mecotic and gonorrheal infection.
Epidemiology, pathogeny, pathological anatomy. A source of an infection are T. Zarazheniye's patients occurs, as a rule, at sexual contact. To emergence of T. at women a hypovitaminosis, decrease in body resistance as a result of the general diseases, neuroendocrinal disturbances, in particular a hypo-ovaria, a mechanical and chemical injury of a vagina, decrease in acidity of the vulval environment and bacterial pollution of a vagina promote. The trikhomonadonositelstvo is characteristic of men. At the same time externally healthy men are the most frequent carriers of trichomonads and distributors of an infection. Extra sexual infection of T. meets extremely seldom.
The main place of parasitizing of trichomonads at women is the vagina, however they can be implemented also into an urethra, a bladder, a cavity of the uterus. Sometimes they are found in uterine tubes (in a pyosalpinx), in cysts of ovaries, purulent exudate at a pelviperitonitis. Endometritises of a mecotic etiology are described. At men the main place of defeat at T. the urethra is. Other departments of urinogenital system are usually infected for the second time. Vulval trichomonads, getting to urinogenital ways of the man, breed and extend on a mucous membrane of an urethra, getting into bulbous and urethral glands and causing in them an inflammation. At hron. the course of a disease the infection extends to a bladder, a renal pelvis. Nek-ry researchers point to rather frequent damage of a prostate gland. The possibility of spread of an infection on limf is experimentally proved, to ways. Trichomonads are parasites of cavities, however detection in some cases of erosive and ulcer processes in outside genitals with extensive infiltrative changes in a submucosal layer says that they can be also tissue parasites. The hyaluronidase emitted by trichomonads promotes a loosening of fabrics and penetration into intercellular spaces of the toxic products of exchange which are formed as a result of life activity of trichomonads and the accompanying microflora.
In the infected mucous membrane of urinogenital bodies the hyperemia, swelling and hypostasis, places — small hemorrhages, desquamation of an epithelium and melkoochagovy ulcerations develops. The exudate of lymphoid elements amplifies. In a vagina inflammatory changes can extend also to surface layers of a muscular coat. In the centers of defeat growth of granulyatsionny fabric and further formation of sharp-pointed condylomas is observed.
Immunity at T. no, perhaps recurrent disease. Nevertheless in an organism develop nek-ry immunol. shifts (in blood serum specific agglutinins are found, at administration of mecotic antigen the positive intracutaneous test and positive RSK is noted).
Clinical picture. It is accepted to distinguish a fresh disease of T. with an acute, subacute and torpid current, chronic (duration of a disease of 2 months and more) and asymptomatic (trikhomonadonositelstvo). The course of a disease and feature a wedge, pictures depend on virulence of the activator of the reactivity of an organism accompanying pathology (hron. alcoholism, heavy inf. diseases, etc.). Incubation interval, as a rule, from 5 to 15 days.
A trichomoniasis at women. For T. at women multifocal defeat of urinogenital bodies is characteristic. Most often the vagina is surprised, 'also the urethra, parau-retralny channels, glands of an entrance of the vagina, a bladder can be surprised. In a wedge, a picture signs of a vulvovaginitis (see) and a colpitis (see) — an itch, burning sensation in a vagina, in external genitals and a crotch, emergence from a vagina of the foamy putreform allocations of yellow color strengthening an itch and burning in most cases prevail. Patients complain of pains at the sexual intercourses and unpleasant feelings in the bottom of a stomach. At damage of an urethra and bladder perhaps speeded up urodynia (see the Bladder, diseases). The endometritis of a mecotic etiology is shown by long uterine bleedings. At sick T. the acrimony, decrease in working capacity, deterioration in a dream is observed. At survey reveal a hyperemia, puffiness and small ulcerations of a mucous membrane of a vagina, its threshold and signs of an endocervicitis (see the Cervicitis), at a chronic current of a trichomoniasis — sharp-pointed condylomas (see the Wart). Degree of manifestation of symptoms of T. depends on a condition of an organism, age, the accompanying infection (first of all, gonorrhea and candidiasis). More often the disease accepts hron. a current with the periods of remissions and aggravations. For hron. T. it is characteristic the erased wedge, a picture. Persistent current of T. it is observed at its combination to gonorrhea and candidiasis. It is quite often promoted by the treatment directed only against T.
Trikhomonoz at men proceeds in the form of an urethritis, a balanoposthitis, a paraurethritis, a vesiculitis, cooperite, prostatitis, an epididymite, an orchitis. Gistol. changes in fabrics and a wedge, a picture at T. generally a little in what differ from inflammatory diseases of these bodies of other etiology. An urethritis — the most frequent a wedge, a form T. at men. The fresh mecotic urethritis is clinically shown the same as an urethritis (see) other etiology. The torpidnost of a current and scarcity of symptomatology, difficulty of detection of the activator in separated or scraping from an urethra therefore the T is more often is characteristic of an urethritis of the mecotic nature. remains to not noticed patients that becomes the reason of a frequent reinfitsirovaniye of women — partners in sex life. The acute course of process is promoted by sexual excesses, injuries of skin and mucous membrane of urinogenital bodies, an unusual exercise stress, etc. The acute course of a disease is more typical for the mixed gono-reyno-mecotic infection.
At an acute mecotic urethritis plentiful foamy allocations in 1 — 2 week spontaneously decrease, and the disease becomes oligosymptomatic. In 95,3% of cases the disease accepts hron. a current with periodic aggravations. At inadequate treatment the disease can proceed many years. The mecotic urethritis often is followed by a mecotic paraurethritis, to-ry can become the reason of a persistent course of mecotic process and infection of the sexual partner since despite treatment protozoa can remain a long time in channels of parauretraljny glands (see). The inflammatory phenomena at the same time are most expressed in an acute stage of a disease.
Vulval trichomonads, getting at the sexual intercourse on an internal leaf of a prepuce and a surface of a balanus, quickly breed in a preputial bag, causing a mecotic balanoposthitis (see the Balanitis, a balanoposthitis), to-ry unlike a balanoposthitis of a gonorrheal etiology it is seldom combined with an acute urethritis, and develops separately, in some cases is followed Torahs-pidno by the proceeding urethritis. The acute balanoposthitis arises more often at a narrow and long prepuce, traumatization of its internal leaf and a balanus; it is characterized by accumulation of foamy contents of gray-yellow color, in Krom trichomonads are found.
The mecotic epididymite (see) results from penetration of the simplest of an urethra on a deferent duct in an epididymis. As a rule, it is preceded by a slow urethritis. It is often combined with an orchitis (see). Unlike the rough beginning of an acute gonorrheal orchiepididymitis the mecotic orchiepididymitis develops gradually, within several days. It is shown by sharp morbidity, infiltration and increase in an epididymis and small egg with formation of a uniform inflammatory conglomerate. The surface of the inflamed epididymis happens usually uneven, hilly. More often its tail part is surprised.
Mecotic a vesiculitis (see), cooperite (see. Bulbous uretraljnye glands) and prostatitis (see) arise against the background of hron. a mecotic urethritis as a result of penetration of trichomonads and the accompanying microbic flora into channels of glands. The combination of a mecotic urethritis to prostatitis meets more often. Mecotic prostatitis can proceed for years asymptomatically, and the activator keeping the pathogenicity causes infection of the sexual partner, and also promotes a periodic aggravation of an urethritis. A wedge, a picture same, as at inflammatory diseases of these bodies of other etiology.
The diagnosis shall be surely confirmed with detection of trichomonads. Any of methods does not provide absolute identification of trichomonads. For the purpose of successful diagnosis it is necessary to combine various techniques (microscopy of native and stained preparations, crops), to repeatedly repeat analyses, to take material from the different centers of an invasion, and also to investigate fresh urine, to follow rules of the equipment of an intake of material and transportation. Patients within 5 — 7 days before capture of the analysis shall not apply antitrichomonads-nye of means, local procedures. At women make microscopic examination of allocations from a vagina, an urethra, parauretral-ny channels, the channel of a neck of uterus and an urocheras (native drugs or the painted smears). Material is taken away a loop, a glass tubule or a pipette with a rubber barrel. If necessary previously enter 2 — 3 ml of sterile isotonic solution of the sodium chloride which is warmed up to 37 ° into a vagina. Live trichomonads easily are found under a microscope thanks to their active movement. More informatively luminescent microscopic examination. In doubtful cases make crops of material on mediums. At men the diagnosis is confirmed by detection of the activator in allocations or, better, in scrapings from an urethra, and also in separated from the inflamed courses of ria-rauretralny glands, in a secret prostatic, bulbouretralny glands and seed bubbles. At a balanoposthitis investigate scraping from an erozirovanny surface of a balanus. It is extremely important to make a research of urine, in a cut, according to a number of researchers, the activator it is possible to find more often than in separated urethras. The probability of finding of the activator increases after preliminary massage of a prostate, seed bubbles and an urethra.
The differential diagnosis is carried out with inflammatory diseases of urinogenital system of other etiology, and especially with gonorrhea (see), on the basis of a bacteriological and bakterioskopichesky research.
Treatment should be carried out as at a wedge, displays of a disease, and at a trikhomonadonosi-telstvo to both spouses (sexual partners) at the same time. During treatment and the subsequent control sex life is forbidden. It is necessary to influence on the activator, and also the factors contributing to development of T.: treatment of a hypovitaminosis, hypo-ovaria, anemia, diabetes mellitus; sanitation of a vagina is necessary. Treatment of ostrotekushchy forms T. it can be limited to one causal treatment — purpose of antimecotic means.
From antimecotic means the greatest distribution was gained Trichomonacidum (see), metronidazole (see), fasizhin. Treatment by metronidazole is carried out by preferential short courses; it is appointed on 0,5 g by 2 times a day during food within 5 days. Fasizhin give 150 mg 2 times a day within 7 days or once
2 Ltd companies of mg (4 tablets on 500 mg). Contraindications to reception of these drugs are diseases of a nervous system, system of a hemopoiesis, a disease of a liver, pregnancy, a lactation, etc. However in connection with adverse influence of T. on the course of pregnancy (premature abortion, danger of infection of a fruit, inflammatory processes in a puerperal period) nek-ry doctors recommend to apply metronidazole from the second trimester of pregnancy by courses till 4 — 5 days in the general dose of 3 g with co-administration of topical treatment.
At intolerance of these drugs or contraindications to their use, at the recurrent persistent course of a disease, and also at accession of candidiasis as a result of use of antimecotic means use topical treatment. To women appoint kanesten in the form of solution or vaginal tablets, solution of sodium salt of levorinum, solution an amfoglyuka-mine, etc. Topical treatment of an urethritis at men is carried out by Osarsolum in the form of powder or 10% of a water or oil suspension, to-ruyu entered daily within 8 — 10 days into an urethra. Topical treatment of a paraurethritis consists in washing of channels by means of the syringe and a needle with the blunted end of 10% a suspension of Osarsolum. At the persistent course of process resort to obliterating therapy or to an extirpation of superficially located course. At formation of abscess treatment operational. Topical treatment of a balanoposthitis is carried out within 10 days by powders of metronidazole and Osarsolum after preliminary washing of a preputial bag solution of an antiseptic agent.
Alternation of powders with lotions of 0,25 — 0,5% solution of silver nitrate has good therapeutic effect.
At prostatitises, vesiculites, epididymites, cooperites it is reasonable to appoint also antibiotics of a broad spectrum of activity.
In some cases after treatment men have post-mecotic inflammatory process which is shown during the period kontrolnogabout observations by scanty non-constant allocations. They are connected with pato-morfol. changes in a mucous membrane of urinogenital bodies, with existence of the accompanying microflora (fungi, staphylococcus, etc.) at total disappearance of trichomonads. Apply instillations in an urethra of the irritating chemical and antiseptic agents, bougieurage, introduction of tampons to fight against this inflammation, etc.
The persons who transferred T., after treatment shall be under dispensary observation.
At women negative takes of analyses at a research of material from various departments of urinogenital system for the 1st, 2nd and 3rd day after the termination of periods during three menstrual cycles are considered as criterion of an izlechennost. Control researches at men are conducted in
7 — 10 days, 1 month and 2 months after the end of treatment. Criterion of an izlechennost at men is the termination of allocations from an urethra, and also lack of the simplest in a secret of a prostate. Control should be carried out better after mechanical and alimentary provocation.
The forecast favorable on condition of performing complex treatment of T. At women not cured by T. development of a leukoplakia is promoted (see) also by a krauroza of a vulva (see), at men not cured mecotic balanoposthitis can lead to a phymosis (see) and to a paraphimosis (see). The bilateral mecotic orchiepididymitis in 70 — 80% of cases is the reason of infertility.
Prevention includes measures of public prevention (identification of sick T., their treatment, dispensary observation), and also personal prevention (it is detailed see Gonorrhoea).
Features of a trichomoniasis at girls. The mecotic vulvovaginitis occurs at girls, as a rule, in the period of a neonatality and puberty. In the period of a neonatality infection occurs during the passing of a fruit on the infected patrimonial ways of mother. Possibility of infection of T. at this particular time, according to many researchers, it is caused by the fact that the condition of a vagina of the newborn girl does not differ from that at the adult woman (a multilayer flat epithelium, pH of a secret 4,5 — 4,0, accumulation in an epithelium of a glycogen). Girls aged from 1 month and prior to puberty in connection with features of a condition of a vagina during this period (a single-layer epithelium, neutral or alkali reaction of a secret, the low maintenance of a glycogen, milk to - you, etc.), at to-rykh have no conditions for existence of trichomonads even in case of their hit in a genital tract, the disease is noted extremely seldom. Therefore at detection of trichomonads in smears from a vagina of girls the repeated research and careful collecting the anamnesis (clarification of a possible way of infection) are necessary. In the pubertal period in connection with increase in concentration of estrogen in an organism of the girl the condition of a vulval epithelium approaches that at adult women. During this period at girls emergence of a mecotic colpitis is possible, and ways of infection and a wedge, a picture do not differ from those at adults.
Treatment of a mecotic colpitis at newborns consists in mechanical removal of trichomonads by means of washing of a vagina through a thin catheter infusions of a camomile, a sage, solution of Furacilin. At the same time carry out treatment of parents of the girl. At treatment of a trichomoniasis at girls in the pubertal period make instillation in a vagina of 1 — 3% of water solution methylene blue or after irrigation of a vagina through a thin catheter of 1% solution of hydrosodium carbonate enter 1 — 2 ml of 2,5% of suspension of Nitazolum. Besides, use inside the specific drugs stated above taking into account age and the weight (weight) of a body of the child. Osarsolum to children is not appointed. The child is allowed in children's collective only after receiving negative takes after the bakterioskopichesky research triple (every other day). In each case the issue of ways of infection shall be resolved.
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