bubble_chart Overview

Trichomonal vaginitis is a common gynecological disease caused by Trichomonas vaginalis. The parasite can be directly transmitted to women through sexual intercourse, as the same type of trichomonad is often found in the urethral and prostatic secretions of the patient's husband. Trichomonads not only reside in the vagina but can also inhabit the lower urinary tract (urethra and paraurethral glands) and the cervical canal. Even carriers of trichomonads may show no clinical symptoms. Trichomonads in the vagina consume glycogen, alter the vaginal pH, and disrupt the defense mechanisms, making secondary infections more likely. Therefore, such carriers often experience trichomonal vaginitis when the vaginal environment changes after menstruation (or during pregnancy, postpartum, and after late abortion), creating favorable conditions for the growth and reproduction of trichomonads. However, this condition is relatively rare. The reason may be that trichomonads rely on glycogen as their food source. Before puberty and after menopause, women have poorer ovarian function and lower estrogen levels, resulting in a lack of glycogen in the vaginal mucosal epithelium. This makes the environment unsuitable for the growth and reproduction of trichomonads, leading to fewer cases of trichomonal vaginitis in these groups.

bubble_chart Etiology

Trichomonal vaginitis is caused by infection with Trichomonas vaginalis. Trichomonas vaginalis is a common sexually transmitted anaerobic parasite, found in approximately 3-5% of asymptomatic women and accounting for 20-50% of sexually transmitted diseases. Trichomonas vaginalis is pear-shaped, with an undulating membrane on its body, an axostyle at the posterior end, and four flagella at the anterior end. The flagella sway with the undulation of the membrane, appearing colorless and transparent, resembling a water droplet. Trichomonas vaginalis is highly contagious. The optimal pH for the survival of Trichomonas vaginalis is 5.5-6. It is inhibited or even killed when the pH falls below 4.5, and its reproduction is completely suppressed when the pH rises to 7.5.

During pregnancy and around the time of menstruation, the vaginal pH increases, which can elevate the infection rate and incidence of Trichomonas vaginalis. Some women may harbor the parasite in their vagina without exhibiting any symptoms.

bubble_chart Clinical Manifestations

The main symptoms of trichomonal vaginitis include increased leucorrhea, which is white to green in color, homogeneous, sometimes purulent, relatively thin, with a fishy odor and foamy in nature. In severe cases, it may be mixed with blood. Another symptom is vulvar cutaneous pruritus, particularly noticeable at the vaginal opening and vulva, accompanied by a burning sensation and dyspareunia. Menstrual irregularities are less common.

When Trichomonas Chinese Taxillus Herb infects the urethra and bladder, it can lead to trichomonal cystitis, causing symptoms such as frequent urination, urgency, and even intermittent hematuria. Trichomonas is also one of the causes of infertility.

bubble_chart Diagnosis

Based on the patient's complaints, medical history, clinical manifestations, and the characteristic yellow-green frothy leucorrhea, as well as the vaginal speculum examination revealing redness and swelling of the vaginal and cervical mucosa with scattered bleeding spots or strawberry-like protrusions (the latter generally not exceeding 5%), a diagnosis can be made. However, sometimes the patient's vaginal discharge is not so typical, so it is still necessary to detect Trichomonas vaginalis in the vaginal discharge to confirm the diagnosis.

The examination method for Trichomonas vaginalis is faster and simpler using the hanging drop method for direct microscopy. In symptomatic cases, the positive rate can reach 80-90%. The method involves using a sterile cotton swab to collect a small amount of discharge from the deeper part of the vagina before bimanual examination, immediately mixing it with a small amount of warm saline solution already placed on a glass slide, and then examining it under the microscope.

The hanging drop method must be performed before the saline cools, as the longer the trichomonads are outside the body, the weaker their motility becomes. Sometimes they may become sluggish or only show flagellar movement. In such cases, their presence can only be inferred by the movement of adjacent white blood cells. In severe cases, the entire microscopic field of the hanging drop slide may be filled with white blood cells, making it difficult to see the trichomonads, and even if seen, they may not be active. In such situations, a 0.1% safranin solution can be used instead of saline, as safranin stains white blood cells light red while leaving the trichomonads unstained and unaffected in their movement, making them stand out clearly against the light red background. The smear method involves spreading the specimen on a glass slide and staining it with Wright's or Giemsa stain for microscopic examination. The culture method is suitable for cases where the above tests are negative but clinical suspicion of trichomoniasis remains, with an accuracy rate as high as 98%.

bubble_chart Treatment Measures

There are many effective treatments for trichomonal vaginitis, but it is often difficult to achieve a complete cure. Treatment must target the life characteristics of vaginal trichomonads (including their resistance to medicinal properties and the condition of the host organism) and select appropriate therapies to achieve ideal results.

1. Local Treatment

(1) Enhancing the defensive capacity of the vagina: Use a 0.5–1% lactic acid or vinegar acid solution, or a 1:5000 potassium permanganate solution to rinse the vagina, or add glucose powder to the vagina to restore its normal physiological defense function and inhibit the growth and reproduction of trichomonads, thereby preventing the onset of the disease.

(2) Anti-trichomonal drugs: Metronidazole tablets (200–400mg) or suppositories (0.5g) are inserted into the vagina after rinsing, once nightly for 10 days as one course of treatment. Alternatively, carbarsone (200mg) or devegan (1 tablet) can be used in the same manner. To prevent recurrence, repeat the treatment for one week after the second and third menstrual cycles. At the same time, vaginal secretions should be examined, and a cure is confirmed if three consecutive tests are negative.

2. Systemic Treatment

Due to the characteristic of trichomonads parasitizing in multiple parts of the human body, patients with trichomonal vaginitis often also have intestinal or urinary tract trichomonad infections. Therefore, trichomonads can not only parasitize in the vagina and vaginal mucosal folds but also in the urinary tract and deep within cervical glands. Local treatment alone is often insufficient for complete eradication, and systemic treatment is usually required. Metronidazole is a highly effective anti-trichomonal drug with good oral absorption, high efficacy, low toxicity, and convenient administration, suitable for both men and women. The dosage is 200mg orally, three times daily for seven days, combined with a 200mg vaginal suppository nightly. In recent years, a single 2g dose of metronidazole has been found to be more effective than 200mg three times daily for seven days. The single dose is economical, reliable, and highly effective, but patients must avoid alcohol for 24 hours after taking the medication. For those who do not respond to a single large dose, a regimen of 0.5–1g twice daily for seven days may be used. If necessary, a metronidazole sensitivity test can be performed, and treatment may be more effective if the trichomonads are sensitive.

After taking metronidazole, especially in a single large dose, some individuals may experience nausea, vomiting, vertigo, headache, rash, or granulocytopenia. Early pregnancy use may lead to fetal malformations, so local treatment is preferred before 20 weeks of pregnancy, and oral administration should be avoided. Trichomycin can inhibit trichomonads, fungi, and amoebae. If necessary, trichomycin can be taken orally at 100,000–200,000 units twice daily for 5–7 days. During treatment, hygiene should be maintained, sexual intercourse should be avoided, and underwear should be changed daily. For patients with recurrent episodes, their partners should also be treated simultaneously with oral metronidazole, using the same regimen.

bubble_chart Follow-up Consultation

To prevent the recurrence of hidden trichomonads, follow-up is essential. Specifically, after a cure, re-examinations should be conducted every three months, immediately after each menstruation ends. If results are negative, local treatment should still be administered 1–2 times to consolidate the therapeutic effect. Trichomonads hidden in the male urethra and prostate are often a major cause of recurrence in women. Therefore, examining the urine and prostatic fluid of the husband of a recurrent patient should be routine, and simultaneous treatment should be administered.

bubble_chart Prevention

Because trichomonads have strong adaptability to changing environments and considerable resistance to soap solutions of different concentrations, they are easily transmitted. Therefore, it is particularly important to implement proper hygiene and preventive measures. The following points should be noted:

1. Eliminate the source of pestilence. Due to the high infectivity and widespread prevalence of this disease, as well as the significant proportion of healthy carriers, routine trichomonas leucorrhea examinations should be conducted for outpatients and hospitalized patients in gynecology and obstetrics departments as much as possible, aiming for early detection and timely treatment to eliminate the source of pestilence. To achieve prevention and control goals, regular mass screenings and treatments should also be carried out in factories, schools, township enterprises, and residential communities, with special attention paid to the prevention and treatment of patients' spouses.
2. Cut off transmission routes. Improve public welfare and living conditions by promoting showers and abolishing public baths. Replace seated toilets with squat-style ones, strictly prohibit trichomonas patients from entering swimming pools, and refrain from renting out public swimwear and towels. Medical instruments and bedding used in hospitals must be strictly disinfected. Disposable sanitary covers on examination tables should be replaced for each patient immediately after use.
3. Conduct health education campaigns to raise public awareness of prevention.
4. Strictly manage and isolate patients and carriers for treatment.