Amebic vaginitis is often secondary to intestinal infection. The amebic trophozoites in the patient's stool are excreted with fecal mucus and directly spread to the vulva and vaginal opening.

bubble_chart Etiology

Under healthy conditions, the disease generally does not occur. However, if overall health is poor, especially when there is an injury to the vagina, and local resistance is reduced, the amoeba trophozoites can take advantage of the weakened state to invade, grow, and reproduce, leading to amoebic vaginitis.

bubble_chart Pathological Changes

The formation of ulcers is the fundamental lesion of amoebic vaginitis. When amoebic protozoa invade the vaginal mucosa, their pseudopod activity and secreted histolytic enzymes cause necrosis of mucosal cells, leading to ulcer formation with raised edges. The surrounding area of the lesion is infiltrated with lymphocytes and a few plasma cells. The surface of the ulcer is covered with yellowish-brown necrotic material, containing dissolved cell debris, mucus, and amoebic trophozoites.

bubble_chart Clinical Manifestations

The vaginal discharge is serous or mucous, and large trophozoites can be found in it. When the vaginal mucosa forms ulcers and bleeds, the discharge may turn purulent or bloody. Sometimes, fragile ulcers can appear on the cervix or vulva, merging into large areas of necrosis. In rare cases, due to severe connective tissue reactions, irregular tumor-like hyperplasia may occur, which is firm in texture, with ulcer surfaces covered by bloody mucous discharge, easily misdiagnosed as malignant tumors.

bubble_chart Diagnosis

Due to the rarity of this disease, it may sometimes be overlooked by clinicians. However, a diagnosis can be made based on a history of diarrhea or dysentery and relevant tests. The most reliable diagnosis involves identifying amoebic trophozoites in vaginal secretions (while also examining the patient's stool). Direct smear or culture methods can be used to detect Entamoeba histolytica protozoa, along with pathological examination of the lesions. For cases of chronic vaginal ulcers with negative secretion tests, a biopsy should be performed.

The treatment principle focuses on systemic therapy combined with local management. Commonly used drugs include: ① Emetine hydrochloride, which is most effective against amoebic trophozoites but has uncertain effects on cysts. It is highly toxic and contraindicated for patients with cardiac or renal insufficiency, the elderly, those in weak condition, and pregnant women. The usual dose is 0.06g (1mg/kg) per day via deep intramuscular injection for 6–9 days as one course, with repeat treatment only after 20–30 days. ② Carbarsone, 0.25g per dose, twice daily for 10 days as one course. ③ Metronidazole, 200–400mg three times daily for 10–14 days as one course. ④ Java brucea fruit (Fructus bruceae), effective for acute amoebiasis and also used for chronic patients and carriers. Take 10–15 seeds orally, three times daily for 7 days as one course. Local treatment: The above drugs can be prepared as a solution for vaginal irrigation or as powders and suppositories inserted into the vagina once daily for 7–10 days as one course.