Trichomoniasis is an infectious disease transmitted mainly through sexual contact, clinically manifested by lesions of various parts of the genitourinary system; the causative agent is Trichomonas vaginalis. The frequency in different states ranges from 2 to 40% of the population. The proportion of urogenital trichomoniasis among other sexually transmitted diseases is 65-80%. The predominant gender is female. The predominant age is 16-35 years. Classification

    • Fresh trichomoniasis (with a disease duration of up to 2 months)
    • Acute, subacute, torpid, chronic (with a disease duration of more than 2 months)
    • Trichomonas carriage (trichomonas are found in the absence of signs of inflammation). Etiology
    • Trichomonas vaginalis belongs to the protozoa, the class of flagellates, the genus Trichomonas. Urogenital Trichomonas come in three forms: pear-shaped, amoeboid and budding. Found only in humans. Unstable in the external environment
    • The route of infection is sexual, infection by household means does not occur often. It is also possible to infect newborns through the birth canal. Risk factors
    • promiscuous sex life
    • Unfavorable socio-economic factors
    • Rare use of barrier methods of contraception
    • Abuse of alcohol, drugs. Pathogenesis
    • The causative agent, getting on the mucous membrane of the genitourinary organs, penetrates into the subepithelial connective tissue (through the intercellular spaces), causing an inflammatory reaction
    • Often (in 75% of cases) associated with chlamydia, gonococci, mycoplasmas, fungi of the genus Candida and other causative agents of sexually transmitted diseases
    • In later years, torpid forms of trichomoniasis are more often observed, which is due to the suppression of the body’s immune status, varying degrees of virulence of the pathogen, and association with other microorganisms.

Clinical picture

    • The incubation period is 3-28 days.
    • Women: Acute or subacute vaginitis, urethritis, and possibly cystitis.
    • Discharge from the genital tract is profuse, greenish-yellow, frothy, with an unpleasant odor due to the presence of anaerobic microorganisms.
    • Characterized by itching, burning, dysuria, dyspareunia.
    • Vaginal examination a Exudate accumulates in the posterior fornix of the vagina. The walls of the vagina are hyperemic, have a characteristic strawberry appearance
    • Inflammatory changes in the mucous membrane of the vagina and cervix. For severe forms, multiple petechial hemorrhages and erosion of the mucous membrane are characteristic. At present, granulomatous inflammation and loosening of the epithelium of the cervix, typical of trichomoniasis, are not often observed.
    • Often the disease is asymptomatic.
    • The disease is often combined with gonorrhea (trichomoniasis is also detected in 90% of cases of gonorrhea).
    • Men – urethritis, prostatitis, rarely epididymitis
    • Often asymptomatic
    • Minor foamy or purulent discharge from the urethra, dysuria
    • Chronization of the process in almost 100% of cases leads to the development of chronic prostatitis.

Laboratory research

    • Microscopy (dark-field, phase-contrast or light) of discharge from the genital tract reveals the pathogen in about 50-60% of cases. Apply native and stained with methylene blue or Romanovsky-Giemsa product. With a slight increase, mobile Trichomonas and the beating of their flagella are visible. At high magnification, large pear-shaped microorganisms are visible; often find a large number of leukocytes
    • Direct immunofluorescent test allows to identify the pathogen in 70-90% of cases
    • Sowing discharge on special media makes it possible to diagnose trichomoniasis in 99% of cases.

ev, but it will take 4-7 days to get results

    • Pop smear
    • Serological study.

Differential Diagnosis

    • Women – candidal and bacterial vulvovaginitis, gonorrhea
    • Men – chlamydial urethritis, gonorrhea.


Tactics of conducting

    • Outpatient management
    • Sexual intercourse until recovery is not recommended
    • The main condition for the effectiveness of therapy is the simultaneous treatment of all sexual partners
    • Trichomonas are able to absorb smaller microorganisms, incl. other causative agents of sexually transmitted diseases, therefore, after the cure of trichomoniasis, it will be necessary to exclude other sexually transmitted diseases.

Drug therapy

    • Metronidazole 2 g once, 250 mg 3 times a day or 500 mg 2 times a day for 7 days (women), 500 mg 2 times a day for 7 days (men)
    • Tiberal 500 mg 2 r / day for 5 days
    • Tinidazole
    • 2 g once
    • 0.5 g every 15 minutes for an hour
    • Terzhinan one tablet intravaginally at night. Before the introduction of the tablet will need to be held in water for 20-30 seconds. Course – 6-20 days
    • Alternative Products
    • Clotrimazole 100 mg vaginal tablets 1 r / day for 14 days
    • Douching with 0.9% solution of NaCl or weak solutions of acetic acid.


    • Metronidazole should be avoided or given at low doses in hepatic impairment
    • When treating with metronidazole, it is not recommended to drink alcohol due to the likelihood of developing a teturam-like reaction.
    • When using metronidazole, the development of leukopenia, candidiasis, nausea, vomiting, dry mouth, drowsiness or insomnia, skin rashes is likely
    • Side effects of tiberal: headache, dizziness, neurological disorders, gastrointestinal disorders.

Drug Interactions

    • Treatment with metronidazole can be started no earlier than 2 weeks after taking disulfiram.
    • Metronidazole and tiberal enhance the effect of indirect anticoagulants. Pregnancy
    • Metronidazole is prescribed in the 1I-III trimesters of pregnancy, 0.5 g 2 r / day for 7 days
    • Locally prescribed vaginal tablets Klion-D.

Cure Criteria

    • After 12-14 days after treatment, a provocation is prescribed. Types of provocations
    • Alimentary
    • Physiological (menstruation)
    • Physical (massage of the urethra on the bougie)
    • Biological (single, multiple injection of 20 mcg of pyrogenal)
    • After the provocation, after 24, 48 and 72 hours, the discharge of the urethra is taken for bacterioscopic examination, and in the absence of the discharge, threads from the urine, scraping from the mucous membrane of the urethra.


    • Men
    • Balanitis and balanoposthitis
    • Littreit
    • Morganite
    • Soft and hard urethral infiltrates
    • Colliculitis
    • Prostatitis
    • Epididymitis
    • Women
    • Endometritis
    • Salpingitis.

The prognosis for early treatment is favorable. However, due to the likely low-symptomatic course of the disease, complications may develop. Prevention. In case of casual sexual intercourse, barrier methods of contraception should be used.

Synonym. Trichomoniasis

See also Bacterial vulvovaginitis, Gonorrhea, Pelvic inflammatory disease. Gonococcal infection, Prostatitis, ICD urethritis. A59 Trichomoniasis



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