This is the 2673rd article of Da Medical Care
A panicked female patient suddenly walked into the busy but orderly urology clinic, and when the other patients walked out of the clinic, she whispered, "Doctor, what should I do if I have bugs in my urethra?" "This startled the young doctor, how big the worm was, how did it get in, how long did it take?" I'm afraid I'm going to arrange an emergency cystoscopy... Although confused, the doctor asked the patient to sit down and ask for the medical history step by step. Patient Ms. Liu is 45 years old this year, cashier, usually in addition to dancing square dancing also has no hobbies, this more than a month feels rapid urination and frequent urination, urinary has obvious burning pain, usually also often feel that the vulva itching is unbearable, the secretions in the underwear have also increased a lot, yellow with a fishy smell, last week in the lot hospital tested urine and secretions, the result was to get a report to see insects, they directly ran to the big hospital to see. Picking up the microbial report and taking a look, the doctor was relieved that it was not an insect that had burrowed in, but a "vaginal trichomoniasis". Next, this article will popularize a niche but not uncommon infectious disease of the female urinary system - trichomoniasis urethritis.
What is Trichomoniasis vaginalis?
Trichomonas vaginalis is neither an insect nor a bacterium or mold, but a parasite with flagella, belonging to the protozoa class, without a capsule stage, only a form of trophozoite. The trophozoite is pear-shaped and about 7-32 microns long, so it is completely invisible to the naked eye. It has 3-5 flagellar at the front end and one flagella after the wave membrane on the side, which is shorter than the front. Trichomoniasis vaginalis is highly adaptable to its surroundings. Prefer humidity, can live at 3-5 ° C for 21 days, 46 ° C can still live for 20-40 minutes, of which 35-37 ° C, pH 5-6 at the fastest reproduction, so the perineum has become their favorite base. The trophozoite vitality of trichomoniasis is relatively tenacious, and it can still live for about 6 hours in a dry environment, so it may still be contagious for a short time after leaving the human body.
How is trichomoniasis urethritis infected and what are the clinical manifestations?
Trichomonas vaginalis mostly infect female groups, male infection is relatively rare, mostly asymptomatic carriers, the transmission route is mainly through sexual activity or direct contact infection, studies have shown that it can also be transmitted through indirect contact such as public baths, public swimming pools, toilet toilets, contaminated towels, etc., but there is still controversy. Therefore, female patients are mostly infected with trichomoniasis vaginitis first, secrete pus with worms to infect the urethra, and then form trichomoniasis urethritis. Clinical symptoms are often atypical, with most patients being prolonged asymptomatic carriers who develop onset when they are tired, frail, or immune, and less than 17% of patients have symptoms. Typical symptoms are seen primarily in people with acute infection and include itching of the vulva, burning sensation, frequent urination, dysuria, lower abdominal pain, or dyspareunia. If intervention is not taken in time or treatment is inadequate, it may turn into a chronic infection, manifesting only as vulvar itching and mild urination discomfort, but still contagious.
How is trichomoniasis urethritis diagnosed and treated?
As with other bacterial urinary tract infections, the diagnosis of trichomoniasis urethritis is not difficult and is based on laboratory tests: trichomoniasis on secretory objectives, or positive culture, positive nucleic acid amplification test (NAAT), rapid antigen, or positive nucleic acid probe test. Because patients with trichomoniasis urethritis tend to have trichomoniasis vaginitis, the urethra and guided secretions are presented for testing at the same time. At present, NAAT is the gold standard, but the operation is more difficult, and the requirements for operators and hardware facilities are high, so microscopy + training is still the mainstream diagnostic method.
Trichomonas vaginalis is essentially a protozoa, so traditional antibiotics and antifungal drugs can not kill it, which is why many patients treat it as a common urinary tract infection or vulvitis, and try to take oral "cephalosporin" or topical lotion, apply "ducknin" and so on can not achieve the purpose of treatment. In fact, 5-nitroimidazoles are currently the only drugs that can effectively cure vaginal trichomoniasis, mainly metronidazole and tinidazole. The efficacy of the two is similar, the former is less expensive, but the side effects are larger, mainly gastrointestinal reactions; the latter has fewer side effects, but the cost of treatment is high, and patients can choose according to economic conditions. Existing therapeutic consensus recommends that treatment be required, regardless of symptoms, and that co-treatment is required for those with fixed sexual partners to reduce population carrying. In addition to medication in accordance with medical advice, abstinence from alcohol, avoidance of sexual life during treatment, regular cleaning of the vulva and timely disinfection of underwear also have a positive effect on the treatment of diseases. In general, radical treatment can be achieved within 7 days of regular treatment.
After standardized treatment, Ms. Liu has also recovered and returned to the square dance team with confidence.
bibliography:
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2.Trichomoniasis- CDC Fact Sheet. Centers for Disease Control and Prevention. January 31, 2017. www.cdc.gov/std/trichomonas/stdfact-trichomoniasis.htm (Accessed on March 05, 2018).
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4.Forna F, Gülmezoglu AM. Interventions for treating trichomoniasis in women. Cochrane Database Syst Rev 2003; :CD000218.
5.Workowski KA, Bolan GA, Centers for Disease Control and Prevention. Sexually transmitted diseases treatment guidelines, 2015. MMWR Recomm Rep 2015; 64:1.
Author: Niu Xinhao, Bao Juan
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