Trichomoniasis is a common sexually transmitted disease caused by trichomonas vaginalis infection, which only involves urogenital system, mainly vagina, urethra and prostate. Most men have no symptoms after being infected with Trichomonas vaginalis, but most women have symptoms, which are foul yellow-green vaginal secretions and vulvar irritation. People infected with trichomoniasis without clinical symptoms are called carriers. In addition, individuals infected with trichomonas are more susceptible to other sexually transmitted diseases. In recent years, trichomonas vaginalis has been considered to be related to premature rupture of membranes and premature delivery.

Second, the diagnosis points

(1) Clinical features

Female patients are mainly characterized by vaginitis, with typical manifestations of increased leucorrhea and moderate to severe vulvar itching. Vaginal secretions are thin, yellow-green, foamy and may have a bad smell. The pH value of vaginal fluid increased obviously, often >: 5.0. Examination shows that vaginal mucosa is congested, red and swollen, scattered in small bleeding spots, erythema and edema of cervix and punctate bleeding make it have a characteristic strawberry-like appearance, and the posterior fornix is often filled with a characteristic gray-yellow foamy leucorrhea. Some patients may feel pain during sexual intercourse and urination. If the latter appears, it suggests that trichomonal urethritis infection is complicated. The symptoms of the disease often fluctuate with the menstrual cycle and generally worsen after menstruation. Male trichomoniasis often infects the prostate and urethra, most of which are asymptomatic, but it often leads to repeated infection of sexual partners. In addition, Trichomonas vaginalis is also one of the causes of male nongonococcal urethritis. The patient may have a small amount of clear urethral secretions intermittently, and may have dysuria and itching of glans penis. Trichomonas urethritis in most men is self-limited, which may be caused by anti-trichomonas components in male prostatic fluid.

(2) Laboratory inspection

1. Direct microscopic examination adopts hanging drop method: take a drop of vaginal secretion from the posterior fornix of vagina and mix it with a drop of physiological saline on the glass slide, and put it under a high-power microscope (100× or 400×) for examination. If you see an oval, flagellated and movable parasite, you can diagnose it. Another important finding of hanging drop microscopy is the existence of a large number of neutrophils in vaginal secretions. Male patients were examined by hanging drop microscopy with urethral secretions or sediments from the first urination in the morning before the first urination.

2. Trichomonas culture is more sensitive than direct microscopic examination. Culture the culture in an anaerobic environment for at least 48 hours. If it is negative, it should be cultivated continuously for 7 days and checked regularly.

Third, treatment.

Systemic treatment and local treatment can be used. Trichomonas vaginalis is often accompanied by trichomonas infection in urinary system, and can hide in cervical glands, vaginal folds and lower urethra. It is not easy to completely disappear after simple local medication, and it is easy to relapse after drug withdrawal, which makes the disease incurable for a long time. Therefore, systemic treatment is the first choice, and a single dose is advocated, and those with negative menstrual period for three consecutive times are cured. The sexual partners of trichomoniasis patients must receive treatment at the same time.

(1) systemic therapy

Metronidazole (metronidazole) is the most effective method to treat trichomoniasis. Usage: take metronidazole 2.0g once, or take metronidazole 500mg orally twice a day for 7 days. One-time administration is the first choice. If the above treatment scheme fails, the drug-resistant Trichomonas vaginalis strain should be given metronidazole 500mg orally twice a day for 7 days; If the treatment is still ineffective, the dosage should be increased, with metronidazole 2.0g, 1 time, 1 time daily for 3-5 days. Because the disease is easy to recur after menstruation, it is best to treat it 1 course after the next menstruation to consolidate the curative effect. Drinking alcohol and alcoholic beverages should be avoided during the treatment of this medicine, so as not to cause sulfur-like reaction of alcohol withdrawal. And pay attention to the side effects of drugs.

(2) local treatment

1. Enhance vaginal defense. Wash vulva and vagina with 0.5% lactic acid or acetic acid solution, or wash vagina with 1:5000 potassium permanganate.

2. Metronidazole 200mg or Diweijing 1 tablet or carbaarsenic 400mg were inserted into the posterior fornix of vagina every night for 7 ~ 10 days. If you clean the vagina with the above acidic solution first, then put the suppository, the effect will be better.

(3) Special treatment

1. Treatment of pregnant women Because metronidazole has carcinogenic effect on rodents and mutagenic effect on bacteria, it should not be taken in the first three months of pregnancy, and local treatment should be given priority to, but the effect is not satisfactory. For patients who still have serious symptoms after the second trimester of pregnancy, metronidazole 2.0g can be taken once.

2. Treatment of sexual partners The sexual partners of trichomoniasis patients must receive treatment at the same time with the same dose.

Four. prevent

Trichomoniasis can be transmitted directly through sexual intercourse or indirectly through bathing, swimming pools, toilets or contact with contaminated clothes and equipment. Therefore, in the prevention of trichomoniasis, attention should be paid to improving public health facilities, changing sitting toilets into squatting toilets, bathing, trichomoniasis patients and people with insects are not allowed to enter public swimming pools. Sexual life should be forbidden during treatment, and both husband and wife should be treated at the same time. In addition, medical units should do strict disinfection and isolation to prevent cross-infection.