List of Abbreviations
HIV - human immunodeficiency virus
DNA - deoxyribonucleic acid
STI — sexually transmitted infection
ICD — International Classification of Diseases
PCR — polymerase chain reaction
RNA - ribonucleic acid
NASBA (Nucleic Acid Sequence-Based Amplification) is a transcription-mediated amplification reaction
Terms and Definitions
Urogenital trichomoniasis is a sexually transmitted infection caused by the pathogen Trichomonas vaginalis.
Trichomonas vaginalis is a flagellated protozoan unicellular parasite that causes lesions of the human urogenital tract.
1. Brief information on the disease or condition
1.1 Definition of the disease or condition
Urogenital trichomoniasis is a sexually transmitted infection caused by the pathogen Trichomonas vaginalis.
1.2 Etiology and pathogenesis of the disease or condition (group of diseases or conditions)
Trichomonas vaginalis is a unicellular microorganism belonging to the phylum Protozoa, family Trichomonadidae, genus Trichomonas.
T. vaginalis has an oval, rounded, or pear-shaped morphology. The size of trichomonads can range from 8 to 40 µm or more. The protozoan has 5 flagella, 4 of which are located at its anterior end, and one inside the undulating membrane, which provides active movement of the trichomonad. The nucleus of T. vaginalis is localized in its anterior part. The axostyle originates in the nucleus — a hyaline cord crossing the cell lengthwise and ending in a sharp tip that facilitates the attachment of the protozoan to epithelial cells of the urogenital tract.
T. vaginalis is an obligate parasite that acquires essential nutrient components from the genital secretions via phagocytosis of epithelial cells, symbiotic, and opportunistic microorganisms.
Trichomonads exhibit tropism for squamous epithelium. Upon infection, reaching the mucosal epithelium, T. vaginalis perform active movements and, owing to their ability to secrete a cell-dissociating factor, penetrate through intercellular spaces into the subepithelial connective tissue, lymphatic clefts, and vessels.
In men, the epithelium of the mucous membrane of the distal urethra in the fossa navicularis region is primarily infected; thereafter, the pathogens spread along the mucosa of the anterior and posterior urethra, from where they can penetrate into the tissues of the prostate gland, seminal vesicles, etc.
In women, trichomonads typically infect the mucous membrane of the vagina and ectocervix, less frequently the cervical canal, urethra, paraurethral ducts, vestibular glands, urinary bladder, and fallopian tubes.
Infection in adults occurs through sexual contact with a person with urogenital trichomoniasis, in children — via the intranatal route and through sexual contact; in exceptional cases, young girls may become infected due to a breach of personal hygiene rules and childcare practices.
1.3 Epidemiology of the Disease or Condition
Urogenital trichomoniasis is one of the most common sexually transmitted infections (STIs). According to World Health Organization estimates, approximately 250 million people are infected with Trichomonas vaginalis annually. Within the structure of all STIs, trichomoniasis ranks among the leading places in individuals seeking specialized dermatovenereological, obstetric-gynecological, and urological care for infectious and inflammatory diseases of the urogenital tract.
In the Russian Federation, a downward trend in the incidence rates of urogenital trichomoniasis has been observed in recent years; however, they remain fairly high, which is largely driven by the overdiagnosis of the disease. In 2022, the incidence rate was 22.7 per 100,000 population.
1.4 Features of Coding the Disease or Condition
Trichomoniasis (A59):
A59.0 — Urogenital trichomoniasis;
A59.8 — Trichomoniasis of other sites;
A59.9 — Trichomoniasis, unspecified.
1.5 Classification of the disease or condition
The clinical classification of urogenital trichomoniasis is based on the localization of the pathological process.
1. Trichomoniasis of the lower urogenital tract in women:
1.1 vulvitis;
1.2 vaginitis;
1.3 cervicitis;
1.4 urethritis;
1.5 cystitis.
2. Trichomoniasis of the pelvic organs and other urogenital organs in women:
2.1 vestibulitis;
2.2 periurethritis;
2.3 salpingitis.
3. Trichomoniasis of the lower urogenital tract in men:
3.1 urethritis;
3.2 balanitis and balanoposthitis;
3.3 cystitis.
4. Trichomoniasis of the upper urogenital tract and other urogenital organs in men:
4.1 epididymitis;
4.2 prostatitis;
4.3 vesiculitis;
4.4 paraurethritis.
1.6 Clinical presentation of the disease or condition
Trichomoniasis of the lower urogenital tract
In 20–40% of patients, urogenital trichomoniasis has a subjectively asymptomatic course.
In women, in the presence of clinical manifestations, the following subjective symptoms may occur: greyish-yellow vaginal discharge, often foamy, with an unpleasant odor; itching and burning in the genital area; pain during sexual intercourse (dyspareunia); itching, burning, and pain during urination (dysuria); discomfort and/or pain in the lower abdomen.
Objective symptoms of the disease in women include: hyperemia and edema of the vulvar and vaginal mucosa; greyish-yellow, liquid, foamy vaginal discharge with an unpleasant odor; rarely, erosive and ulcerative lesions of the genital mucosa and the skin of the inner thighs; petechial hemorrhages on the mucosa of the vaginal portion of the cervix.
In men, subjective symptoms of the disease include: greyish-yellow, liquid urethral discharge; itching and burning in the urethra; pain in the perineum radiating to the rectum; pain during sexual intercourse (dyspareunia); itching, burning, and pain during urination (dysuria); less commonly, erosive and ulcerative lesions on the skin of the glans penis; hematospermia (rarely).
Objective symptoms of the disease in men include: hyperemia and edema in the area of the external urethral meatus; scanty or moderate greyish-yellow, liquid urethral discharge; less commonly, erosive and ulcerative lesions on the skin of the glans penis.
Trichomoniasis of the pelvic organs and other urogenital organs
Subjective symptoms in women include:
> in vestibulitis: minor greyish-yellow vaginal discharge
, often foamy, with an unpleasant odor, pain, and edema in the vulvar area. When a gland abscess forms, symptoms of general intoxication join; pain increases when walking and at rest, becoming throbbing in nature;
> in salpingitis: pain in the lower abdomen, often
crampy in nature; greyish-yellow vaginal discharge, often foamy, with an unpleasant odor; in the chronic course of the disease, subjective manifestations are less pronounced.
Objective symptoms in women include:
> in vestibulitis: minor greyish-yellow, liquid vaginal
discharge, hyperemia of the external openings of the vestibular gland ducts, pain and edema of the ducts upon palpation. When a gland abscess forms: general and local hyperthermia, scanty greyish-yellow discharge upon palpation of the gland; clearly demarcated infiltration, hyperemia, and marked tenderness are determined in the projection area of the duct;
> in salpingitis: in the acute course of the inflammatory process, enlarged,
painful fallopian tubes upon palpation, shortening of the vaginal fornices, greyish-yellow, liquid foamy discharge from the cervical canal; in the chronic course of the disease, minor tenderness, thickening of the fallopian tubes.
Subjective symptoms in men include:
> in epididymitis: greyish-yellow, liquid discharge from the urethra
, dysuria, dyspareunia, tenderness in the epididymis and inguinal region; pain in the perineum radiating to the rectum, lower abdomen, and scrotum; pain may spread to the spermatic cord, inguinal canal, lumbar region, and sacrum;
> in prostatitis: pain in the perineum and lower abdomen radiating to
the rectum, dysuria;
> in vesiculitis: pain in the sacrum, perineum, and anus,
aggravated by urination and defecation, frequent urination, nocturnal erections, possible hematospermia.
Objective symptoms in men include:
> in epididymitis: greyish-yellow, liquid discharge from the urethra
canal, palpation reveals enlarged, dense, and tender testis and epididymis, hyperemia and edema of the scrotum in the affected area;
> in prostatitis: palpation reveals a tender, indurated
prostate gland;
> in vesiculitis: palpation reveals edema and tenderness in
the area of the seminal vesicles.
In persons of both sexes, involvement of the paraurethral glands is possible, with subjective symptoms being: itching, burning, pain during urination (dysuria); greyish-yellow, liquid urethral discharge; pain during sexual intercourse (dyspareunia); pain in the area of the external urethral meatus. Objective symptoms of paraurethritis are: greyish-yellow, liquid urethral discharge, presence of dense, painful millet-sized formations in the area of the excretory ducts of the paraurethral glands.
Subjective and objective symptoms of urogenital trichomoniasis in children and adolescents are similar to those in adults. A feature of the clinical course in girls is more pronounced subjective and objective symptoms.
2. Diagnostics, medical indications and contraindications for diagnostic methods
The diagnosis is established only after laboratory confirmation of the presence of Trichomonas vaginalis in clinical samples obtained from the urogenital tract.
2.1 Complaints and Anamnesis
Subjective clinical manifestations of urogenital trichomoniasis are described in the "Clinical Presentation" section.
2.2 Physical Examination
An examination of the skin of the external genitalia and anogenital region, visible mucous membranes of the external genitalia and urethra is performed, the presence of free discharge and its characteristics are evaluated, and palpation of the urethra and regional lymph nodes is carried out.
In women: inspection of the vaginal mucosa and speculum examination of the cervix (using a Cusco speculum); assessment of discharge in the posterior and posterior-lateral vaginal fornices and from the cervical canal; bimanual pelvic examination.
In men: palpation of the scrotal contents, digital rectal examination (as clinically indicated).
Objective clinical manifestations of urogenital trichomoniasis identified during physical examination are described in the "Clinical Presentation" section.
2.3 Laboratory Diagnostics
Laboratory diagnostics of urogenital trichomoniasis is indicated for the following persons: ■ persons with clinical and/or laboratory signs of an inflammatory process of the urogenital tract and reproductive system;
during pre-gravid screening of sexual partners;
during examination of women during pregnancy;
prior to upcoming surgical (invasive) procedures on the genitals and pelvic organs;
persons with a history of perinatal loss and infertility;
sexual partners of patients with STIs;
victims of sexual assault [15, 31, 42, 43].
It is recommended to confirm the diagnosis of urogenital trichomoniasis in persons with a pronounced clinical picture based on the results of native smear microscopy (phase-contrast or dark-field microscopy): microscopic examination of female genital discharge for trichomonads (Trichomonas vaginalis) and/or microscopic examination of urethral discharge for trichomonas vaginalis (Trichomonas vaginalis) [21, 22, 28, 31, 44, 45].
LeR CLoE 5Level of Recommendation - C (Level of Evidence - 5)
Comments: a prerequisite for native smear microscopy is performing the study immediately after obtaining the biological material. The highest sensitivity (up to 70%) and specificity (up to 100%) of native smear microscopy have been established in clinically pronounced forms of the disease, especially in women.
It is recommended to laboratory confirm urogenital trichomoniasis in patients using molecular biological methods aimed at detecting specific T. vaginalis DNA and/or RNA fragments, using test systems approved for medical use in the Russian Federation (PCR): molecular biological examination of urethral discharge for trichomonas vaginalis (Trichomonas vaginalis) and/or molecular biological examination of female genital mucosal discharge for trichomonas vaginalis (Trichomonas vaginalis) and/or molecular biological examination of urine for trichomonas vaginalis (Trichomonas vaginalis) [26-31, 33-36, 46, 47].
LeR CLoE 2Level of Recommendation -C (Level of Evidence 2).
Comments: the sensitivity of molecular biological methods is 88-97%, specificity is 98-99%. Various inhibitory factors can affect the sensitivity of the test, therefore strict requirements are imposed on the organization and workflow of the laboratory to exclude contamination of clinical material.
It is recommended that laboratory confirmation of urogenital trichomoniasis be performed in patients with low-symptomatic and asymptomatic forms of the disease based on the results of: microbiological (culture) examination of urethral discharge for Trichomonas vaginalis and/or microbiological (culture) examination of vaginal discharge for Trichomonas vaginalis and/or microbiological (culture) examination of prostatic secretion for Trichomonas vaginalis [24, 25, 30, 37, 38].
FOR CLeve 5Recommendation Grade - C (Level of Evidence 5).
Comments: culture examination is indicated for mild and asymptomatic forms of the disease, as well as in cases where the suspected diagnosis is not confirmed by microscopic examination. The sensitivity of the culture method reaches 95%, but the method is more labor-intensive and time-consuming compared to molecular biological methods, which limits its application.
To obtain reliable laboratory test results, it is necessary to comply with a number of requirements, which include:
— adherence to the timing of obtaining clinical material taking into account the use of antibacterial drugs: for the identification of T. vaginalis by the culture method and RNA amplification method (NASBA) — no earlier than 14 days after completion of drug therapy; based on DNA amplification methods (PCR, real-time PCR) — no earlier than one month after completion of drug therapy;
— obtaining clinical material from the urethra no earlier than 3 hours after the last urination; in the presence of heavy urethral discharge — 15–20 minutes after urination;
— obtaining clinical material from the cervical canal and vagina outside of menstruation;
— compliance with the conditions for sample transport to the laboratory.
It is not recommended to perform laboratory diagnostics of urogenital trichomoniasis in patients of all age groups and categories based on the results of microscopic examination of stained smears due to the subjectivity of result interpretation [21, 22, 28, 31, 33, 34, 61].
FOR BLevel 2Recommendation Grade - B (Level of Evidence 2).
It is not recommended to use other laboratory test methods, including the direct immunofluorescence assay for the identification of T. vaginalis and enzyme-linked immunosorbent assay (ELISA) for the detection of antibodies to T. vaginalis, for the diagnosis of urogenital trichomoniasis in patients of all age groups and categories [30].
GCR CLEL 5Grade of Recommendation — C (Level of Evidence — 5)
Comments: biological, chemical, and dietary provocation tests should not be used to improve the diagnostic and treatment efficacy of urogenital trichomoniasis in patients of all age groups and categories [30, 32].
2.4 Instrumental Diagnostics
Not applicable.
2.5 Other Procedures
It is recommended to consult an obstetrician-gynecologist when the inflammatory process involves the pelvic organs, and in the management of pregnant women with urogenital trichomoniasis, to determine the management strategy [41, 56].
GCR CLEL 5Grade of Recommendation — C (Level of Evidence — 5)
It is recommended to consult a urologist to diagnose potential complications of the reproductive system, in case of prolonged course and inefficacy of previously administered therapy for epididymitis and prostatitis [41, 56].
GCR CLEL 5Grade of Recommendation — C (Level of Evidence — 5)
3. Treatment, including drug and non-drug therapies, diet therapy, and pain management
3.1 Conservative Treatment
Treatment of urogenital trichomoniasis is carried out using synthetic antibacterial agents (imidazole or nitroimidazole derivatives).
It is recommended for the treatment of lower urogenital tract trichomoniasis in adults to prescribe one of the following drugs orally for the eradication of T. vaginalis and clinical cure:
metronidazole** 2.0 g single dose [1, 2, 3-5, 8-12, 14, 19, 31].
FOR ALevel 1Recommendation Grade - A (Level of Evidence 1)
Comments: International practice indicates the acceptability of using metronidazole** 500 mg twice daily for 7 days in adults [1, 2, 3-5, 8-12, 14, 19, 31, 53, 54, 58, 59].
or
tinidazole 2.0 g single dose [1, 2, 3-5, 8-12, 14, 19, 31, 53].
FOR ALevel 1Recommendation Grade - A (Level of Evidence 1)
Comments: International practice indicates the acceptability of using tinidazole at a dosage of 500 mg twice daily for 5 days for the treatment of adults [1, 2, 3-5, 8-12, 14, 19, 31, 56, 59].
or
ornidazole 500 mg twice daily for 5 days [6, 7, 9, 13, 14, 48].
FOR ALevel 2Recommendation Grade - A (Level of Evidence 2)
Comments: International practice indicates the possibility of using ornidazole 1.5 g as a single dose for the treatment of adults [6, 7, 9, 13, 14, 54].
It is recommended in the treatment of complicated forms of urogenital trichomoniasis in women to simultaneously use topical antiprotozoal and antibacterial agents in gynecology along with oral medications:
metronidazole vaginal gel 5 g intravaginally twice daily for 5 days [51, 52, 57]
GCR CLEL 5Grade of Recommendation — C (Level of Evidence — 5)
Comments: it is acceptable to use metronidazole in the form of vaginal tablets [57].
It is recommended for the treatment of pregnant women to achieve eradication of T. vaginalis and clinical cure to prescribe one of the following drugs orally:
metronidazole** 2.0 g single dose [16, 17, 53].
FOR CLevel 5Recommendation Grade - C (Level of Evidence 5)
Comments: the use of metronidazole**, ornidazole, and tinidazole is possible no earlier than the 2nd trimester of pregnancy, taking into account their effect on the fetus and involving obstetricians-gynecologists. According to international literature, metronidazole** may be used at a dosage of 500 mg twice daily for 7 days [16, 17, 56, 59]. Intravaginal use of imidazole derivatives simultaneously with oral medications is possible in accordance with the instructions for use.
It is recommended for the treatment of children over 3 years of age to achieve eradication of T. vaginalis and clinical cure to prescribe one of the following drugs orally:
metronidazole** [15, 18, 50, 51, 56, 57].
GCR CLEL 5Grade of Recommendation — C (Level of Evidence — 5)
or
ornidazole 25 mg/kg of body weight orally once daily for 5 days [15, 55]
GCR CLEL 5Grade of Recommendation — C (Level of Evidence — 5)
Comments: The drug is contraindicated in children under 3 years of age. Treatment of trichomonal infection in children weighing more than 35 kg is carried out in accordance with adult dosage regimens.
In children with confirmed trichomonal infection, sexual transmission must be ruled out.
Systemic enzyme therapy, immunomodulatory therapy, and therapy with local antiseptics and disinfectants should not be performed (such use is not justified from an evidence-based medicine perspective).
In the absence of treatment efficacy, it is recommended to rule out reinfection and prescribe another imidazole or nitroimidazole derivative or course treatment regimens [8-12, 56].
GCR CLEL 5Grade of Recommendation — C (Level of Evidence — 5)
3.2. Surgical treatment
Not applicable.
3.3. Other treatment
Diet therapy is not indicated.
Pain management is not performed.
4. Medical Rehabilitation and Sanatorium-Resort Treatment
Not applicable.
5. Prevention and Dispensary Observation
Prevention
• avoidance of casual sexual contacts;
• use of barrier contraception methods;
• screening and treatment of sexual partners [40].
Dispensary follow-up (Active surveillance)
Control of treatment efficacy is carried out by microscopic examination of a native preparation and/or microbiological (culture) method and/or detection of Trichomonas vaginalis RNA (Trichomonas vaginalis) (NASBA) 14 days after completion of treatment, and detection of Trichomonas vaginalis DNA (Trichomonas vaginalis) by PCR — no earlier than one month after completion of treatment. If examination results are negative, patients do not require further follow-up [41, 54].
6. Organization of Medical Care
There are no indications for hospitalization in a medical organization.
Medical care is provided as part of primary specialized healthcare by dermatovenereologists in an outpatient setting.
When a patient is identified, form No. 089-u/kv "Notification of a patient with a newly diagnosed case of: syphilis, gonococcal infection, chlamydial infections, trichomoniasis, anogenital viral herpes infection, anogenital (venereal) warts, mycosis, scabies" is filled out in the manner established by the letter of the Ministry of Health of the Russian Federation dated March 2, 2015, No. 13-2/25.
7. Additional Information
Patients with a diagnosed urogenital trichomoniasis must be screened for other sexually transmitted infections, including syphilis, as well as HIV, hepatitis B and C. Determination of hepatitis B virus surface antigen (HBsAg) in blood; determination of antibodies classes M and G (IgM, IgG) to human immunodeficiency virus HIV-1 in blood; determination of antibodies classes M and G (IgM, IgG) to human immunodeficiency virus HIV-2 in blood; determination of antibodies to Treponema pallidum using nontreponemal tests (RPR, VDRL) (qualitative and semi-quantitative test) in blood serum; determination of hepatitis C virus (Hepatitis C) antigen in blood.
If the source of infection is unidentified, repeat serological testing for syphilis is recommended after 3 months, and for HIV, hepatitis B, and C - after 3–6–9 months. If the HIV status is unknown or previously negative at the time of diagnosis and after 6 months, HIV testing is recommended.
Criteria for Evaluating the Quality of Medical Care
№ | Quality criteria | Performance evaluation |
|---|---|---|
1 | Diagnosis confirmed by microscopy (examination of a native preparation) and/or molecular biological methods and/or culture examination | Yes/no |
2 | Therapy with metronidazole**, tinidazole, or ornidazole administered | Yes/no |
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Khryanin A.A., Reshetnikov O.V. Clinical and microbiological efficacy of metronidazole and ornidazole in the treatment of urogenital trichomoniasis in men. Publication: Antibiotics and Chemotherapy. 2006, No. 51, vol. 1, pp. 18-21
Vickovic, N., et al. Metronidazole 1.5 gram dose for 7 or 14 days in the treatment of patients with chronic prostatitis caused by Trichomonas vaginalis: A randomized study. J Chemother, 2010. 22: 364.
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A.L. Tikhomirov, Ch.G. Oleynik "Urogenital Trichomoniasis" Dermatology and Venereology | Published 22-01-2010
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Ryumin D.V., Lipova E.V., Batkaev E.A. UROGENITAL TRICHOMONIASIS (Manual for Physicians) Moscow 2001
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Appendix A1. Working Group Composition
Kubanov, Aleksey Alekseevich - Academician of the RAS, President of the Association of Clinical Dermatovenereologists and Cosmetologists (RODVK), Director of the State Research Center of Dermatovenereology and Cosmetology of the Russian Ministry of Health.
Serov Vladimir Nikolaevich - Academician of the Russian Academy of Sciences, Doctor of Medical Sciences, Professor, President of the Russian Association of Obstetricians and Gynecologists.
Abuduev Nazirbek Karimullaevich - Doctor of Medical Sciences, Senior Researcher at the State Research Center of Dermatovenereology and Cosmetology of the Russian Ministry of Health, member of the Russian Society of Dermatovenereologists and Cosmetologists.
Apolikhina Inna Anatolyevna - Doctor of Medical Sciences, Professor, Head of the Department of Aesthetic Gynecology and Rehabilitation at the National Medical Research Center for Obstetrics, Gynecology and Perinatology named after Academician V.I. Kulakov of the Russian Ministry of Health, member of the Russian Society of Obstetricians and Gynecologists.
Blokhin, Boris Moiseevich - Doctor of Medical Sciences, Professor, Honored Doctor of the RF, Member of the Executive Committee of the Union of Pedians of Russia, Chairman of the Russian Society for Pediatric Emergency Medicine, Chairman of the European Working Group for Simulation Training in Pediatric Emergencies, Honorary Member of the New York Academy of Sciences.
Bogdanova Elena Vitalievna - Senior Researcher at the Scientific and Organizational Department of the State Research Center of Dermatovenereology and Cosmetology of the Russian Ministry of Health, member of the Russian Society of Dermatovenereologists and Cosmetologists.
Vasiliev Mikhail Mikhailovich - Doctor of Medical Sciences, Professor, Leading Researcher at the State Research Center of Dermatovenereology and Cosmetology of the Russian Ministry of Health, member of the Russian Society of Dermatovenereologists and Cosmetologists.
Vlasov, Vasily Viktorovich - Doctor of Medical Sciences, Professor, Member of the Expert Committee on Medical Research of the WHO Regional Office for Europe 2007-2017, Member of the RAS Commission against the Falsification of Scientific Research, the RAS Commission on Pseudoscience, RAS Expert, Member of the Public Council under the Russian Ministry of Health, Vice President of the Society for Evidence-Based Medicine.
Gomberg Mikhail Alexandrovich - Doctor of Medical Sciences, Professor, Chief Researcher at the Moscow Scientific and Practical Center of Dermatovenereology and Cosmetology of the Moscow Healthcare Department, member of the Union "National Alliance of Dermatovenereologists and Cosmetologists", Member of the Royal College of Physicians (RCP), Member of the American Academy of Dermatology (AAD), member of the European Academy of Dermatology and Venereology (EADV), Senior Advisor to the International Union against Sexually Transmitted Infections (IUSTI).
Grekova, Yulia Nikolaevna - Doctor of Medical Sciences, Associate Professor, Leading Researcher at the Scientific Clinical Department of Syphilidology and STIs of the Ural Research Institute of Dermatovenereology and Immunopathology, Yekaterinburg.
Dolgushina, Nataliya Vitalievna - Doctor of Medical Sciences, Professor, Deputy Director - Head of the Department of Scientific Activity Organization of the National Medical Research Center for Obstetrics, Gynecology and Perinatology named after Academician V.I. Kulakov of the Russian Ministry of Health, Member of the Russian Society of Obstetricians and Gynecologists.
Zemtsov Mikhail Alekseevich - Candidate of Medical Sciences, Honored Doctor of the Russian Federation, Chief Physician of the Stavropol Krai Clinical Dermatovenereology Dispensary, Chief Freelance Dermatovenereologist and Cosmetologist of the Ministry of Health of Stavropol Krai, member of the Russian Society of Dermatovenereologists and Cosmetologists.
Ziganshin Oleg Raisovich - Doctor of Medical Sciences, Professor, Chief Physician of the Chelyabinsk Regional Clinical Dermatovenereology Dispensary, Head of the Department at the South Ural State Medical University of the Russian Ministry of Health, member of the Russian Society of Dermatovenereologists and Cosmetologists.
Ivanova, Maisa Afanasievna - Doctor of Medical Sciences, Professor, Chief Researcher at the Central Research Institute of Health Organization and Informatics of the Russian Ministry of Health, Chief Researcher at the Moscow Scientific and Practical Center of Dermatovenereology and Cosmetology of the Moscow Healthcare Department.
Georgy Leonidovich Katunin - Candidate of Medical Sciences, Dermatovenereologist at the State Research Center of Dermatovenereology and Cosmetology of the Russian Ministry of Health, Member of the Russian Society of Dermatovenereologists and Cosmetologists.
Roman S. Kozlov - Corresponding Member of the RAS, Doctor of Medical Sciences, Professor at the Research Institute of Antimicrobial Chemotherapy, Smolensk State Medical Academy.
Lyudmila A. Lyubasovskaya - Candidate of Medical Sciences, Head of the Department of Clinical Pharmacology of Antimicrobial and Immunobiological Drugs at the Institute of Microbiology, Antimicrobial Therapy and Epidemiology, National Medical Research Center for Obstetrics, Gynecology and Perinatology named after Academician V.I. Kulakov of the Russian Ministry of Health, member of the Russian Society of Obstetricians and Gynecologists.
Malova, Irina Olegovna - Doctor of Medical Sciences, Professor, Head of the Department of Dermatovenereology and Cosmetology at the Irkutsk State Medical University of the Ministry of Health of the Russian Federation, Irkutsk.
Minullin, Iskander Kagapovich - Chief Physician of the Republican Clinical Skin and Venereal Dispensary, Honored Doctor of the RF, Chief Specialist in Dermatovenereology and Cosmetology of the Ministry of Health of the Republic of Tatarstan, Chief Specialist in Dermatovenereology and Cosmetology of the Volga Federal District.
Elena A. Mezhevitinova - Doctor of Medical Sciences, Leading Researcher at the Scientific-Polyclinical Department, National Medical Research Center for Obstetrics, Gynecology and Perinatology named after Academician V.I. Kulakov of the Russian Ministry of Health, member of the Russian Society of Obstetricians and Gynecologists.
Irina A. Nechaeva - Candidate of Medical Sciences, Dermatovenereologist at the State Research Center of Dermatovenereology and Cosmetology of the Russian Ministry of Health, member of the Russian Society of Dermatovenereologists and Cosmetologists.
Viktoriya V. Onipchenko - Chief Physician of the Novosibirsk Regional Clinical Skin and Venereological Dispensary, Chief Specialist in Dermatovenereology and Cosmetology of the Novosibirsk Oblast, member of the Russian Society of Dermatovenereologists and Cosmetologists.
Yury N. Perlamutrov - Doctor of Medical Sciences, Professor at the A.I. Evdokimov Moscow State University of Medicine and Dentistry of the Russian Ministry of Health, member of the Russian Society of Dermatovenereologists and Cosmetologists.
Plakhova Ksenia Ilyinichna - Doctor of Medical Sciences, Scientific Secretary, Acting Head of the STI Department, State Research Center of Dermatovenereology and Cosmetology of the Russian Ministry of Health, member of the Russian Society of Dermatovenerologists and Cosmetologists.
Potekaev, Nikolay Nikolaevich - Doctor of Medical Sciences, Professor, Director of the Moscow Scientific and Practical Center of Dermatovenereology and Cosmetology of the Moscow Healthcare Department, Chief Freelance Specialist in Dermatovenereology and Cosmetology of the Russian Ministry of Health, Chief Specialist in Dermatovenereology and Cosmetology of the Moscow Healthcare Department, Head of the Department of Skin Diseases and Cosmetology at the Faculty of Additional Professional Education of the Pirogov Russian National Research Medical University of the Russian Ministry of Health, President of the National Alliance of Dermatologists and Cosmetologists of Russia.
Tatyana V. Priputnevich - Doctor of Medical Sciences, Head of the Department of Microbiology, Clinical Pharmacology and Epidemiology, National Medical Research Center for Obstetrics, Gynecology and Perinatology named after Academician V.I. Kulakov of the Russian Ministry of Health, member of the Russian Society of Obstetricians and Gynecologists.
Prozherin, Sergey Vitalievich - Dermatovenereologist at the Sverdlovsk Regional Center for Prevention and Control of AIDS, Sverdlovsk Region.
Margarita R. Rakhmatulina - Doctor of Medical Sciences, Professor at the Department of Dermatovenereology and Cosmetology with a Course of Clinical Laboratory Diagnostics, A.I. Burnazyan Federal Medical Biophysical Center of the Federal Medical-Biological Agency of Russia, member of the Russian Society of Dermatovenereologists and Cosmetologists.
Rudneva, Nataliya Sergeevna - Candidate of Medical Sciences, Chief Freelance Specialist Dermatovenereologist and Cosmetologist of the Ministry of Health of Tula Oblast, Associate Professor at the Department of Propaedeutics of Internal Diseases and Dermatovenereology Course at the Medical Institute of Tula State University, Member of the Russian Society of Dermatovenereologists and Cosmetologists.
Sokolovskiy, Evgeniy Vladislavovich - Doctor of Medical Sciences, Professor, Head of the Department of Dermatovenereology with a Clinic at the First Pavlov State Medical University of St. Petersburg, Member of the Russian Society of Dermatovenereologists and Cosmetologists.
Viktoriya S. Solomka - Doctor of Biological Sciences, Deputy Director for Scientific Work at the State Research Center of Dermatovenereology and Cosmetology of the Russian Ministry of Health, member of the Russian Society of Dermatovenereologists and Cosmetologists.
Sysoeva, Tatyana Aleksandrovna - Candidate of Medical Sciences, Associate Professor at the Department of Dermatovenereology and Cosmetology of the Russian Medical Academy of Continuous Professional Education (RMAPO), Member of the Russian Society of Dermatovenereologists and Cosmetologists.
Igor S. Tartakovsky - Doctor of Medical Sciences, Professor, Chairman of the Microbiology Committee of the Federation of Laboratory Medicine.
Aleksey A. Khryanin - Doctor of Medical Sciences, Professor at the Department of Dermatovenereology and Cosmetology, Novosibirsk State Medical University of the Russian Ministry of Health, member of the Russian Society of Dermatovenereologists and Cosmetologists.
Chikin Vadim Viktorovich - Doctor of Medical Sciences, Senior Researcher at the Department of Dermatology, State Research Center of Dermatovenereology and Cosmetology of the Russian Ministry of Health, member of the Russian Society of Dermatovenerologists and Cosmetologists.
Conflict of interest: the authors declare no conflict of interest
Appendix A2. Methodology for Developing Clinical Guidelines
1. Specialist physicians: dermatovenereologists, obstetrician-gynecologists, urologists, pediatricians.
2. Residents and trainees of continuing professional education courses in the specified specialties.
Table 1. Levels of Evidence (LoE) grading scale for diagnostic methods (diagnostic interventions)
LoE | Definition |
|---|---|
1 | Systematic reviews of studies controlled with a reference method or systematic review of randomized clinical trials with meta-analysis |
2 | Individual studies with reference standard control or individual randomized controlled trials and systematic reviews of studies of any design, except randomized controlled trials, with meta-analysis |
3 | Studies without consecutive reference standard control or studies with a reference standard not independent of the test method, or non-randomized comparative studies, including cohort studies |
4 | Non-comparative studies, case report |
5 | Only justification of mechanism of action or expert opinion is available |
Table 2. Scale for grading levels of evidence certainty (LEC) for prevention, treatment, and rehabilitation methods (preventive, therapeutic, and rehabilitative interventions)
LoE | Definition |
|---|---|
1 | Systematic review, randomized controlled trials with meta-analysis |
2 | Individual randomized controlled trials and systematic reviews of studies of any design, except for randomized controlled trials, with meta-analysis |
3 | Non-randomized comparative studies, including cohort studies |
4 | Non-comparative studies, case reports or case series, case-control studies |
5 | Only justification of the mechanism of action of the intervention (preclinical studies) or expert opinion is available |
Table 3. Scale for grading grades of recommendation (GR) for prevention, diagnostic, treatment, and rehabilitation methods (preventive, diagnostic, therapeutic, and rehabilitative interventions)
GoR | Definition |
|---|---|
A | Strong recommendation (all considered efficacy criteria (outcomes) are important, all studies have high or satisfactory methodological quality, their conclusions regarding the outcomes of interest are consistent) |
B | Conditional recommendation (not all considered efficacy criteria (outcomes) are important, not all studies are of high or acceptable methodological quality, and/or their conclusions on the outcomes of interest are inconsistent) |
C | Weak recommendation (lack of adequate quality evidence (all considered efficacy criteria (outcomes) are unimportant, all studies are of low methodological quality, and their conclusions on the outcomes of interest are inconsistent) |
Procedure for updating clinical guidelines.
The mechanism for updating clinical guidelines provides for their systematic review at least once every three years, as well as upon the emergence of new evidence-based medicine data on the diagnosis, treatment, prevention, and rehabilitation of specific diseases, or in the presence of justified additions/comments to the previously approved clinical guidelines, but no more frequently than once every 6 months.
Appendix A3. Reference Materials
No
Appendix B. Physician Action Algorithms
Nitroimidazole derivatives are used in the treatment.
Appendix C. Patient Information
1. To prevent reinfection with the urogenital trichomoniasis pathogen, examination and treatment of sexual partners are required.
2. During the period of treatment and dispensary follow-up, it is necessary to abstain from sexual contact or use barrier methods of contraception until cure is established.
3. To establish a cure, a follow-up visit to the physician is required for examination (by microscopic, microbiological methods, NASBA 14 days after the end of treatment, PCR or real-time PCR methods - no earlier than a month after the end of treatment).
Examination for other sexually transmitted infections is recommended.
Appendix G. Assessment Scales, Questionnaires, and Other Evaluation Tools
There is no universally accepted rating scale.