Urogenital trichomoniasis

The role of trichomoniasis in the structure of inflammatory diseases

Trichomonal vaginitis is considered within the general structure of inflammatory diseases of the female pelvic organs. For a full understanding of the pathological process, it is necessary to consider the basic aspects:

• Etiological factor: identification of the main pathogens causing inflammation.
• Classification: division of diseases according to the clinical course of the process and the localization of inflammation (in this case, involvement of the lower sections).
• Pathogenesis and spread: it is important to know the routes of infection spread in the body and the factors that contribute to this.
• Defense mechanisms: physiological barriers that prevent the entry and further progression of infection in the female reproductive system.

Specific infections and concomitant pathologies

The study of urogenital trichomoniasis is inextricably linked with the understanding of other specific sexually transmitted infections (STIs). This same group includes gonorrhea and genital chlamydia.

Differential diagnostics and a comprehensive approach require knowledge of other lower tract infections, including bacterial vaginosis and vaginal candidiasis. In an unfavorable course and overcoming of protective barriers, the inflammatory process can ascend. This leads to the development of pelvic inflammatory disease (PID), which requires a comprehensive study of lesions of the uterus and its appendages.

Mandatory HIV screening for STIs

The presence of any sexually transmitted disease in a patient (including trichomoniasis) is a direct clinical indication for mandatory HIV testing. This is due to common risk factors. In addition to patients with STIs, pregnant women, donors, hospitalized patients, drug users, and workers in mandated occupations are subject to screening.

HIV infection is transmitted in several ways:

1. Parenteral: through contaminated blood, tissue transplantation, or the use of non-sterile needles.
2. Vertical: from mother to fetus (transplacentally, intrapartum, or postnatally through breastfeeding).

Important: the virus is definitively not transmitted through household contact, food, water, or insect bites. To prevent transmission during casual contact, the use of a condom is strongly recommended, which is simultaneously the main protection against trichomoniasis.

Clinical presentation and stages of concomitant HIV infection

Since patients with STIs are at risk, the physician needs to know the initial manifestations of HIV. In 50% of infected individuals, the acute phase occurs after 5–6 weeks and manifests as fever, night sweats, diarrhea, myalgia, lymphadenopathy, and a diffuse maculopapular rash.

Subsequently, the asymptomatic carriage stage sets in (from several months to years), when the patient is contagious but has no external symptoms. With the progression of immunodeficiency (decrease in the CD4/CD8 index), severe AIDS-associated diseases develop:

• Pneumocystis pneumonia and extrapulmonary tuberculosis.
• Chronic persistent vaginal candidiasis (lasting more than 1 year).
• Neurological disorders (progressive dementia, toxoplasmic encephalitis).
• Skin manifestations (Kaposi's sarcoma, multi-focal herpes zoster).

Life expectancy after the appearance of the first signs of AIDS (cachexia, prolonged fever) does not exceed 5 years.

Diagnostics and treatment principles

For each nosological form in gynecology, its own diagnostic methods are applied. In the case of mandatory HIV screening in patients with trichomoniasis, the following are used:

• ELISA (enzyme-linked immunosorbent assay): to detect specific antibodies (usually appear 1–2 months after infection).
• Immunochemical analysis: performed for confirmation upon a positive ELISA result.
• PCR (polymerase chain reaction): an additional method to detect viral DNA and RNA.

The treatment of viral immunosuppression is based on antiretroviral drugs that suppress viral replication. These include reverse transcriptase inhibitors (zidovudine, phosphazide, zalcitabine, nevirapine) and HIV protease inhibitors (saquinavir, indinavir, ritonavir). Therapy must be started as early as possible and continued for as long as possible. Additionally, endogenous interferon inducers and symptomatic treatment of secondary infections are used.

Class and exam questions

What else to study on this topic

• Bacterial vaginosis and vaginal candidiasis: etiology and clinical presentation.
• Pelvic inflammatory disease (PID) and routes of infection spread.
• Gonorrhea and genital chlamydia in the structure of specific STIs.
• Detailed classification of inflammatory processes by clinical course.
• Specific treatment of developed AIDS-associated diseases and chemoprophylaxis.

Other topics in the "Gynecology" section

Prepared by WhiteCoat Pro faculty in accordance with the medical school curriculum. For educational purposes only.