滴虫性尿道炎

　　滴虫性尿道炎的致病菌为阴道毛滴虫。阴道毛滴虫为一种鞭毛虫，属原虫类，没有包囊期，只有滋养体期。滋养体呈梨形，长约7-32微米，略大于分叶核白细胞。煞白透明，有折光性。其前端有鞭毛3-5根，平均4根，侧面有波动膜(undulatingmembrane)，核呈卵圆形，细胞浆内有颗粒，后有鞭毛一根，较前端者短。阴道毛滴虫对周围的适应性很强。喜潮湿，在3-5℃能生活21天，46℃尚能生活20-40分钟，25-42℃时增长景气，其中以35-37℃，pH5-6时景气率最快。在半燥热的周围中，尚可生活6小时左右，所以毛滴虫离开人体后也能传播。

　　The disease has the following sources of infection:

　　1, The female is infected with Trichomonas vaginalis (trichomonas vaginalis, abbreviated as TV) through swimming, bathing, sexual contact, etc., and then it lives in the vagina. Then it causes urinary tract infection, and then it is infected with the male through sexual contact. In addition to causing trichomonas urethritis, it can also cause cystitis and prostatitis.

　　2, The reservoir of infection is trichomonas patients and carriers, mainly transmitted through sexual contact, and can also be transmitted indirectly through public bathhouses, swimming pools, sit-down toilets, etc. It can cause female trichomonas vaginitis, and then lead to urethral suppuration. The cause of trichomonas urethritis is through sexual contact, trichomonas enters the male urethra, causing male trichomonas urethritis and prostatitis. Regarding the question of whether pure trichomonas can cause urethritis, some scholars are skeptical. Many scholars have found trichomonas in urethral secretions at the same time, and also found that there are pathogens other than the disease, such as common pathogenic bacteria, chlamydia trachomatis, mycoplasma, etc. Therefore, when there are pathogens other than the disease, trichomonas can cause disease.

　　As for the modes of transmission, there are two types: direct transmission, which is sexual transmission, and indirect transmission. Abroad, vaginitis trichomonalis is mainly transmitted through sexual contact, therefore, it is classified as a sexually transmitted disease. In China, the mode of transmission is different. Due to the large population in China and relatively backward public health facilities compared to developed countries, the transmission in public places has also become an important mode of transmission. For example, if the seats of public bathhouses or the seats of public toilets are contaminated by the secretions of carriers, those who sit on the seats or toilets later may be infected. The pool in public bathhouses, the swimming pools that are densely populated in summer and not strictly disinfected, sharing others' underwear, renting swimsuits, etc., may all cause the transmission of trichomonas. In addition, the mutual use of bathing basins among family members and iatrogenic cross-infection are also reasons for the indirect transmission of trichomonas.

　　Complications in male and female patients with trichomonas urethritis:

　　1, Complications in male patients:Epididymitis, prostatitis, seminal vesiculitis, etc.

　　2, Complications in female patients:Endometritis, salpingitis, pelvic inflammatory disease, peritoneum, etc.

　　First, the symptoms of male trichomonas urethritis

　　1, Symptom one:The incubation period of trichomonas urethritis is usually 4-7 days. In severe cases of infection, there may be itching and burning sensation in the vulva and inner thigh. At the same time, if the urinary tract is infected, those with urethritis and cystitis may have symptoms such as frequent urination, urgency, pain during urination, and hematuria. Retrograde infection leading to pyelonephritis may cause chills, back pain, high fever, malaise, and gastrointestinal reactions. Physical examination may show tenderness and percussion pain at the costovertebral angle. Symptoms and signs are the same as those of general bacterial urinary tract infection.

　　2, Symptom two:Pain is felt during urination. In the morning, there is a small amount of secretion at the urethral opening, which is serous and occasionally purulent.

　　Second, symptoms of female trichomonas urethritis

　　The symptoms of trichomonas urethritis are mainly manifested as persistent vulvovaginitis, increased vaginal discharge, which is serous or purulent, thin, with small bubbles in the discharge, foul smell, yellow-green. There is pain during sexual intercourse. Difficulty in urination, vulvar itching. In severe cases, there is itching, burning sensation in the vagina, vulva, and inner side of the thigh. At the same time, if urinary tract infection and cystitis occur, symptoms such as frequent urination, urgency, and dysuria may occur, and hematuria may occur.

　　The preventive measures for trichomonas urethritis include the following aspects:

　　First, general prevention

　　1. Develop the habit of washing hands:Vaginal trichomonas have a strong adaptability to the surrounding environment. They can enter the urethra and cause infection through the process of defecation, so developing good hygiene habits is also very important, especially before and after meals.

　　2. Clean frequently:When cleaning the vulva and anus, pay attention to the order, wash the vulva first and then the anus, and do not do the opposite; towels and basins should be used by the same person, otherwise bacteria can easily enter the urethral orifice.

　　3. Sanitary napkin selection:Always use products with a Ph4 weak acid formula to avoid poor-quality products from destroying the normal flora of the human body, which may反而 weaken the local resistance. Pay attention to the quality of sanitary napkins when purchasing, and do not store them for a long time to avoid the breeding of bacteria, which may cause vulvar and vaginal infections. When symptoms such as vulvar itching and increased leukorrhea appear, see a doctor early.

　　4. Drink as much water as possible:Clinical evidence shows that drinking a large amount of water every day and urinating every 2-3 hours can prevent the reproduction of vaginal trichomonas in the urinary tract, reduce the incidence of urinary tract infections, and this is the most practical and effective method of preventing urinary tract infections. Therefore, this harmless method plays an irreplaceable role in the early stage or remission stage of urethritis.

　　5. Pay attention to personal hygiene:Take a bath frequently, do not advocate taking a bath in a basin, and store clothes separately; change and wash underwear frequently, especially new underwear or underwear that has not been worn for a long time, and wash and dry it before wearing; wear breathable and moisture-absorbent cotton underwear, try to wear less tight pants or jeans, and wear more breathable dresses, which is very important for protecting women's health.

　　6. Choose cotton underwear:Avoid wearing tight pants and underwear, choose breathable and comfortable cotton underwear to keep the genital area clean and dry, and reduce the chance of growth of vaginal trichomonas.

　　7. Ensure sufficient sleep and regular sexual life:The role of sleep is self-evident, and it plays a crucial role in the prevention and treatment of all diseases. Therefore, remember not to stay up late, as this will reduce the body's resistance to diseases. Also, control the frequency of sexual life; for those who have more than 3 sexual intercourses per week, the incidence of urinary tract infections will greatly increase. During this special stage in summer, it is appropriate to reduce the frequency.

　　8. Urinate as soon as possible after sexual intercourse:The purpose of urination is to flush out bacteria, reduce accumulation, and clean the private parts with warm water.

　　Second, male urethritis prevention

　　1. Instruct the patient to avoid sexual activity before recovery; abstain from alcohol, spicy foods, and drink plenty of water.

　　2. In the family, necessary isolation should be done, such as using separate towels, bathtubs, basins, and toilets, or disinfecting them after use.

　　3. Male urethritis patients need to understand what is safe sex, what is risky sex, and how to avoid risky sex.

　　4. Encourage the use of condoms.

　　Third, the prevention of female urethritis

　　Generally speaking, the treatment of female urethritis is more likely to recur, which is usually related to the special physiological structure of women. Therefore, in daily life, attention should be paid to:

　　1. Stick to drinking plenty of water

　　The urine excreted by the kidneys has a flushing effect on the bladder and urethra, which is conducive to the excretion of bacteria. Drinking plenty of water every day and urinating once every 2-3 hours can prevent the proliferation of bacteria in the urinary tract, reduce the incidence of urinary tract infections, and this is the most practical and effective method for preventing urinary tract infections. Drinking plenty of water every day during the acute or remission stage of the disease is also conducive to the recovery of the disease, and drinking tea or dilute bamboo leaf tea also has a certain preventive effect.

　　2. Pay attention to personal hygiene

　　A large number of bacteria reside in the female genitalia and urethral orifice, which is a prerequisite for the occurrence of urinary tract infections. Therefore, it is necessary to pay attention to the cleanliness of the vulva, use a delicate pH4 acidic female care solution to wash the private parts, and do not use pool or basin baths. Change your underwear frequently, and pay special attention to this during marriage, menstruation, pregnancy, and puerperium. Diaper changes should be frequent for infants.

　　3. Try to avoid using urinary tract infection instruments and catheters

　　(1) Urological instruments are prone to carry bacteria from the distal urethra into the bladder and upper urinary tract, and it is easy to develop persistent bacteriuria after catheterization, therefore, it should be avoided as much as possible. When necessary, strict disinfection should be carried out, and urine culture should be performed 48 hours after the use of urological instruments to observe whether urinary tract infection occurs. For patients who already have bacteriuria before the urological examination, it is advisable to control the infection first. Some patients may not have bacteriuria at the time, but have a history of recurrent urinary tract infections or urinary tract abnormalities. Antibiotics should be taken for prevention 48 hours before and after the urological examination. Administration of antimicrobial drugs in the first three days of indwelling catheterization can prevent or delay the occurrence of urinary tract infection, but there is no preventive effect after 3 days.

　　(2) Additionally, a closed drainage system connected to an indwelling urinary catheter can significantly reduce the incidence of urinary tract infections.

　　Laboratory examination for trichomonas urethritis:

　　1. Common examination items:Examination for trichomonas vaginitis, urinalysis, blood routine, stool routine, urethral secretion examination, urethral orifice examination, and midstream urine bacterial culture count.

　　2. Urinalysis examination:White blood cell count is increased or pusuria is present, accompanied by an increase in red blood cells, and a few cases show gross hematuria. Urinalysis examination can find a large number of pus cells and red blood cells in the first cup, while the second and third cups are basically normal. The bacterial count in the initial urine culture is significantly higher than that in the middle urine. The smear examination of urethral or vaginal secretions can show gonococci within or outside the cells in gonococcal urethritis. Non-specific urethritis can be detected by culture of secretions or anterior urethral swabs, with a large number of bacterial growth. If no bacteria are found in the smears and cultures, there is a possibility of mycoplasma or chlamydia infection, and special culture methods or PCR tests can be performed.

　　The diet of trichomoniasis urethritis patients should be light and easy to digest, with an emphasis on eating more vegetables and fruits, and a reasonable diet. Pay attention to adequate nutrition. In addition, patients should also pay attention to avoiding spicy, greasy, and cold foods. Dietary taboos:

　　1. Avoid spicy foods.

　　2. Avoid seafood and other irritants.

　　3. Avoid sweet and greasy foods.

　　First, the treatment of male trichomoniasis urethritis

　　1. Oral metronidazole, 0.2 to 0.4g, 3 times a day, for 10 days as a course. Locally, use Joyan Clean Vulva Wash or 1:5000 silver nitrate solution to rinse the urethra and retain the solution for 3 to 5 minutes.

　　2. When there is simultaneous infection of the prostate and seminal vesicle, the patient may have seminal emission or bloody seminal fluid. At this time, the treatment should include massaging the prostate once a day and adding other antibiotic treatments. Sexual life should be prohibited before definite cure.

　　Second, the treatment of female trichomoniasis urethritis

　　1. Metronidazole (Tinidazole):200 mg each time, 3 times a day, for 7 to 10 days; at the same time, use Joyan Gel Disinfectant, insert into the vagina, once a night, for 7 to 10 consecutive days. Metronidazole treatment is effective, but due to the disulfiram-like effect of metronidazole, alcohol should be prohibited during and within 24 hours after treatment. In addition, it should not be used in the first three months of pregnancy, and can be taken after three months of pregnancy.

　　2. Nitazoxanide:250 mg each time, 2 times a day, for 6 days; or use 1% lactic acid, Joyan Clean Vulva Wash, rinse the vagina and then use Joyan Gel Disinfectant, insert into the vagina, once a night, for a total of 10 days.

　　3. Fluconazole:200 mg each time, 3 times a day, for 5 consecutive days.

　　4. Sedum:Sedum 30 grams, Coptis 15 grams, Rhus Toxicodendron 6 grams, Phellodendron 30 grams, decocted and taken internally, steam and wash the vulva externally twice a day.