Trichomonas vaginitis

　　Trichomonal vaginitis is a common vaginitis caused by Trichomonas vaginalis. When the vaginal pH changes before and after menstruation, the Trichomonas hidden in the glands and vaginal folds often reproduce, causing an inflammatory attack. The vaginal pH of patients with trichomonal vaginitis is 5 to 6.5. Trichomonas not only resides in the vagina but also often invades the urethra and paraurethral glands, even the bladder, renal pelvis, and the prepuce creases, urethra, or prostate of males. Its modes of transmission include: direct transmission, through sexual contact. Since males often have no symptoms after infection with trichomonas, they are more likely to become a source of infection. Indirect transmission: through public bathhouses, bathtubs, towels, swimming pools, toilets, clothing, equipment, and dressings, etc.

　　If trichomonal vaginitis is not treated promptly, it often leads to female infertility. Under normal circumstances, the important conditions for women to become pregnant are that the husband's sperm reach a certain quantity and have good motility. However, when a woman is infected with trichomonal vaginitis, Trichomonas vaginalis can engulf sperm, reducing the amount of sperm and hindering the production of lactic acid, resulting in a vaginal pH of 5 to 6, whereas the normal vaginal pH should be 4.2 to 5.

　　Due to changes in the vaginal environment's acidity and alkalinity, the vitality of sperm is affected, and at the same time, due to sperm being engulfed, the number of sperm in the vagina is reduced. Both are important conditions for conception and are severely affected, which is why trichomonal vaginitis can lead to infertility. Moreover, when a woman has trichomonal vaginitis, there is a large increase in purulent vaginal discharge, and the discharge also contains a large number of white blood cells, which will also hinder the survival of sperm and reduce the number of sperm. With fewer sperm and poor motility, infertility is exacerbated.

　　Although trichomonal vaginitis can lead to infertility, female patients do not need to worry too much. As long as trichomonal vaginitis is cured, fertility can be restored.

　　Trichomonal vaginitis, due to varying degrees of onset, presents with different symptoms. The following sections introduce the acute, chronic, and asymptomatic infections of trichomonal vaginitis.

　　1. Acute infection: Manifested as a diffuse vulvovaginitis. The most common symptoms include increased vaginal discharge, vulvar irritation and itching, dysuria, or an unpleasant odor. Severe cases may present with lower abdominal pain. During the acute phase, there is a large amount of leukorrhea, which may soak through the patient's underwear, often requiring the use of sanitary napkins.

　　The external genitalia appear red and swollen, the vagina is congested, and there is an increase in vaginal discharge, varying from slight and thin to large and thick. 10% to 30% of female patients exhibit typical copious foamy yellow-green discharge, often with an unpleasant odor. The cervix is congested and swollen, with widespread erosion of the cervical epithelium and pinpoint bleeding, known as strawberry cervix, although this sign is less common.

　　2. Chronic infection: If the acute infection is not treated in time, it may turn into chronic infection. At this time, the vaginal discharge will be less than that during acute infection, mostly grayish white milky, still with an odor, and urinary tract infection may occur with symptoms such as frequent urination, urgency, and dysuria.

　　During gynecological examination, the vulvar and vaginal mucosa is pale red or slightly congested, and there is a grayish white milky foam-like vaginal discharge accumulated in the posterior fornix, with an odor. This period is of great importance in epidemiology and is the main period of transmission.

　　3. Asymptomatic infection: 10% to 50% of female infected individuals may have no clinical symptoms, but 50% of asymptomatic carriers may develop symptoms within half a year.

　　The preventive propaganda for trichomoniasis vaginitis should be strengthened because it is highly contagious and can cause great harm. Therefore, more attention should be paid to it.

　　1. Strengthen health propaganda and popularize health knowledge.

　　2. Conduct general surveys and treatments for female workers in factories, residents, and schools, especially nursery workers, to eliminate the source of infection.

　　3. Medical units should thoroughly disinfect medical instruments and dressings.

　　4. Strict isolation system to prevent cross-infection, each person should change a pad for gynecological examination.

　　5. Prohibit trichomoniasis patients from entering swimming pools or public bathhouses; do not rent swimming trunks and bath towels. For the public:

　　(1) Do not take a bath in a bathtub or public bathhouse, and take a shower instead.

　　(2) Do not share bath towels with others, and do not rent swimming trunks.

　　(3) Do not sit on the wet chairs in public toilets or bathhouses.

　　(4) The underwear should be disinfected by boiling frequently.

　　6. The patient should be isolated from family members and actively treated; at the same time, the male or sexual partner should also be examined. If positive, they should be treated together.

　　7. Abstain from sexual intercourse during the illness. For those who have recurrent attacks after treatment, the male's urine and prostatic fluid should be re-examined. If positive, treatment should be given.

　　Dietary prescription for trichomoniasis vaginitis:

　　1. Fresh crown flower 500 grams, fresh lotus root juice 500 milliliters, sugar powder 500 grams. Wash the fresh crown flower clean, add an appropriate amount of water, boil for 3 times, each time for 20 minutes. Merge the 3 boiled liquids, continue to simmer and concentrate with low heat, add fresh lotus root juice, heat until thickened, pour in sugar powder, turn off the fire, mix well, dry in the sun, crush, pack and store. Dissolve 10 grams with boiling water for immediate intake, 3 times a day.

　　2. Wrap the seed of Plantago asiatica in a cloth, put it in a pot, add an appropriate amount of water, boil the juice and remove the medicine bag, then cook the juice with glutinous rice and Poria powder into porridge, add a little sugar, and it is ready. Take one dose per day, and use it for 5 to 7 days as a course of treatment.

　　Trichomoniasis vaginitis requires different treatment plans based on different population categories. Since trichomoniasis vaginitis can be directly transmitted through sexual contact, both partners should be treated simultaneously. For married patients, the route of administration should be local treatment, systemic medication, or a combination of both. For unmarried patients and sexual partners, systemic medication is recommended. The following are the principles of different medication methods:

　　1. Local treatment:It is generally adopted to use metronidazole vaginal suppositories, but it should be noted that it is best to rinse the vagina before local medication to improve the therapeutic effect.

　　2. Initial treatment with systemic medication:Single oral dose of metronidazole or tinidazole. Due to the poor compliance of patients taking medication, especially sexual partners who often find it difficult to complete the prescribed course of treatment, systemic medication is recommended. It should be noted that alcohol should not be consumed during or within 24 hours after taking metronidazole, and within 72 hours after taking tinidazole. It is not advisable to breastfeed while taking medication, and vaginal suppositories are recommended for administration during breastfeeding.

　　3. Treatment for sexual partners:Single oral dose of metronidazole or tinidazole, and since trichomoniasis vaginitis is mainly transmitted through sexual contact, sexual partners should also be treated simultaneously, and sexual intercourse is prohibited during treatment.

　　4. Treatment during pregnancy:Single oral dose of metronidazole. Patients in the first trimester of pregnancy must communicate with their doctor during treatment, as metronidazole can cross the placenta and enter the fetus. Although there is no evidence to prove its carcinogenic effect, given the potential carcinogenic risk of metronidazole has not been completely ruled out, it is essential to follow the doctor's advice when treatment is needed, and it is recommended not to use metronidazole in the early stages of pregnancy and to avoid single large doses of medication.