Appendix II: by Pan, Yaogui
Prevention and treatment of trichomonas vaginalis and mold infection
Physiology of the Vaginal Canal
The epithelial cells in the vaginal mucosa of healthy adult women contain glycogen. In addition, the vagina hosts gram-negative bacteria, commonly known as Doderlein's bacilli. These bacteria have the ability to convert glycogen into lactic acid, maintaining an acidic environment in the vagina with a pH of 4.5. This acidity serves to inhibit the growth of pathogenic bacteria, thereby preserving the vagina's natural biological characteristics and self-defense functions.
Trichomonas Vaginitis
1. Etiology
The causative agent is Trichomonas vaginalis, a member of the whipworm family. It is pear-shaped and slightly larger than a neutrophil. The organism has four flagella at its apex, a fluctuating membrane around its body, and an axial column at its tail. It moves by rotating along a straight axis and propelling forward.
Optimal growth occurs at a pH range of 5.5 to 6.0, while growth is inhibited at pH levels below 4.5 or above 7.5.
The organism thrives best at temperatures of 35–37°C but can survive for 7-9 hours at temperatures of 10°C and 38-40°C. It can live for 120-150 hours at 25-27°C (typical bath water is around 30°C), survive for 5 days in regular well water, 9 hours in soapy water, and 12-20 hours in dry conditions. Clearly, it can exist widely in nature and is easily transmissible.
2. Methods of Transmission
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Direct Transmission: The primary mode is through sexual intercourse.
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Indirect Transmission: Transmission can also occur via bathing pools, bath utensils, underwear, and contamination from personal fecal matter and urine, as well as from toilets and medical equipment.
3. Pathogenesis
While theories vary, it's widely accepted that Trichomonas is not inherently pathogenic. Instead, it consumes glycogen in the vagina, obstructs the formation of lactic acid, and thereby reduces vaginal acidity. This disrupts the natural defense mechanisms of the vagina, making it easier for pathogenic bacteria to multiply and trigger an inflammatory response. Trichomonas does not invade tissues to cause pathological changes.
4. Incidence Rate
The incidence rate in China is estimated to be around 20%, similar to the 20-25% rate in the United States and the 10-25% rate in the Soviet Union. Among factory workers, the rate ranges from 16.7% to 32.36%. The incidence is higher in married women compared to unmarried women, and higher in pregnant women than in non-pregnant women.
5. Symptoms and Signs
Symptoms generally appear one week after infection.
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Vaginal and Vulvar Itching: There's a sensation of crawling insects, but it does not affect sleep or daily activities. This is triggered by the secretion of vaginal fluids. In some cases, this may escalate to dermatitis.
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Increased Vaginal Discharge: The discharge is grey-yellow and foamy (due to the decomposition of carbohydrates and the release of gas). It is thin, with a foul odor, and can sometimes be bloody or purulent. This irritates the skin around the genital area, causing discomfort and pain.
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Infertility: Trichomonas can engulf sperm, and the inflammation in the vagina can adversely affect sperm survival, thus hindering pregnancy.
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Urinary Symptoms: Symptoms may include frequent urination, urgency, and pain during urination — all indicative of a urinary tract infection.
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Speculum Examination: The vaginal wall shows red granules, resembling the appearance of a bayberry.
6. Diagnosis
Diagnosis can be based on the medical history, itching symptoms, and the presence of foamy vaginal discharge. For a definitive diagnosis, microscopic examination of a wet mount to observe live trichomonas is required. Smear and culture methods can also be used for confirmation.
7. Treatment
1. General Treatment:
- Maintain personal hygiene, abstain from sexual activity, minimize local irritation, and keep the affected area dry.
2. Local Treatment:
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Vaginal Acidification: To restore its biological characteristics and self-cleaning functions. Commonly use 0.5% acetic acid or 1% lactic acid for douching once a day for a 10-day course. Note that pregnant women should only use topical application, and unmarried individuals may use a catheter for douching. Garlic broth fumigation is also effective.
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Antiparasitic Treatment: Use of antiparasitic drugs like Metronidazole, Povidone-iodine, and others. Insert one tablet into the vagina every night for a 10-day course. Alternatively, use 100,000 units of Nystatin inserted into the vagina each night for a 14-day course.
3. Systemic Treatment:
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Oral Antiparasitic Medication: Typically, both partners take Metronidazole 0.25g/day for a 10-day course. Alternatively, a single dose of 2g (0.25×8) can be taken, with a cure rate reaching up to 95%. Side effects are not notably more than with the 10-day treatment course.
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Treating Coexisting Conditions: Treating inflammatory diseases of the reproductive system can restore the natural defenses of the vagina, thereby inhibiting the growth of trichomonas.
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Treating Complications: For example, symptomatic treatment for urinary tract infections, and antibiotic treatment for vaginitis (Chloramphenicol 0.25g inserted into the vagina). If symptoms persist after one course of treatment, repeat treatment is advised.
8. Prevention
Strengthen hygiene education and personal hygiene, ban communal bathing, renovate public toilets (change from sitting to squatting styles), isolate bathing utensils (towels, basins), strictly disinfect medical equipment, and manage patients rigorously, especially those carrying the parasite.
Yeast Infection (Candidal Vaginitis)
Yeast infection is caused by Candida albicans and is second only to trichomonas vaginitis in incidence. It is more common in pregnant women, diabetics, and those on long-term antibiotics. It often coexists with other inflammations.
- Method of Transmission: Primarily indirect.
Clinical Manifestations and Characteristics
- Vulvar Itching: Starts from the inner labia and spreads outward; symptoms are quite prominent.
- Vaginal Discharge: Often reduced during the acute phase, resembling curdled milk or bean dregs.
- Speculum Examination: The vulva and vaginal mucosa are often covered by a white membrane; removing it reveals mild redness and swelling.
- Smear and Suspension Tests: Pathogenic fungi can be observed; culture tests can also be performed.
Treatment
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Vaginal Douching: Commonly use 2-4% baking soda or Gentian liquid (4 oz boiled down to 500cc of water), 3 times per day for a 10-day course.
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Antifungal Treatment: 500,000 units nightly, inserted into the vagina for a 10-day course.
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Topical Treatment: Nystatin ointment (for ulcerated surfaces) or 0.5% Gentian violet applied to the vulva and vaginal walls.
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Oral Treatment: 8 tablets of antifungal medication daily.
Prevention
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Strengthen hygiene education and clarify modes of transmission for this condition.
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Treat primary conditions, such as diabetes, and avoid misuse of antibiotics.
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Eliminate sources of infection: Improve bathing utensils, baths, toilets, etc., and strictly disinfect medical equipment to prevent cross-infections.
Comparison Table: Trichomonas Vaginitis vs. Yeast Infection
| Categories | Trichomonas Vaginitis | Yeast Infection |
|---|---|---|
| Pathogen | Trichomonas; not normally present in a healthy vagina. | Candida albicans; normally present in the vagina. |
| Mode of Transmission | Primarily direct: sexual intercourse. | Primarily indirect: via bath utensils, pools, etc. |
| Clinical Features | Inhibits normal formation of lactic acid within vagina, leading to a decrease in vaginal acidity and disruption of its natural defense mechanisms, creating a favorable environment for pathogenic bacteria to grow and proliferate, causing vaginitis. However, it is not pathogenic in itself. | Yeast exists normally but only becomes pathogenic when acidity increases, such as in diabetics or pregnant women. |
| Pathogenesis |
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| Treatment |
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This paper was originally published in Nanling Medicine,1979；1:45-47 Changhang Hospital, Pan Yaogui
from 潘耀桂：阴道内滴虫和霉菌感染的防治
