Prevention and treatment of trichomonas vaginalis and mold infection   (draft)

Appendix II: by Pan, Yaogui

Prevention and treatment of trichomonas vaginalis and mold infection   

Physiology mechanism 生理 of vaginal channel: 

The vaginal mucosa epithelial cells of adult healthy women contain animal starch, and the vagina contains gram-negative bacilli, the so-called vaginal bacillus (Doderlein’s bacilli), which can decompose starch into lactic acid to maintain a certain acidity (PH=4.5) in the vagina, to prevent pathogenic bacteria from multiplying in the vagina, thereby maintaining biological characteristics and self-defense function in the vagina. 

    为阴道毛滴虫，属鞭虫种系，呈梨形，较中性白血球稍大，其顶端有四条鞭毛，体部有波动膜，尾部有轴柱，活动为直轴转动和向前波动。

    当PH5.5-6.0时最适宜生长:当PH<4.5>7.5时就不易生长。

    当温度在35℃-37℃最适宜生长，但在一10℃和38-40℃亦能活7-9小时。而25-27℃可活120-150小时(一般浴水约30℃);普通井水可活5天，在肥皂水中可活9小时在干燥环境中可活12-20小时。。

1 Trichomonas vaginitis

1.1. Etiology

Trichomonas vaginalis, a whipworm strain, is pear-shaped and slightly larger than neutrophils; it has four flagella at the top, a fluctuating membrane at the body, and an axial column at the tail, with the activities rotating along a straight axis and fluctuating forwards. 

Optimum PH5.5-6.0 for growth: PH<4.5>7.5 for poor growth. The optimum growth temperature is 35 C-37 C, but it can survive 7-9 hours at a temperature of 10 C and 38-40 C. While from 25 to 27. degree. C. to 120 to 150 hour (generally about 30. degree. C. in bath water); Normal well water can live for 5 days, 9 hours in soapy water and 12-20 hours in a dry environment. Apparently, it can widely exist in nature and is easy to get spreaded. 

1.2 Method of dissemination: 

1.2.1  Direct transmission: sexual transmission is dominant. 

1.2.2  Indirect infection: via bath, bath utensils, underwear and personal feces, urine infection, toilet, medical equipment, etc. 

1.3 Pathogenesis

Although there are different theories, it is mostly believed that trichomonas is not pathogenic.  It mainly consumes glycogen in vagina and hinders the formation of lactic acid, thus reducing the acidity in vagina and destroying the defense function of vagina.  Pathogenic bacteria are then easy to propagate and cause inflammatory reaction. Trichomonas does not invade tissues to cause pathological changes. 

1.4  Incidence rate: 

In China, the incidence of minor illnesses is about 20% (20–25%) 小发病牵国国内统计为20%左右 in the United States and 10%-25% in the Soviet Union) and 16.7%-32.36% in factories.  It is higher among married women than among unmarried women; the rate is higher for pregnant women than other women. 

   

1.5  Symptoms and Signs: 

Symptoms usually begin one week after infection. 

1.5.1 Vaginal vulva is itchy and has the sensation of insect crawling, but does not affect sleep and activity, only triggered by secretion stimulation. A few cases evolve to dermatitis. 

1.5.2 Vaginal secretions increased, a yellowish foam (due to decomposition of carbon water compounds and discharge gas), thin, with a bad smell or hemorrhagic, purulent, stimulate the pudendal skin and cause discomfort and pain. 

 2.阴道分泌物增多，呈灰黄色泡沫状(因分解炭水化合物而排出气体)、稀薄、有臭味或血性、脓性，刺激阴部皮肤而致不适及疼痛。

1.5.3  Infertility:  trichomonas can devour sperm, vaginitis can affect sperm survival so as to interfere with pregnancy. 

1.5.4 Urinary system symptoms: urethritis symptoms such as frequent micturition, urgency urination, and urinary pain. 

1.5.5  Examination of vaginal speculum: red granules are observed on the vaginal wall, in the shape of waxberry fruit. 

1.6 Diagnosis: 

According to medical history, pruritus and foamy leucorrhea can be diagnosed. The diagnosis requires suspension for the detection of active trichomonas, as well as smear and culture methods. 

1.7 Treatment: 

1.7.1  General treatment: pay attention to personal health, avoid sex life, reduce local stimulation, keep local dry. 

1.7.2 Local treatment: 

    ①阴道酸化，恢复其生物特性和自净作用。常用0.5%醋酸液或1%乳酸液冲洗，每天一次，10天为一疗程，注意孕妇只能擦洗，未婚者用导尿管冲洗。大蒜头煎汤熏洗亦有效。

    ②驱虫治疗:灭滴灵、滴维净、卡巴肿等，每晚塞阴道内1片，10天为一疗程。曲古霉素10万单位，每晚一片塞阴道，14天为一疗程。

1. Vaginal acidification to restore its biological characteristics and self purification. Commonly used 0.5% acetic acid solution or 1% lactic acid solution washing, once a day, 10 days as a course of treatment, pay attention to the pregnant women can only be swabbed, unmarried with catheter washing. Decocting garlic in soup and fumigating and washing are also effective. 
2. deworming treatment: one tablet was stuffed into the vagina every night for metronidazole, diweijing, and carboprost, with 10 days as a course of treatment. The quantity of tricitabine was 100,000 units. One tablet was used to plug the vagina every night, and 14 days constituted a course of treatment. 

1.7.3 Systemic treatment: 

1. Oral anthelmintic; (for ordinary couples), metronidazole 0258/ day, 10 days as a course of treatment. Or 2 g (0.25×8), the cure rate is 95% and the side effects are not more than 10 days therapy. (1-HI) 
2. Treatment of comorbidity: the treatment of genital inflammation can restore the biological characteristics of the vagina, which is not conducive to the growth of trichomonas. 
3. Complications of treatment: for example, symptomatic treatment of urinary tract infection, antibiotic treatment of vaginitis (chloramphenicol 0.25 for vagina), and repeated treatment if there were still symptoms after one course of treatment. 

   3.全身治疗:

    ①口服驱虫药;(一般夫妻同时服)灭滴灵0258/日，10天为一疗程。或2克(0.25×8)顿服，其治愈率达95%，副作用并不比10日疗法多。(1-HI)

    ②治疗并存病:治疗生殖系炎症可恢复阴道生物特性，从而不利滴虫生长。

    ③治疗并发症:如:尿路感染对症治疗，阴道炎抗菌素治疗(氯霉素0.25塞阴道)，如果经治疗一疗程仍有症状可重复治疗。

1.8  Prevention: 

Strengthen health education, do a good job in personal health, ban pool bath, transform public toilets from sitting to squatting, bath isolation (with individual towels and basins), medical equipment disinfection, treatment and strict management of the patients carrying worms.   

       

    六、诊   断:

    根据病史，骚痒症状及白带呈泡沫状等即可诊断。确诊需悬液检见活动的毛滴虫，还可用涂片及培养方法。

2 Mycotic vaginitis (candidal vaginitis) 

Mycotic vaginitis is vaginal inflammation caused by Candidaalbicans. Its incidence rate is second only to trichomonas vaginitis, and it is more common in pregnant women, patients with diabetes and those who have long-term application of antibiotics. And is often complicated with other inflammation. Candida can be parasitic in the vagina at ordinary times, and whenever glycogen in the vagina increases: when the acidity increases, it can rapidly proliferate and cause symptoms. First, the mode of infection: mainly indirect. 

                2 霉菌性阴道炎(念珠菌阴道炎)

    霉菌性阴道炎是由白色念珠菌(Candidaalbicans)所致的阴道炎症。其发病率仅次于滴虫性阴道炎，多见于孕妇、糖尿病患者及长期应用抗菌素者。并常与其他炎症并发。

    念珠菌平时可寄生于阴道，每当阴道内糖元增多:酸性增强时即可迅速繁殖而引起症状。

    一、传染方式：以间接为主。

    二、临床表现及特征：

    1.外阴奇痒:由小阴唇内侧开始后蔓延至外部症状十分显著。

    2.阴道分泌物:急性期常减少，呈凝乳块或豆渣样白带。

    3.窥阴器检查;外阴、阴道粘膜常被一层白膜复盖，揭除后显示粘膜轻度红肿。

    4.分泌物涂片及悬液检见病原菌，亦可作培养。

    三、治   疗:  

    1冲洗阴道:常用2-4%苏打水或龙胆草液(4两煎成500cc水)3/日，10天一疗程。

集育

    2.制霉菌素，50万单位每晚一次，塞阴道，10天一疗程。

    3.曲古霉素膏外用(溃疡面)或0.5%龙胆紫涂外阴及阴道壁。

    4.内服治带净片8片，8/日。

 四、预防:

    1.加强卫生宣传教育，说明此病传染方式。

    2.治疗原发病，如糖尿病。避免滥用抗菌素。

    3.杜绝传染源:改良浴具、浴池、厕所等，医疗器械严密消毒，以杜绝交叉感染。

II. Clinical manifestations and characteristics: 

1. Abnormal vulva itching: The symptoms that begin on the inner side of the labia minora and spread to the outside are very significant. 
2. Vaginal discharge: it is often reduced in the acute phase, with a white discharge like curds or bean dregs. 
3. Examination of vaginal speculum; Vulva and vaginal mucosa were often covered with a layer of white membrane, and the uncovered mucosa showed mild swelling. 
4. Excreta smears and suspensions may be cultured if pathogenic bacteria are detected. III. Therapies: 1 Vaginal irrigation: 2-4% soda water or Radix Gentianae liquid (decocted into 500cc water in 4 pairs) was usually used for 3/ day, and a course of treatment lasted for 10 days. Set education 2. Nystatin, 500,000 units once every night, vaginal plug, 10 days of treatment. 3. Qugu mycin ointment is applied externally (on the ulcer surface) or 0.5% gentian violet is applied to the vulva and vaginal wall. 4. Take 8 Zhidai Jing tablets orally, 8/ day. IV. Prevention: 1 to strengthen health publicity and education, that the disease transmission. 2. treating primary diseases such as diabetes. Avoid abuse of antibiotics. 3. Eliminate the source of infection: improve the bath, bath, toilet, etc., and closely disinfect the medical devices to eliminate cross infection.   Comparison of trichomonas vaginitis and mycotic vaginitis      

滴虫性阴道炎和霉菌性阴道炎比较表

病名	滴虫性阴道炎	霜菌性阴道炎
病原体	毛滴虫，正常健康阴道内无。	白色念球菌，正常阴道内也存在。
传染方式	以直接为主: 性交等方式	以间接为主; 通过浴具、浴池等。
临床特征	阻止阴道内正常乳酸形成，阴道内酸度减低，破坏正常防御机能，有利于病菌生长、繁殖而致阴道炎，本身无致病性。	在正常阴道内霉菌虽存在，但不致病，而每当阴道酸度增强时(如糖尿痼患者或孕妇及常用抗菌素者)则霉菌即可迅速繁殖，而引起阴道发炎。
发病机理	1. 外阴，阴道痒，不影响工作和睡眠。 2. 白带多、灰黄色、或伴有血性及脓性，呈泡沫状 3，阴道壁有红色颗粒，呈杨梅果样。 4. 或有尿道炎症状并存。 5. 悬液检查见活毛滴虫。	1. 外阴奇痒，重者可影响睡眠及工作。 2. 白带多少不一，呈乳凝块或豆渣样。 3. 阴道粘膜被一层由膜覆盖，揭除后可见粘膜红肿。 4. 无泌尿系炎症情况。 5. 悬液检查可见白色念球菌。
治疗	1. 常用酸性液冲洗阴道，如0.5%醋酸或1%乳酸、大蒜头液熏洗。 2. 驱虫治疗: 灭滴灵、滴维净、卡巴肿、曲古霉素等塞人阴道内或口服灭滴灵。 3、抗菌素同时合并应用(青链、氯等)。 4. 治疗并发病，泌尿系炎症 (呋喃坦啶)。 5.  治疗、管理带虫者。	1. 常用碱性液冲洗阴道，如2-4%苏打水。 2. 制霉菌素，曲古霉素，阴道内用药。 3. 一 般不用抗菌素。   4. 病因治疗: 如糖尿病的治疗等。 5. 不需要治疗带菌者(因为正常阴道内有霉菌存在)。

By Yaogui Pan, Gynaecology and Obstetrics Department

Nanling Medicine, 1979; 1:45-47