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0The scientific heritage No 12 (12),2017
MEDICAL SCIENCES
29
FEATURES OF TRICHOMONAD PARASATISM IN FEMALE REPRODUCTIVE ORGANS
Kobevka V.M.
Tokar P.Y.
Semeniak A. V.
Candidate of medical science, associate professor of the department of obstetrics and gynecology of Higher
State Educational Institution of Ukraine «Bukovinian State Medical University», Chernivtsti, Ukraine
ABSTRACT
We have carried out a clinical and laboratory examination of 100 women with trichomoniasis, which is characterized by polymicrobial associations with opportunistic microorganisms in 42%, with opportunistic and pathogenic microorganisms in 48%, with pathogenic microorganisms alone in 10%, with lactobacilli in 28% of cases. Lack of pronounced signs of inflammation and leukocyte response was observed in 72% of cases. In case of the disease without any lactobacilli or lask of clinical and laboratory signs of inflammation we observed menstrual disorders in 36% of patients with trichomoniasis.
Keywords: trichomoniasis, pelvic inflammatory disease (PID)
Topicality. The most common among the pelvic inflammatory diseases is urogenital trichomoniasis (UT), caused by Trichomonas vaginalis. Trichomonads are flagellated protozoa, they number more than 20 species and more than 120 strains. The incidence of the disease in different populations ranges from 30% to 80% in the structure of pelvic inflammatory diseases and can reach up to 90%; they are highly contagious and spread fast in certain populations, especially among young people. It is usually transmitted sexually or by household way in case the rules of aseptic are not followed [1].
The main site of trichomoniasis parasites is vagina and lower parts of the urinary tract. Due to the flagella, Trichomonas vaginalis spreads easily along the genital tract and facilitates the simultaneous affection of different parts of the urogenital system and internal genitalia. In 10-20% of cases vaginal Trichomonas spread into the uterus, fallopian tubes and the abdomen. Absorbing pathogens, Trichomonas are infectious agents in the upper parts of the reproductive organs and even in the abdomen. [3].
UT, can be rarely found as monoinfection. Basically, trichomoniasis is a mixed protozoal and bacterial process. Almost all the microorganisms that exist in the vagina (except lacto- and bifidobacteria) may contribute to the inflammatory process. An association of Trichomonas with opportunistic microorganisms (staphylococcus, streptococcus, E. coli), intracellular pathogens (Chlamydia, ureaplasma, mycoplasma) as well as with viruses is of particular importance. Chlamydia and gonococci also belong to the microorganisms which are absolute pathogens and coexist with Trichomonads [3].
The feature of Trichomonas vaginalis parasitism is keeping inside the parasite cells of other pathogens, protecting them at the same time against the antibacterial agents, antibodies, lymphocytes, which makes a mixed trichomonad and bacterial infection highly resistant to any treatment.
Typical symptoms of UT include frothy vaginal discharge ranging from scarce to abundant, with sharp odor and dysuria, possible itching of the vulva, pain in the abdomen, developing vulvitis, vaginitis, cervicitis; exocervix resembles a strawberry top ("strawberry cervix") [1].
The condition may be acute, subacute, torpedo (low symptomatic ), chronic and asymptomatic. Acute course with severe clinical picture is short symptomat-ically, Trichomonas vaginalis is not always immediately detected, which prevents timely diagnosis and treatment [4, 5].
Delayed or inadequate treatment of acute process, as well as lack of prevention, explains the high incidence of chronic forms of protracted, often obliterated course, tendency to relapse, presence of complications (infertility, menstrual dysfunction, the occurrence of ectopic pregnancy, pelvic pain), resistance to a therapy [ 4].
Objective. To determine the status of vaginal microbiota in the presence of trichomonas and features of their parasitism on female reproductive organs, influence of trichomoniasis on reproductive system.
Materials and methods.
To achieve this goal, we have conducted clinical and laboratory examination of 100 women with UT from the main group. To compare the state of vaginal microbiota and Trichomonas vaginalis impact on women's genitals, we formed a reference consisting of 20 women. Both the women fom the main and from the reference groups were somatically healthy.
As the material for the study, we used discharge from the vagina and cervical canal, scrapes of the columnar epithelium from the cervical canal. We used clinical and laboratory, bacterioscopic, bacteriological and statistical research methods.
Results and discussion.
The women from the main group had recurrent abnormal vaginal discharge, varied in intensity and character as well as pelvic inflammatory diseases in their history, signs of inflammation of internal genital
organs . In most of the episodes the discharge passed by itself, the treatment was not provided and the syptoms appeared again after regular intervals.
The women in the reference group had no complaints about abnormal vaginal discharge or pelvic inflammatory diseases, which served as a criterion for their inclusion in the reference group.
While studying smears of the women in the reference group, we revealed some lactobacilli. We also found yeast-like fungi of Candida, 102 CFU genus in two women from the reference group (10%).
Trichomonas parasitism on the vaginal mucosa and cervix is characterised by polymicrobial associations with opportunistic microorganisms in 42% of cases, with opportunistic and pathogenic microorganisms in 48%, with pathogenic microorganisms alone in 10% of cases. We can therefore conclude that Trichomonas vaginalis contributes to the progression of sustainable pathological process in the female reproductive organs.
Among opportunistic pathogens that coexisted with Trichomonas vaginalis Candida albicans was found in 34% of cases (p <0,05), S.aureus in 22% (p <0,05), S.epidermidis in 36% (p <0, 05), E. coli in 28% (p <0.05), and they coexisted simultaneously.
Intracellular parasites, which were found, included Chlamydia trachomatis in 26% of cases (p <0,05), Mycoplasma hominis in 16% (p <0,05), Ureaplasma urealyticum in 12% (p <0.05), gram-negative diplococci morphologically similar to gonococcus in 38% of cases.
We have also found simultaneous contamination of the vaginal mucosa and cervical canal by multiple pathogens, in particular, Chlamydia trachomatis coexists with gram-negative diplococci, morphologically similar to gonococcus in 16% of cases.
We found vaginalis, papilloma virus in 6% of women from the main group, herpes virus in 8% of them along with Trichomonas vaginalis.
When analyzing the results of bacteriological and bacterioscopic examination of discharge from the vagina and cervical canal of the women from the main group, the patients can be divided into the following subgroups depending on the microbiota, clinical symptoms, on leukocyte reaction of the female body.
Vaginal discharge of 28 women from the first subgroup (28%) who complained about abundant foamy discharge with an unpleasant odor, abdominal pain, vaginal discharge, contained Trichomonas vaginalis, oportunistic, pathogenic microorganisms and, along with them, a small number of lactobacilli; leukocytes in this case outnumbered the admissible limit, and were, on average, 25-50. Thus, the women from the first subgroup experienced a pronounced inflammation of the vagina with the classical clinical picture.
The second subgroup included 32 women (32%), whose vaginal discharges contained Trichomonas vaginalis, oportunistic microorganisms, rare lactoba-cilli; the number of leukocytes was normal, up to 15. The women of this group complained about minor periodic discharges with an unpleasant odor, moderate
The scientific heritage No 12 (12),2017 aching pain in the lower abdomen. There was no inflammatory response from the female body despite the pathogenic organisms.
The third group consisted of the remaining 40 women (40%), who had Trichomonas vaginalis, opportunistic and pathogenic microorganisms, did not have any lactobacilli; the number of leukocytes in most of them (85%) was not over the accessible limit and amounted to 10-15. The women complained about minor periodic discharges without odor or with unpleasant odor; aching abdominal pain did not depend on the menstrual cycle; 36% of women experienced disorders in their menstrual cycle as long irregular abundant menstruations.
Conclusions.
1. Trichomonads, which are parasitizing on female reproductive organs, promote the development of a mixed protozoal and bacterial process with different degree of vaginal microbial ecology disorder and severity of leukocyte reaction in response to the presence of pathogenic organisms.
2. In 72% of cases urogenital trichomoniasis does not cause leukocyte reaction, even in the presence of other pathogens, indicating a decrease in the immune status due to Trichomonas vaginalis.
3. Pronounced clinical picture of the leukocyte response was observed only in 28% of patients, which complicates timely diagnosis and early treatment of the disease.
4. In case of the disease without lactobacilli and lack of clinical and laboratory signs of inflammation menstrual cycle disorders were observed in 36% of the patients.
References
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