Today all women undertaking pregnancy, are required to undergo a series of studies for STDs, even if they only have one permanent partner, and signs of infection and any ailments no. This is due to the wide spread of genital infections among the population, including those in the reproductive age, often asymptomatic and latent course of the disease, and extremely dangerous, heavy and negative influence of these agents on the fetus, pregnancy and subsequent childbirth. Causative agents of genital infections can be not only viral and microbial, but also belong to a special class, such as trichomoniasis. Is a common sexual infection that deserves special attention in the period of gestation.
Trichomoniasis and pregnancy: an unfavorable combination
Among all known sexually transmitted diseases, and dangerous in the period of gestation, should take vaginal trichomoniasis. It is of particular causative agent is Trichomonas Trichomonas vaginalis, belonging to the group protozoa single-celled parasites that actively penetrate into the region of the vaginal mucosa and the urethra (the urethra is in women or men). This is the only protozoan parasite that can infect the urinary organs of both men and women.
Features of trichomoniasis in pregnant women
Trichomonas infection is among the widely and actively disseminated diseases of urogenital and sexually active young people. She is one of the most common diseases of this group.
Who data suggests that trichomoniasis migrates annually to 185 million people. But not all of it has a classic shape and flow, there is a classification of infection that is associated with the specifics of its flow.
According to the medical classification trichomoniasis can have uncomplicated and complicated form. In addition, the duration of infection it could be a fresh infection, which was not more than two months ago, as well as chronic infectionI occurring in the body for months and years.
Fresh infection could be three options:
- acute infection with bright and noticeable symptoms
- subacute course of the disease,
- torpid when it is manifestations, there are only laboratory data of infection.
Causes of trichomoniasis in pregnant women
The main pathogen is the microorganism the simplest class of flagellates (Flagellata). According to the biological classification refers to Trichomonas vaginalis, affects the genitourinary system in men and women, including pregnant. Trichomonas that live in the vagina, have only one stage of development trophozoites, Trichomonas is not a typical cyst formation, which leads to a particularly infected by it. If we consider the parasite in the microscope, is a single cell, bounded from the external environment by a membrane having a pear shaped or oval with the nucleus inside, which is located closer to the part of the body where the Trichomonas has 4 flagella. The parasite is small – 5 to 10 µm, and stained by specific dyes, allowing it to identify in smears, focusing on mobility, form and size of the pathogen.
Over many years of cohabitation with a man, traditional flagellate parasite has learned to disguise by changing the shape of the body – from flagellate to amoeboid form, and simulating blood cells. It may resemble platelet or leukocyte, which leads to certain difficulties in diagnosis.
One of the prerequisites for the survival of the parasite is the presence of a moist environment, which is available in the genitourinary tract. On the background of drying it quickly dies. In conditions of wet surfaces in the environment (walls in the bathtub, toilet seat, basin) can live for several hours, resistant to higher temperatures up to 50°C and above, is not afraid of ultraviolet rays, exposure to antiseptics.
For this infection though and probably household infection, but the percentage of such is very low. Possible infection with the use of common hygiene and wearing underwear, but most of the infected make intimate contact without barrier contraception. Infection during oral and anal intercourse is unlikely.
The mechanism of development of infection in gestation
The penetration of trichomonads on the surface of the mucous membranes of the genitals and urinary tract can cause irritation and inflammation. This gradually leads to degenerative and infiltrative changes of the mucous membranes and underlying tissue in the affected area. Due to its mobility and activity of Trichomonas can be spread from the genital area up to the genital and urinary tract, infecting more and more new departments. In addition, Trichomonas in the presence with them of other types of infections (gonococcus, chlamydia), can absorb and pass along with other around the urinary tract. This forms the result of a chronic inflammatory process in the reproductive organs, which threatens the women in the fallopian tubes adhesion process. It may be threatening ectopic pregnancy or infertility, and if pregnancy occurs with the presence of active infection may harm the fetus.
Manifestations of trichomoniasis: especially in pregnant women
The incubation period from the time the penetration of the parasite into the body before the first signs of infection, ranges from several days to two months. Previously since the end of the incubation period, formed the acute manifestation of the disease with which the woman is usually turned to the doctor. Often it was the pain inside the vagina and a strong intense itching, redness and swelling of the genitals, discomfort with urination. Also was a typical selection of foam nature, with a yellowish or greenish tint and a very unpleasant smell. This was accompanied by the sensation of fat in the pelvic area and the weight of it, frequent stools and urine separation. It was also typical of the General state, with onset of fever and fatigue, severe weakness. The mucous membrane was detected during the inspection of severe redness and swelling and small hemorrhages.
It is important
Today, such manifestations are rare, even among pregnant women. Pathology almost immediately becomes chronic and indolent phase. Approximately half of the women the first signs of infection are possible after six months or more from the moment of infection, including during pregnancy.
Woman in pregnancy against the backdrop of trichomoniasis to mention the pain in the abdomen, with itching, periods of Muco-purulent discharge, frequent urination, discomfort during intimacy. Often the presence of Trichomonas is determined by first study, when a woman turns to the doctor for statement on the account of pregnancy, which complicates the further course of gestation.
The impact of trichomoniasis in pregnancy in the mother’s body
There is evidence that trichomoniasis can lead to various pregnancy complications. Itself pregnancy on the background of chronic inflammatory process is already under question, there is often an ectopic pregnancy, leading to bleeding, rupture of pipes and complications. There is also evidence that in the later stages trichomoniasis provokes premature birth and prenatal rupture of membranes, which leads to the birth of a premature baby with a low body mass and immaturity. Yet ultimately the mechanism of the effect of Trichomonas on amniotic membrane has not been elucidated, there is also the risk of developing postpartum complications endometritis and bleeding.
The impact of trichomoniasis in pregnancy on the fetus
Trichomonas is not able to penetrate through the placenta and infection of the fetus, in connection with which various anomalies of development of infection is unlikely. But with the passage of the baby through the birth canal is possible in 5-10% of neonatal development of defeat, especially it is typical for girls with the formation of vulvitis and vaginitis specific nature. However, the presence of trichomoniasis leads to that possible on the background of other infections and complications.
Due to the aggressive environment that Trichomonas forms inside the vagina, there is a drift of pathogens in the cervix, which is fraught with inflammation of the lower pole of the amniotic SAC and running in the early stages of a miscarriage, and late preterm birth.
It is important
Although the pathogens do not penetrate to the fetus, but they can be carriers of chlamydia and gonococci, extending to the uterine cavity and the child’s body. This is due to the fact that Trichomonas phagocytose these pathogens, not killing them inside.
Analysis of trichomoniasis in pregnant women: normal and decoding
Diagnosis of infection is based on several key points indicate sex with an infected partner or a possible infection with trichomoniasis, in combination with available data of inspection and survey women in the doctor’s office. But confirms the diagnosis analysis at trichomoniasis, undertaken during pregnancy and exposing themselves to pathogens or antibodies to them (as well as a survey partner with the same results).
Shown holding instrumental diagnosis of colposcopy in detection of changes in the cervix and vagina in every length and stage of the disease. In parallel, appointed by ultrasound genitals and fetus to assess the possible influences on him by Trichomonas and other possible pathogens. But the leading role in determining the diagnosis belongs to the laboratory studies.
How is laboratory diagnosis:
- The first step when conducting a pelvic exam, the doctor will fencethe total of smearthat is examined under a microscope (bacterioscopy). To detect Trichomonas, the optimal fence with the posterior fornix of the vagina. Immediate research can determine a reduction of the cilia of Trichomonas and the mobility of the Taurus themselves, which gives preliminary results within 20 minutes. Is the count of the number of pathogens and the reaction of the surrounding tissues according to the level of white blood cells and the inflammatory changes.
The dried stained smear often gives negative results due to loss of mobility and destruction of the pathogen. This leads to possible errors in diagnosis.
- To confirm the diagnosis, need using cultural method is the inoculation of detection of specific flora. Room discharge obtained from the vagina, on nutrient medium, where Trichomonas grow well, allows for counting the number of parasites and to determine their sensitivity to antibiotics. This method helps in the treatment of infection and control.
- The most accurate method of detecting Trichomonas vaginalis is the study of PCRthat identifies the DNA of the pathogen in the material taken. The accuracy reaches 95% and above, the analysis is prepared up to two days. If the results are controversial or questionable, further illustrates the holding of direct immunofluorescence studies, is the identification of antibodies in the blood of pregnant women.
Treatment of trichomoniasis in pregnancy
The primary goal of treatment is complete elimination of Trichomonas vaginalis from the genital tract and urinary tract. The treatment is carried out on an outpatient basis, only in pregnant women with complicated course of disease and serious health problems, hospitalization. The duration of therapy is up to 4 weeks depending on the severity and extent of the lesion. At the same time a woman needs to be treated for her sexual partner to prevent re-infection then, at the time of treatment sex life is allowed only with a condom.
Among the drugs that are used in the treatment of disease, apply imidazole derivative Ornidazole, African, metronidazole and others that are prohibited for use in the first trimester of pregnancy. This is due to their potentially hazardous impact on the fetus. After this period, its application was acceptable for a short period under strict medical supervision. Although less efficient than conventional schemes but with the pregnancy this treatment only reduces the load on the body as the mother, so the fetus.
It is important
In the first trimester systemic therapy replaces only local preparations in the form of a vaginal candles or tablets.
To treatment was the most effective therapy begins with the identification of the pathogen and the parallel survey of the partner and provide treatment for him.
The management of women with trich during pregnancy
If trichomoniasis is identified before birth, then the birth of a child takes place in the observation office, in a separate delivery room. The newborn at risk of infection are thoroughly examined and if necessary treated. All women who have been diagnosed with an infection that is the control smear on flora after treatment. First time smear is performed immediately after the end of therapy, then monthly for three consecutive times. 4 weeks after the end of treatment to investigate antibodies to Trichomonas, determining the effectiveness of treatment.
With early detection of trichomoniasis and its full treatment prognosis for pregnancy and the fetus are favorable, there is complete recovery without any consequences.
Parezca Allen, pediatrician, medical columnist