29.03.2024

Diagnosis of hepatitis C: tests and their meanings

The relatively recent use of molecular tests (detection of antigens and amplification of the nucleic acid) greatly improved the quality of diagnostics of STIs.

Modern laboratory diagnostics has many ways to confirm the diagnosis of trichomoniasis.

Timely and adequately appointed, the analyses contribute to a better control of Trichomonas infection, prevent chronic inflammatory pelvic disease, reduce the risk of infertility associated with trichomoniasis.

Epidemiology

There are 3 species of trichomonads faced by people:

  • oral tenax (elongata);
  • intestinal (hominis or abdominalis);
  • vaginal (vaginalis).

The greatest pathogenicity is Trichomonas vaginalis, a species only found in the urogenital tract. About the possibility to start the pathological process of other trichomonads to the present debate.

Found that T. Tenax inhabits the teeth with caries and T. Hominis is a commensal flora of the large intestine, and sometimes leads to dyspeptic disorders.

Non-protein shell contributes to antibiotic resistance, but is destroyed in the appointment protivoprotozoynoy drugs. After chlamydial and gonococcal infections, trichomoniasis ranks 3rd among all STIs.

Trichomonas vaginalis has 5 flagella, their location provides progressive wave-like motion. Method of transmission – sexual. The pathogen is rarely found in women post-menopausal period and in virgins.

The signs of Trichomonas infection

Specific clinical signs of Trichomonas infection. In acute process contains abundant, irritating the skin, discharge, severe itching of the genitals, a month later, the clinic becomes less pronounced, until complete absence of symptoms and periodicals of their appearance under the influence of precipitating factors.The pathogen is Trichomonas vaginalis, the simplest single-celled pathogen, the highest priest, class of flagellates Flagella, family Trichomonadidae, Trichomonas.

In some patients the symptoms of Trichomonas infection completely absent, asymptomatic carriers, according to various estimates, from 10 to 30% in men in 90% of cases pathology is diagnosed already in the chronic form.

On the basis of some clinical manifestations, the diagnosis is considered to be unverified, a similar pattern can be at many diseases: candidiasis, nonspecific inflammation, venereal disease, etc.

On examination, the patient is taken into account the age, as in more Mature age the immune system weakens, and hence the clinical manifestations may be erased.

Forms of urogenital trichomoniasis

Forms of urogenital trichomoniasis:

  • sharp;
  • subacute;
  • torpid (sluggish).

The infection has passed into the chronic form, requires only 4 weeks to delay specific therapy. Urogenital, Trichomonas can occur as a single infection, mixed or combined forms, it is necessary to consider at carrying out of complex diagnostics.

In recent years there has been a decreasing trend in the incidence in some regions, but the situation is not universal.

Complications of trichomoniasis

Trichomonas often provoke inflammation in the prostate gland that in some cases leads to disruption of fertility. In men trichomoniasis often than in women occurs in the form of a carriage. In this case, the person feels healthy, but can infect a partner. The diagnosis is confirmed by laboratory tests.

According to the study, in patients with chronic inflammatory process in the prostate in 30% of cases diagnosed with concomitant trichomoniasis. In women, these pathogens affect adverse outcomes of pregnancy, infertility and chronic inflammatory processes of pelvic organs.

During childbirth 5% of cases is infection of the child, but due to the peculiarities of the epithelium may occur self-recovery. Intrauterine fetal infection with trichomoniasis can lead to fatal consequences.

The infection may face even girls, whose result can be chronic salpingoophoritis that upon reaching childbearing age is complicated by pathologies of the reproductive system.

Like all sexually transmitted infections, Trichomonas increases the risk of HIV infection through sexual contact with an infected partner, and women more and contribute to the development of cervical cancer, especially in combination with HPV.

How to detect trichomoniasis in men and women?

So, how is it possible to identify trichomoniasis and what are the ways better skomponuem according to numerous clinical guidelines, which are the same type and for Russia, and abroad.

Use four of laboratory method:

  • microscopy of native and stained preparation as the first stage of diagnosis;
  • culture;
  • immunological;
  • genodiagnostics.
PCR-based diagnostics of trichomoniasis

Several factors are identified that influence the sensitivity of laboratory diagnosis. Not always in a single survey it is possible to reliably establish the diagnosis of trichomoniasis. Some experts believe that in the PCR diagnosis, the accuracy is close to 100%, are found false-negative results, the frequency of which about 25%.

The unreliability of diagnosis can affect the indolent infectious process.

According to a comprehensive comparison of efficiency (Crucitti T.) diagnostics various modifications of the method, differing in the primers (DNA target), it is concluded that the level of sensitivity of PCR method – from 53 to 87 %.

It is associated more with technical difficulties and human error, therefore, for the reliability of the diagnosis recommended confirmation of at least 2 diverse tests. Every year is improving the efficiency of the primers, so the question of the effectiveness of PCR-based analysis requires further clarification, to date, a maximum of 95%.

Sometimes the technician may incorrectly interpret the result: in the literature there is evidence that some non-pathogenic flagellate protozoa (Pleuromonas jaculans) or intestinal Trichomonas regarded as pathogenic vaginal Trichomonas.

Cultural and microscopic methods for diagnosing trichomoniasis

There is a provision that the diagnosis confirms discovery of life forms of microorganisms in smears or crops. When taking a banal smear is difficult to obtain the material, because the pathogen is localized in the folds of the cervical canal or in limited inflammatory foci the prostate gland.

Bacteriological examination gives less reliable results in men, as in the discharge of the urethra contains fewer pathogens, and their physical activity is reduced. Diagnostic value of microscopic examination of native discharge from the urethra, compared to the cultural methods of diagnosis ranges from 10-60%, the sensitivity of stained smears about 60%.

Culture method increases the level of diagnosis, but due to incorrect transportation and destruction of pathogens or when a small number of them the accuracy of the result is questionable.

Blood tests for trichomoniasis (immunological methods)

In an alternative diagnosis of trichomoniasis can be considered immunogeneticheskie ways to confirm the diagnosis. Antibodies in the blood is diagnosed with accelerated reaction immunofluorescence.

According to the results of specialists, patients with culturally proven trichomoniasis, antibodies are present in 100% of cases. The disadvantages of the method include the inability to determine the effectiveness of treatment, as a positive result persists for 12 months after recovery.

Since 1985, some hospitals conducted the ELISA test to estimate serum immunoglobulin (IgG) and secretory (IgA). Test positive after previously suffering Trichomonas infection and as nanodiagnostic can not be used without performing bacterial seeding.

Immunological method is considered more specific and sensitive compared with immunofluorescence analysis and reaction of hemagglutination. The research was conducted, the purpose of which was to establish the most effective method of diagnosis among the various modifications of ELISA. The findings showed that the positive result of immunofluorescence analysis are not always confirmed by other methods.

Of the latest methods of diagnosis can be considered for detection of Trichomonas variant of capillary liquid chromatography. The result of the research is prepared for a few minutes, sensitivity 83% and specificity of about 99%.

When diagnosed with “Trich”?

If to summarize all the data of domestic and foreign literature on diagnostic sensitivity for trichomoniasis, the picture looks as follows:

  • PCR 55-95%;
  • culture method – 49-90%.
  • smear microscopy is 30-79%.

Positive results of microscopic examination in the confirmation of any other way to diagnose reliably establish the diagnosis of trichomoniasis.

Sexually active infected women have a high risk of reinfection; therefore, it should be re-screening 3 months after treatment.

Repeated examinations of vaginal discharge in women and prostatic secretions in men with inflammation in the prostate (preferably after a few sessions of massage) improves detection of Trichomonas.

To clarify topical diagnosis additionally, conduct clinical and instrumental examination. In men, transrectal ultrasound examination, in women, ultrasound of the reproductive system.

Mandatory shown screening for HIV, syphilis (DAC), and hepatitis b and C.

Treatment for both partners.

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