Sexually Transmitted Diseases - I. I. Mavrov 2005

Genitourinary diseases caused by protozoa
Urogenital giardiasis

The disease is reported sporadically. Observations have established that urogenital giardiasis occurs more frequently than previously believed.

Etiology. The CAUSATIVE AGENT OF urogenital giardiasis is Lamblia intestinalis, which belongs to pathogenic Protozoa. The Cell resembles a flattened pear divided along its longitudinal axis by a supporting Structure, the axostyle, into two symmetrical halves. Two nuclei are located in the anterior part of the parasite. The Cytoplasm is homogeneous, devoid of vacuoles, and contains fibrils that perform a supportive function. A disk-shaped sucker depression is located at the blunt end of the flat side, by means of which the lamblia attaches to The surface of the urogenital epithelium. The length of the parasite is 10-20 mpm, and its width is 6-15 mpm. Movement is carried out by four pairs of flagella. Oscillatory or dancing movements are characteristic of lamblia in fresh preparations. Lamblia are relatively rarely detected in urogenital secretions.

Epidemiology. Lamblia intestinalis are quite widespread pathogens and occur very frequently as parasites in humans. Epidemic outbreaks of giardiasis are recorded in winter resorts and other areas where overloaded sewage Treatment plants and contaminated Water supply sources have led to sudden mass outbreaks of giardiasis. Urogenital giardiasis is a relatively rare condition. However, a growing body of evidence indicates an increasing rate of lamblia infection among homosexual men.

Sexual contact is the primary mode of transmission of Lamblia intestinalis among homosexual men (D. William et al., 1979; S. Dritz, 1980). V. Klan et al. (1979) detected this pathogen in 18.3% of homosexual men. Lamblia may be found in the Urinary Tract simultaneously with other microorganisms, including pathogenic protozoa (Trichomonas vaginalis, Entamoeba histolytica). This aggravates the disease course in the Urogenital System and prolongs the duration of the illness. Giardiasis is also diagnosed in homosexual men with AIDS.

Clinical manifestations. Urogenital giardiasis is typically persistent with a high tendency toward relapse. It manifests as urethritis, which most frequently runs a chronic course with relapses of proctitis, affecting the Prostate Gland and Urinary Bladder. Patients complain of mucous urethral discharge, sometimes lower abdominal pain, itching, painful burning in the Urethra and perianal region, a feeling of heaviness in the abdomen, and note maceration (moisture) in the perianal and perineal areas. Due to intense itching, patients scratch the Perineum and external genitalia. Symptoms of the disease can persist for a long time and are refractory to treatment.

Diagnosis is based on the Clinical presentation of the disease and the detection of the parasite in urogenital secretions. Both native preparations and those treated with Lugol's iodine are examined. When prominent symptoms of the disease are present, large numbers of parasites are typically found in the urogenital secretions.

Treatment. Patients are prescribed mepacrine (acridine) orally at 0.1 g 3 times a day for 5 days (after a 3-day break, the course of treatment is repeated), or metronidazole orally at 0.25 g twice a day for 7-10 days (the course of treatment can be repeated if necessary). When indicated, instillations of a 4% mepacrine solution into the urethra and urinary bladder are performed. For women, metronidazole may be additionally administered intravaginally—1 vaginal tablet (0.5 g) every other day for 10 days.

Aminoquinol is also used (orally at 0.12 g 2-3 times a day, 20-30 minutes after meals, in 5-day cycles with 4-7 day breaks; it is recommended to conduct 2 treatment cycles, or 3 if efficacy is insufficient) along with enteroseptol (orally at 0.25 g 2-3 times a day for 2-4 weeks). The latter can be prescribed in combination with sulfonamides.

Furazolidone at 0.1 g 2-4 times a day and delagil at 0.25 g 3 times a day for 7-10 days are recommended. Tinidazole is taken at 0.15 g twice a day for 7 days or as a single 0.5 g dose.

Antibiotics have no detrimental effect on lamblia and may even promote their proliferation.

Prophylaxis of urogenital giardiasis boils down to the timely detection and treatment of patients, sources of infection, close contacts, as well as lamblia carriers.