Clinical and Morphological Diagnosis and Treatment of Sexually Transmitted Infections - Yakimova T. P. 2007

Trichomoniasis. Clinical features and morphological diagnosis of trichomonal infection. Treatment of trichomoniasis

Trichomoniasis is one of the most common Sexually Transmitted Infections. Over 170 million cases of trichomoniasis are reported worldwide every year. Today, trichomoniasis represents a pressing medical, social, and economic issue in many countries globally, including Ukraine. It is associated with atypical pelvic inflammatory disease and Infertility, and poses a particular threat to pregnant women. Women infected during Pregnancy and Childbirth are predisposed to Premature Rupture of membranes, spontaneous miscarriages, and preterm birth. Furthermore, evidence suggests a potential indirect link between Cervical Cancer and trichomonal infection, which promotes epithelial dystrophy, atrophy, and atypia. Like other Sexually Transmitted Diseases, trichomoniasis increases the risk of HIV acquisition by impairing local vaginal Immunity. The causative agents of trichomoniasis are trichomonads, which can facilitate HIV transmission by promoting the local accumulation of the AIDS virus within susceptible Cells of the inflammatory infiltrate (lymphocytes and macrophages) that arise during the infection.

Trichomonads are Protozoa belonging to the flagellate Class, which exist solely in a trophozoite form and do not form cysts. They parasitize mammals, birds, fish, and invertebrates. Human trichomonads are strictly species-specific and do not occur in animals.

Trichomoniasis accounts for over 55% of cases among patients attending venereology clinics. Currently, a significant infection rate is observed across certain population groups, with levels depending on numerous factors such as age, sexual activity, sexual practices, number of partners, coexisting genital tract infections, Phases of the Menstrual cycle, and others. Optimal Diagnosis of trichomoniasis relies on meticulousness and proper conditions in sample collection, laboratory Methods, and related Procedures.

Trichomonads are typically transmitted through sexual contact. However, transmission is also believed to be possible via contaminated towels, instruments, shower room equipment, and other items, as well as through close non-sexual contact. Newborns are infected during delivery from an infected mother.

Three species of trichomonads parasitize The Human Body: Trichomonas vaginalis, Trichomonas buccalis, and Trichomonas intestinalis. Trichomonas vaginalis was first described by the French anatomist A. Donné in 1836, although research into this pathogen did not truly begin until the 20th century. A. Donné (1836) reported that vaginal trichomonads cause urethritis, colpitis, cystitis, Endocervicitis, and bartholinitis in women, and urethritis, balanoposthitis, prostatitis, vesiculitis, epididymitis, and orchitis in men. Trichomonas buccalis (Trichomonas tenax) was discovered by Goodley in 1917 and inhabits the Oral Cavity. Trichomonas intestinalis (Trichomonas hominis) was discovered by Leuckart in 1879, following C. Davaine's observation in the digestive tract in 1860. These are three distinct pathogenic species, and transformation of one species into another does not occur. Since the 1880s, The Study of the Pathogenesis and immunology of this protozoan has utilized molecular biological and immunological methods, leading to the characterization of many of its virulence factors.

In most cases, trichomoniasis proceeds without clearly defined clinical symptoms. Specialists are increasingly concerned about the rising number of untreated asymptomatic cases. For instance, more than 8 million new cases are reported annually in the USA alone, with the frequency of asymptomatic trichomoniasis exceeding 50%.

T. vaginalis is currently referred to as Trichomonas urogenitalis. These organisms are more frequently detected in women with multiple sexual partners, particularly sex workers. Trichomonal infection predominantly occurs in the 20–45 age group, whereas other sexually transmitted infections are more commonly reported among individuals aged 20–29. Newborns infected by their mothers may develop urogenital tract disorders, and the infection rate among young girls ranges from 2% to 17%.

In cases of heavy trichomonal infection, patients exhibit a moderate to pronounced inflammatory response in the urogenital tract. The Metabolic waste products of these pathogens exert toxic effects on host Tissues. Hyaluronidase secreted by trichomonads leads to significant tissue loosening, facilitating the spread of toxic bacterial metabolites and accompanying flora into intercellular spaces, which triggers purulent inflammation, severe dystrophy of both epithelial and inflammatory elements, and their subsequent breakdown.

Although T. vaginalis was discovered over 160 years ago, its pathogenic mechanisms are not yet fully understood. Recent data indicate that intercellular adhesion, hemolysis, and extracellular Proteins are involved in the interaction between the pathogen and host cells. Factors playing a definite role in disease pathogenesis include infection intensity, the pH of the Vagina and other secretions, and the condition of the mucous membranes of the vagina and other PARTS OF THE Urogenital System.

The interaction of trichomonads with the rest of the vaginal microbial flora plays a special role in the pathogenesis of trichomoniasis, as the parasite employs specific mechanisms to evade the host immune system.

The ability of T. vaginalis (urogenitalis) to survive in the vagina remains an enigma. The normal vaginal pH is 4.0–4.5, whereas trichomonads require a less acidic environment with a pH above 5.0. It is also known that elevated vaginal pH levels are observed alongside a concurrent decrease or complete absence of acidophilic lactobacilli and an increased role of anaerobic microorganisms.

It turns out that in vitro, under concentrated pH conditions, lactobacilli do not affect the growth of trichomonads; however, the parasite exerts a harmful effect on them. There are several explanations for this phenomenon: either trichomonads are capable of phagocytosing lactobacilli, much like other microorganisms, or lactobacilli are destroyed by products secreted by the trichomonads.

Trichomonads possess The ability to "bypass" the host immune system. Recently, the mechanisms by which they evade immune surveillance have become clearer. First, trichomonads exploit "niches" characterized by low Complement levels. For instance, cervical mucus is remarkably deficient in complement, and the complement activity of menstrual Blood is half that of venous blood, while in about a third of women, menstrual blood lacks it entirely. Consequently, an increase in trichomonad numbers is observed during this period, allowing the infection to persist post-menstruation. Many trichomonal virulence factors are iron-dependent, which triggers disease exacerbation during this phase. Trichomonads also employ other pathways to circumvent the host immune system. Products secreted by trichomonads can destroy host Antibodies, namely IgG, IgM, and IgA. Furthermore, the pathogens secrete large quantities of highly immunogenic soluble Antigens, the continuous release of which can neutralize antibodies or cytotoxic T lymphocytes that serve as local anti-trichomonal protective barriers.

Consequently, to survive in a constantly changing microenvironment, trichomonads utilize numerous adaptive mechanisms. During menstruation, the vaginal environment undergoes significant alterations driven by an influx of erythrocytes, host macromolecules, and serum, resulting in a shift in pH. The protozoa survive under these exact conditions, and menstrual blood supplies them with iron, a key factor in trichomonal Gene regulation.

The primary diagnostic method for trichomoniasis is Cytological examination through microscopic analysis of discharges and smears from the vaginal and cervical contents. Additionally, biomaterial for Cell/15.html">Microscopy includes secretions from the Urethra, vagina, and prostate, examining both native and stained preparations. In native preparations, trichomonads are motile. Alongside native preparations, samples of the biomaterial are prepared for staining and subsequent microscopic examination. The main staining methods include 1% Loeffler's methylene blue, Gram stain, Romanowsky-Giemsa stain, and Pappenheim stain.

MORPHOLOGICAL Structure OF trichomonads. Trichomonas vaginalis (urogenitalis) is a pear-to-oval-shaped flagellated protozoan ranging from 5 to 30 µm in length. Elongated forms also occur, which is related to the pH of the vaginal environment. The anterior end of the protozoan bears 4 flagella, while a 5th flagellum runs along the posterior surface, tracing the outer edge of the undulating membrane located on one side of The Cell. The undulating membrane extends over about 2/3 of the trichomonad's body. Powered by the flagella and the undulating membrane, trichomonads are capable of active movement and can also migrate via pseudopodia. Pseudopodia can form large, sluggish amoeboid shapes. The almond-shaped Nucleus resembles a plum stone and is located in the anterior part of the Organism, featuring a nucleolus in its center. Anterior to The Nucleus lies the blepharoplast, consisting of four circularly arranged granules. Attached to one of the granules is the axostyle, which runs the entire length of the trichomonad and projects beyond the cell by 1/4 of its length. Digestive vacuoles are present in the Cell Cytoplasm and are clearly visible under microscopy of native and stained micropreparations. Alongside the classical forms, giant specimens of Trichomonas vaginalis measuring up to 50–70 µm with multiple nuclei and flagella have been described, while smaller protozoa measure 5 to 11 µm. In men, particularly during acute infections, small elongated forms with pointed ends are observed. Although Trichomonas vaginalis does not form true cysts, cystoid forms of trichomonads have been reported (Bazarnova M.A. et al., 1991). These are non-motile, flagellum-free forms resistant to therapeutic interventions. Nonetheless, protozoologists deny the existence of true cystoid forms, considering them to be degenerate yet capable of regeneration.

Trichomonads reproduce via direct binary fission into 2 daughter cells, though unfavorable conditions may trigger multiple fission yielding up to 8–24 daughter cells. Trichomonads can simultaneously exist in three forms: flagellated (pear-shaped), amoeboid, and budding.

Amoeboid trichomonads exert a potent proteolytic effect on epithelial and inflammatory cells, damaging fibroblasts and macrophages while suppressing their function.

Budding forms of trichomonads serve as reproductive units; they are small, measuring 1.5 to 4 µm, and lack nuclei and flagella.

Atypical forms of trichomonads also exist, lacking flagella and motility, which complicates their verification.

The optimal conditions for trichomonad survival in the body are a Temperature of 35–37°C and a pH of 5.9–6.5. Strains with weak, moderate, and highly pronounced pathogenicity are distinguished.

Trichomoniasis is exceptionally rare in prepubescent children. It is detected in 10% of women of reproductive age—particularly frequently among gynecological patients—where it often coexists with Gonorrhea, candidiasis, and other bacterial infections. Asymptomatic carriage also occurs. The source of infection is an infected individual or a carrier of vaginal trichomonads. Carriage rates are found in 10–35% of women and 2–16% of men. The disease is typically transmitted sexually. Human infection through swimming pool Water or open bodies of water is impossible due to the pathogen's low resistance to environmental factors. However, the overall state of the organism matters for infection susceptibility, taking into account hormonal factors, somatic diseases, vitamin deficiencies, and others. A crucial role is played by the condition of the functional layer of the vaginal epithelium and its secretory function, as well as its capacity for Glycogen production, which is linked to the woman's estrogen status and vaginal pH. Trichomonad reproduction is optimal at a pH of 5.5–6.0, whereas increased acidity at pH 3–3.5 proves lethal to them.

Women can be infected by men who either display or lack clinical signs of the infection. In men, trichomonads may reside in Littré's glands, the crypts of the Prostate Gland, the Seminal Vesicles, and the urethra.

The presence of trichomonal infection causes purulent exudative inflammation with damage to both the mucous membrane and the underlying Connective Tissue layer of the vagina or other sections of the urogenital tract. There are no disease-specific manifestations, with profuse purulent vaginal discharge being a hallmark of the pathological process.

In Romanowsky-Giemsa or Pappenheim stained preparations, trichomonads are identified most rapidly and reliably. The cytoplasm of trichomonads is pale blue or grayish-blue in color and is frequently vacuolated (see color insert, Fig. 22).

Sometimes the edges of the cytoplasm stain poorly, showing basophilia. The blepharoplast stains pale purple. Microorganisms may be phagocytosed within the cytoplasm of trichomonads, as trichomonads are frequently identified alongside a polymicrobial flora. The Nucleus of the trichomonad stains in various shades of lilac-purple (col. insert, figs. 23 – 25).

The routine method for staining smears for trichomonads in laboratories is staining with a 1% aqueous solution of methylene blue. When stained with methylene blue, trichomonads can sometimes be difficult to identify because they may resemble squamous epithelial cells, particularly if the latter exhibit dystrophic changes with cytoplasmic vacuolization, or if atypical or degeneratively altered pathogens are present.

The Background of the smear typically consists of A large number of leukocytes, occasional eosinophilic granulocytes, histiocytes, macrophages, and a few superficial squamous epithelial cells with pronounced dystrophic changes.

When writing the Conclusion on the COMPOSITION OF THE biomolecule/biomaterial, it is necessary to indicate all the flora present in the smear, characterize it—specifying the type of flora, its quantity, and the intensity of infection—and note any phagocytosis in neutrophils, as this serves as Evidence of the pathogenicity of the microflora.

It is also essential to thoroughly describe The Nature of the exudate, which makes it possible to assess the acuteness and severity of the pathological process, and to prescribe correct, multifactorial, and staged pathogenetic Treatment.

TREATMENT OF TRICHOMONIASIS

Urogenital trichomoniasis frequently proceeds as a mixed protozoan-bacterial disease involving multiple foci of the urogenital tract in the inflammatory process. Consequently, it is advisable to use combination therapy in the treatment of this condition. In addition to protistocidal drugs, Antibiotics, immunotherapy, vitamin therapy, biogenic stimulants, etc., are employed. Local treatments are also widely used: washing and instillation of the urethra in men, vaginal douches and wipes in women, and so forth. The primary principle in treating trichomoniasis, as with other diseases, is an individualized approach. Along with studying the patient's Anamnesis and the results of a comprehensive examination, it is necessary to take into account the sexual history, the number of partners, and sexual contacts for active treatment and subsequent follow-up. Dispensary observation of patients who have had trichomoniasis should be carried out for at least 2 months in men and at least 2 menstrual cycles in women. If the source of the disease is unknown, dynamic medical monitoring of individuals who have suffered from urogenital trichomoniasis is performed for 6 months with monthly blood tests for classical serological reactions. This period is necessary for the Prevention and timely detection of Syphilis, given that the drugs used to treat trichomoniasis also possess treponemicidal activity.

A rapid and vigorous effect on the trichomoniasis pathogen will not be as effective without boosting the body's defense mechanisms and combating the concomitant microbial flora. Such a comprehensive approach increases the body's reactivity and improves the therapeutic efficacy of medications. To avoid "cultivating" strains of *Trichomonas vaginalis* that have low sensitivity to protistocidal agents, treatment must be carried out strictly as prescribed by a physician.

During the treatment of trichomoniasis, patients should strictly abstain from alcoholic beverages. Alcohol impairs the Liver's detoxification function and delays the METABOLISM of medicinal substances. When prescribing treatment, especially to pregnant women and nursing mothers, the side effects of the medications used must be taken into account.

When treating mixed gonococcal-trichomonal infections in a hospital Setting, it is advisable to initially administer protistocidal agents together with immunotherapy, followed by antibiotics.

There is evidence that under The Influence of drugs of the imidazole group, certain trichomonads release paracostal granules containing Proteolytic Enzymes that inhibit metronidazole. This is a kind of defense mechanism: in response to the drug's action, enzymes that inhibit it are released into the extracellular environment. This mechanism is specifically associated with The Emergence of resistance in trichomonads to imidazole group drugs, which must be taken into account during treatment. In such cases, it is advisable to administer a treatment regimen that ensures an excess concentration of the drug in a single dose (so-called burst therapy or flash therapy)—that is, creating a drug concentration that exceeds the inhibitory capacity of the enzymes in the trichomonads' paracostal granules. To achieve this, clinical practice often utilizes a single dose of trichopol (metronidazole) at 2.25 g.

Tinidazole (fasigyn, triconidazole, etc.). Similar in structure and action to metronidazole. Prescribed orally in 0.5 g tablets. Tinidazole administration regimens: 1) a single dose of 2 g (4 tablets); 2) 0.5 g every 15 minutes for 1 hour. Contraindications are the same as for metronidazole: pregnancy and breastfeeding, blood disorders, and active CNS diseases. Alcoholic beverages must not be consumed during treatment. Blood tests must be performed before and during treatment. The administration of tinidazole at 500 mg orally every other day and 500 mg intravaginally every other day for 14 days yields good results.

Ornidazole (tiberal). Exhibits antiprotozoal and antibacterial activity. Unlike other imidazole derivatives (such as metronidazole), it is compatible with alcohol (does not inhibit acetaldehyde dehydrogenase). Taken orally after meals. For trichomoniasis: 1 tablet in the morning and evening for 5 days; for children, a single dose of 25 mg/kg of body weight per day. It is the drug of choice in the treatment of metronidazole- and tinidazole-resistant and so-called "altered" forms of trichomonads.

Secnidazole. By interacting with DNA, it causes disruption of its helical structure and strand breaks, inhibits nucleic acid synthesis, and leads to the death of bacterial and protozoal cells. Taken orally immediately before meals: for urethritis and vaginitis, a single 2 g dose.

Nimorazole (naxogin). Possesses antiprotozoal activity. Disrupts the Introduction/20.html">DNA Structure of susceptible microorganisms (protozoa).

Bactericidal against certain protozoa, including trichomonads and anaerobes such as *Bacteroides* species. Penetrates well into various Organs, tissues, and biological fluids (including vaginal secretions and urine).

Administration and dosage: simultaneous treatment of sexual partners is carried out. Adult dosages are 500 mg twice daily for 6 days or 2 g once daily for 1–2 days. Following the completion of the course and bacteriological cure, Clinical symptoms of the disease may persist for several days.

Nifuratel (macmiror). Exerts antibacterial, antiprotozoal, and antifungal effects. Highly effective against trichomoniasis, acting on the concomitant bacterial and fungal flora that sustains inflammation in vaginitis. Enhances the antifungal effect of nystatin. Taken orally. For vaginal infections: 200 mg 3 times a day after meals. For children: 10 mg/kg/day in 2 divided doses daily. For Urinary Tract infections: orally, adults at a total daily dose of 600–1200 mg, children at 10–20 mg/kg/day (in 2 divided doses); course duration is 1–2 weeks.

Tergynan. Possesses trichomonacidal, antifungal, antibacterial, and anti-inflammatory properties. Administered as 1 vaginal tablet at bedtime. After moistening the tablet in water for 20–30 seconds, insert it deeply into the vagina, then lie down for 10–15 minutes. The average duration of continuous treatment is 10 days. One vaginal tablet contains 200 mg of ternidazole, 100,000 IU of nystatin, 100 mg of neomycin sulfate, and 3 mg of prednisolone sodium metasulfobenzoate.

Nitazole (aminitrazole, tricholaval, etc.). A greenish-yellow crystalline powder, practically insoluble in water and sparingly soluble in alcohol. Used for the treatment of both acute and chronic trichomoniasis in women and men.

Treatment for women is initiated immediately after the end of the current menstruation. The external genitalia and vagina are cleared of mucus using a tampon moistened with a 1% sodium bicarbonate solution. The vagina is then douched with the same solution. Afterward, a vaginal suppository containing 0.12 g of nitazole is inserted into the vagina. The Procedure is repeated every 8–12 hours. Simultaneously, 1 tablet (0.1 g) is prescribed orally 3 times a day for 15 days. The course of treatment consists of 2–3 cycles, each comprising 15 days of local procedures and 15 days of oral tablet administration.

Local treatment in women can also be performed using a 2.5% nitazole suspension or nitazole in the form of an aerosol foam. In a gynecological clinic setting, the external genitalia, vaginal walls, fornices, and cervix are wiped with a tampon moistened with a 1% sodium bicarbonate solution, followed by another tampon moistened with a 2.5% nitazole suspension. The external opening of the urethra and the rectum are treated with a subsequent tampon moistened with the same suspension. A tampon soaked in the nitazole suspension is inserted into the vagina and removed after 8 hours. At home, the patient performs a douche with a 1% sodium bicarbonate solution at night, and then inserts a vaginal suppository containing 0.12 g of nitazole into the vagina before sleeping. Local treatment with nitazole is combined with oral administration According to the methodology and dosage described above. When using aerosol cans, the safety cap is removed, the nozzle is attached, its free end is inserted into the vagina, and the Base of the nozzle is pressed. A single press releases approximately 1.5 g of foam. Approximately 1.5 g of foam is also applied to the external urethral orifice and the rectal mucosa. These manipulations are performed twice a day, morning and evening.

Treatment for men involves prescribing 0.1 g tablets 3 times a day for 15 days. The course of treatment consists of 2–3 cycles of 15 days each, with an interval of 1–2 weeks.

Nitazole is generally well tolerated by patients, although some may experience headache, nausea, malaise, or frequent urination.

Upon reducing the dose or discontinuing the drug, the aforementioned symptoms disappear.

Trichomonacid. A yellow or brownish-yellow amorphous powder. Soluble in water, practically insoluble in alcohol. Exhibits high activity against trichomonads. Used for the treatment of urogenital trichomoniasis in women and men. The drug is administered topically and orally. Orally, it is given at 0.1 g 3 times a day after meals for 3–5 days. Simultaneously, in men, urethral instillations with a 1% trichomonacid solution are performed for 10–15 minutes (10 ml of solution) over 5–6 days. The course of treatment can be repeated after 10–20 days. In women, vaginal suppositories of 0.05 g are prescribed concomitantly with oral administration at night, following vaginal douches with a 2% boric acid solution. Treatment is carried out for 3 menstrual cycles, starting after the end of menstruation.

In large doses and high concentrations, trichomonacid has an irritating effect on mucous membranes. In women, after the administration of suppositories, discomfort and profuse vaginal discharge may occur, which disappear after discontinuing the drug or reducing the dose. In men, heavy urethral discharge may appear. In such cases, instillations are temporarily suspended.

Octylin. The active substance of the drug is noctyl alcohol. Available in 1% and 3% emulsions. It is a homogeneous, whitish, thick mass with a specific pungent odor that separates upon storage. After cleansing the walls of the vagina, its fornices, and the cervix from mucus, the cervical canal is smeared with a 3% octylin emulsion, and a cotton swab moistened with the same emulsion is inserted into the vagina. A second dry swab is inserted on top. After removing the speculum, the external genitalia, the perianal area, and the Perineum are wiped with cotton wool moistened with a 3% octylin emulsion. The external opening of the urethra and its initial part are treated with cotton wool soaked in a 1% octylin emulsion. After 8–10 hours, the patient removes the swabs. The first course of treatment consists of 14 daily procedures. Subsequently, 2–3 repeated courses are carried out, lasting 7 procedures each, administered daily, starting 2–3 days after the end of menstruation.

Currently, strains of urogenital trichomonads resistant to metronidazole preparations have emerged. This is facilitated by self-medication or untimely simultaneous treatment of sexual partners, when the infection is not completely eradicated, and its transmission occurs against the background of a low drug concentration. As a result, a therapeutic concentration of the drug is not achieved, allowing individual protozoan organisms to survive the treatment. Under these conditions, a disease relapse is caused by urogenital trichomonad strains that cannot be eliminated by the dosages usually prescribed for treating a patient with trichomoniasis. In such cases, it is necessary to increase the dosage of protistocidal drugs, although treatment still does not always yield positive results. Therefore, other medicinal agents must be sought to affect strains of urogenital trichomonads resistant to previously used protistocidal drugs.

In cases of trichomoniasis relapses and unsuccessful treatment with metronidazole and tinidazole, arsenic preparations are used.

Novarsenol. A yellow powder, readily soluble in water, containing 19–20% arsenic. Novarsenol is one of the main representatives of organic arsenic preparations possessing chemotherapeutic activity against protozoa. The Mechanism of the therapeutic action of arsenic preparations lies in their ability to block sulfhydryl (thiol) enzyme systems of protozoa, thereby disrupting their metabolism. Novarsenol is available as a powder in sealed ampoules of 0.15 g, 0.3 g, 0.45 g, and 0.6 g. Before use, the ampoule is carefully inspected, because if there are the slightest cracks or caking of the powder, such a drug must not be used. Novarsenol is dissolved in 5 ml of distilled water and administered immediately intravenously, very slowly over 1–2 minutes. The drug must be administered 2 hours after a meal, with a recommendation for a subsequent meal 2 hours after receiving the injection. Before infusing novarsenol, the patient's temperature is measured, because if it rises above 37°C, the drug should not be administered. The drug is injected at 0.15 g daily for 2 days. In women, it is advisable to simultaneously conduct local treatment with one of the drugs chosen by the attending physician.

Contraindications for The Use of novarsenol include: pregnancy, individual intolerance, childhood and age over 50 years, acute infectious diseases, acute gastrointestinal diseases, gastric and duodenal ulcer, cardiovascular diseases, Kidney and liver diseases, Diabetes Mellitus, anemia, Diseases of the Central Nervous system, and acute inflammatory Skin diseases. During the infusion of novarsenol, a nitroid crisis may develop, resembling poisoning with nitro compounds in its symptomatology: flushing and puffiness of the face, dyspnea, chest pain, sometimes urticaria, vomiting, etc. If this complication occurs, the infusion is stopped, and the patient is injected intramuscularly with 1 ml of a 0.1% adrenaline solution and 1 ml of a 10% caffeine-sodium benzoate solution. Fever may develop on the 7th–15th day after the first infusion (“9th-day syndrome”) accompanied by elevated temperature, headache, joint pain, meningeal phenomena, and erythematous rashes. Sometimes hemorrhagic encephalitis, salvarsan dermatitis, polyneuritis, jaundice, and hepatitis develop.

Myarsenol. Contains 18.2–19.2% arsenic. Available in ampoules in the same dosage as novarsenol. The contents are dissolved in 2 ml of sterile water for injection and administered intramuscularly to a depth of 5–6 cm into the upper outer quadrant of the buttock. The injections are sharply painful, which is why it is advisable to dissolve the drug in a 1% novocaine solution (2 ml). The doses are the same as for novarsenol.

Osarsol. A white crystalline powder, odorless, very sparingly soluble in alcohol, soluble in sodium bicarbonate and ammonia solutions. Contains about 27% arsenic. It is a good trichomonacidal agent. For the treatment of trichomonal colpitis, vaginal suppositories are used: 1) osarside, containing 0.25 g of osarsol and 0.3 g each of boric acid, glucose, and sulfamide; 2) osarbon, containing 0.25 g of osarsol and 0.3 g each of boric acid and glucose. In addition, a powder containing 0.25 g each of osarsol and boric acid can be used locally. The powder is evenly rubbed into the vaginal walls using vaginal specula. The procedure is repeated twice a week. A course of treatment consists of 4–6 rubdowns. Furthermore, in men, 3-day courses of oral treatment with osarsol at 0.25 g 3 times a day 1 hour before meals are used. The treatment course is 3 days, with a total course dose of 2.25 g of osarsol.

For the treatment of trichomoniasis, nitrofuran derivatives can also be used. Chemically, these compounds are characterized by the presence of a nitro group -NO₂ at position 5 and various substituents at position 2 of the furan nucleus. Nitrofuran derivatives are effective against gram-positive microbes, as well as certain large Viruses and trichomonads. In A number of cases, nitrofuran preparations inhibit the growth of microorganisms resistant to antibiotics, which is very important in the treatment of mixed gonococcal-trichomonal, trichomonal-mycoplasmal, and trichomonal-chlamydial infections of the urogenital tract. Depending on their chemical structure, individual compounds of this series differ somewhat in their spectrum of action. Thus, furazolidone, which has an oxazolidone nucleus in its side chain, is most effective against gram-negative microbes and trichomonads. Furadantin and furagin, which contain an aminohydantoin nucleus in their side chain, are particularly effective in urinary tract infections.

Furazolidone is a yellow or greenish-yellow powder, odorless, with a slightly bitter taste. Practically insoluble in water, very sparingly soluble in alcohol. It is prescribed at 0.1 g 3–4 times a day, 15–20 minutes after meals. The course of treatment is about 10 days. The drug is well tolerated by patients, although nausea, vomiting, and allergic rashes are possible in some cases. It is contraindicated in severe Heart, liver, and kidney diseases.

Furadantin is a yellow or orange-yellow bitter-tasting powder, practically insoluble in water and alcohol. It is prescribed at 0.1–0.15 g 4 times a day in 7-day courses. The drug is well tolerated by patients, although a decrease in appetite, nausea, and sometimes vomiting are possible in some cases. To prevent these phenomena, it is necessary to wash down the drug with plenty of water. If side effects appear, it is advisable to reduce the dose of the drug and prescribe antihistamines (diphenhydramine, pipolfen) and Vitamins (thiamine bromide, nicotinic acid). Furadantin, like other nitrofurans, is not recommended to be administered simultaneously with nalidixic acid (neggram), as this reduces their antibacterial effect.

Furagin is a yellow or orange-yellow odorless, bitter-tasting powder, practically insoluble in water and alcohol. It acts on microorganisms that are resistant to antibiotics, which is very important in mixed gonococcal-trichomonal infection when gonococcal strains produce penicillinase. The drug is taken after meals at 0.1–0.15 g 3 times a day for 7–10 days. The drug is also effective when used topically in the form of urethral irrigations with a 1:13000 solution in isotonic sodium chloride solution. Vaginal douching is performed with the same solution. Side effects from the use of furagin are the same as with other nitrofuran drugs.

Derivatives of 8-hydroxyquinoline possess antibacterial, antiparasitic, and antifungal activity, which is very important in the presence of a mixed trichomonal infection with gonorrhea, candidiasis, chlamydiasis, and mycoplasmosis. Compounds having halogen substituents (chlorine, bromine, iodine) at positions 5 and 7 of the quinoline nucleus have become widespread.

Enteroseptol exerts an antibacterial and antiprotozoal (trichomonal colitis) effect. It is well suited for use in cases of antibiotic intolerance in patients with gonococcal-trichomonal infection, as well as in chronic Ulcerative Colitis caused by intestinal trichomonads. It is contraindicated in neuritis, impaired liver and kidney function, and iodine allergy. It is available in 0.25 g tablets. It is used at 2 tablets 3 times a day after meals for 10–12 days. Each tablet also contains 0.025 g of cetyltrimethylammonium bromide, a surface-active and antiseptic substance that enhances the antibacterial effect and promotes better distribution of the drug over The surface of the intestinal mucosa. The drug is practically unabsorbed from the gastrointestinal tract and is regarded as a topically acting agent.

Nitroxoline. A yellow-green powder, practically insoluble in water. It exerts an antibacterial and antifungal effect. The drug is often effective when the microflora is resistant to other antibacterial agents. It is prescribed at 0.1 g 4 times a day during meals (to avoid dyspeptic symptoms) for 2 weeks. If necessary, repeated courses are carried out with a 2-week interval.

Aminoacrichine must be classified among antiparasitic agents. It is a reddish-orange odorless powder, slightly hygroscopic. Soluble in water and alcohol. Used in the treatment of trichomonal colpitis topically in the form of a paste: a 2% paste at 5 g is administered into the vagina once every 3 days, preferably on a tampon, for a total of 8 Applications. The course of local treatment can be repeated over 3 menstrual cycles, starting immediately after the end of menstruation. Orally, aminoacrichine is prescribed at 0.1 g 3 times a day for 5 days simultaneously with or after the completion of the first local application of the drug. During repeated courses of local treatment, the drug is not prescribed orally. When applied topically, irritation of the vaginal mucosa may be observed: epithelial desquamation, serosanguineous discharge, edema of the genitalia; a short-term increase in body temperature is sometimes possible. In the presence of side effects, treatment is temporarily discontinued, and the painful symptoms disappear spontaneously. The drug is not prescribed orally in gastritis and PEPTIC ULCER DISEASE. Local application of aminoacrichine is contraindicated in senile atrophic changes of the vaginal mucosa.

Considering that urogenital trichomoniasis usually proceeds as a mixed bacterial-protozoal infection, simultaneously with protistocidal agents, it is often necessary to prescribe antibiotics, which are used according to the treatment regimen for the gonococcal process.

In the combination of trichomoniasis and chlamydiasis or mycoplasmosis, tetracycline antibiotics are used. Different Tetracyclines differ from one another in the characteristics of their antimicrobial action, absorption rate, and elimination from the body. Tetracyclines are well absorbed and rapidly penetrate many organs and tissues. They are excreted from the body in urine, feces, and partially in Bile. They are excreted through the Kidneys by Glomerular Filtration; when excretory renal function is impaired, The excretion of tetracyclines worsens, their blood level rises, which can lead to cumulation phenomena. The antibacterial action of tetracyclines is manifested by their suppression of microbial cell Biosynthesis at the ribosomal level. Due to the commonality of the action of tetracyclines on microorganisms, cross-resistance to the drugs develops. Tetracyclines easily cross the placental barrier, which must be considered when treating pregnant women. Tetracyclines form poorly soluble complexes with calcium, iron, magnesium, and aluminum ions; therefore, when prescribing tetracyclines, milk and dairy products must be excluded from the diet, and the ionic composition of prescribed medications must be taken into account. Poorly soluble complexes of tetracyclines with calcium preparations form dark-colored deposits in dentin and tooth enamel, which is why it is inadvisable to use these drugs in children under 8 years of age, as well as in pregnant women.

Among antibiotics used in mixed infections, tetracycline preparations, Penicillins, macrolides, and fluorinated quinoles have proven themselves well.

✵ penicillins: ampicillin, amoxicillin;

✵ tetracyclines: doxycycline, methacycline;

✵ macrolides: azithromycin (sumamed), josamycin (vilprafen), roxithromycin (rulid), midecamycin (macropen), spiramycin (rovamycin), erythromycin;

✵ fluoroquinolones: ciprofloxacin (ciprobay, quintor, etc.), norfloxacin (norbaktin, nolicin, etc.), ofloxacin (tarivid, etc.), pefloxacin (abactal, etc.).

Tetracycline is a yellow, odorless, bitter-tasting powder, sparingly soluble in alcohol, slightly soluble in water. In gonococcal-trichomonal infection, tetracycline preparations (chlortetracycline, oxytetracycline, tetracycline hydrochloride) are prescribed after protistocidal therapy. For the first 2 days, 0.3 g is given, and on subsequent days, 0.2 g 5 times a day with a night interval of no more than 7–8 hours. The course dose is up to 10 g. In the presence of chlamydiasis or mycoplasmosis, however, tetracyclines are prescribed in maximum doses—up to 2 g per day at equal administration intervals, for 10–15 days. In such cases, the course dose of tetracycline preparations can reach 30 g. To avoid The Development of candidiasis, tetracycline preparations are prescribed together with nystatin or levorin: nystatin is prescribed at 500,000 IU 4 times a day for up to 10 days, and levorin at 250,000 IU 3 times a day.

Methacycline hydrochloride (rondomycin, methacycline) is a semisynthetic derivative of tetracycline. It is active against most gram-negative and gram-positive microorganisms, Chlamydia, and certain protozoa. It is better absorbed into the bloodstream and maintains concentrations lethal to microbes for a longer duration. It crosses the placental barrier and is excreted primarily through urine and bile. The recommended dosage is 0.3 g 2 to 3 times daily at equal intervals.

In the absence of treatment efficacy or in the event of a relapse, repeated treatment courses should be administered, while avoiding the repeated use of the exact same protistocidal agent. A different medication should be prescribed 2 to 3 weeks after the initiation of treatment.

For acute, subacute, or uncomplicated trichomoniasis, etiotropic therapy alone is generally sufficient for a cure. In torpid and chronic trichomoniasis, impaired vascularization followed by scar tissue development in the affected organs prevents protistocidal agents from penetrating the lesions in sufficient concentrations to suppress the parasites, thereby leading to drug resistance in urogenital trichomonads. Therefore, for these Clinical forms of trichomoniasis, treatment should not be limited to protistocidal drugs alone; a comprehensive, combined approach is required, including agents that stimulate the body's reactivity.

Specific immunotherapy options include the anti-trichomonal vaccine. However, it has not proven to be an effective treatment due to The complexity of its preparation and administration, frequent allergic reactions in patients, and a low cure rate. Nonspecific immunotherapy stimulates the body's nonspecific defense mechanisms, enhances the efficacy of protistocidal drugs, and facilitates the resolution of infiltrates and scars. It is administered concurrently with protistocidal therapy. Pyrogenal has demonstrated good efficacy; it is administered every other day, starting at 25–50 MLD (mean pyrogenic dose). The maximum single dose should not exceed 1000 MLD. A full course consists of 25–30 injections. The dose that induces a body temperature elevation to 37–38°C is repeated on subsequent days until hyperthermic reactions cease, after which the dose is progressively increased. If necessary, pyrogenal treatment can be extended for at least 2–3 months. Sensitivity to pyrogenal is determined by the degree of temperature elevation and changes in leukocyte count (leukopenia in the first hours post-injection, followed by leukocytosis after the febrile reaction subsides). Typically, the patient experiences a mild fever accompanied by slight chills and mild malaise following the injection, which may last from 3 to 8 hours.

The Solトリcho-vac (Solco-Trichovac) vaccine has shown promising results. Administration of the vaccine normalizes vaginal pH, thereby restoring normal vaginal microflora by displacing pathogenic microorganisms. The vaccine provides a long-lasting protective effect, preventing reinfection with trichomonads and other nonspecific microorganisms. It is contraindicated during pregnancy. Administered intramuscularly, the primary immunization consists of 1 dose (0.5 ml) given in 3 injections at an interval

of 2 weeks; revaccination involves a single 0.5 ml dose after 12 months. To prepare the vaccine, sterile solvent must be injected into the vial containing the lyophilizate. A single vaccine dose contains 7.5 × 10⁹ inactivated lyophilized microorganisms of the *Lactobacillus acidophilus* strain.

To treat concomitant fungal flora, clotrimazole is successfully used as a topical treatment, possessing a mild anti-trichomonal effect as well. In combination with anti-trichomonal drugs, local treatments such as pimafucin, nizoral, polyginax, batrafen, and mifungar can be utilized. For women, Klion-D (a preparation containing metronidazole and the antifungal agent miconazole) and terzhinan are available in the form of vaginal tablets.

Currently, oral medications such as lamisil, orungal, nizoral, and diflucan are widely used. However, traditional polyene antibiotics (nystatin, levorin) for fungal infections should not be overlooked. Treatment of a concomitant fungal infection must be initiated simultaneously with trichomoniasis therapy.

Autohemotherapy involves the intramuscular injection of the patient's own blood in doses ranging from 3 to 10 ml at intervals of 2 to 3 days, with a course of 7 to 10 injections. It is particularly indicated in cases of trichomonal epididymitis and prostatitis accompanied by pain.

Lactotherapy involves the intramuscular injection of fresh cow's milk, freshly boiled in a test tube, extracted from the center of the tube, and cooled to 35–36°C. It is administered intramuscularly every 2–3 days, starting at 2–3 ml and gradually increasing the dose to 7–10 ml, with a course of 6–8 injections.

Levamisole (Decaris) is used as an active immunostimulant. The drug restores altered T-lymphocyte and phagocyte Functions, as demonstrated in isolated cells from healthy and diseased individuals. Due to its thymomimetic effect, levamisole regulates the cellular mechanisms of The Immune System. It selectively stimulates the regulatory function of T-lymphocytes. Additionally, it acts as an immunomodulator capable of enhancing a weak cellular Immune Response, dampening an overactive one, and leaving a normal response unaffected, making it suitable for treating refractory forms of trichomoniasis. It is prescribed at 150 mg taken with meals twice a week for a total of 6 doses. Alternatively, levamisole can be administered using another regimen: 150 mg for 3 consecutive days, followed by a 7-day break, after which the cycle is repeated.

To enhance the body's immune reactivity, thymalin (10 mg intramuscularly daily for 5 days) or prodigiosan (5–10 mcg in isotonic sodium chloride solution administered intramuscularly once every 4 days) may also be prescribed.

In the presence of infiltrates and scars in the urethra and accessory sex glands, hyaluronidase preparations are particularly indicated. These include lidase and ronidase. Hyaluronidase, or the "spreading factor," causes The breakdown of hyaluronic acid, one of the cementing substances of connective tissue. Hyaluronidase enhances tissue permeability and facilitates fluid movement within intercellular spaces. Lidase is derived from bovine Testes and is available in vials containing 64 IU. Before use, the Contents of the vial are dissolved in 1 ml of a 0.5% novocaine solution. The lidase solution is administered subcutaneously at 64 IU daily, with a course of 10 to 15 injections. Ronidase is a topical hyaluronidase preparation available in vials containing 5 and 10 g of the active substance. A 1–1.5 g amount of ronidase powder is dissolved in 5 ml of sterile isotonic sodium chloride solution, used to moisten a turunda, which is then inserted into the urethra via a urethroscope tube for 1.5–2 hours and removed during urination. Such procedures are performed daily for 15 days.

Methyluracil, pentoxyl, potassium orotate, and similar agents are classified among drugs that stimulate cellular and humoral defense factors, exert anti-inflammatory effects, accelerate the resolution of inflammatory conditions in the urogenital tract, and improve cellular regeneration.

Biogenic stimulators capable of exerting a stimulating effect on the body and accelerating regenerative processes include aloe extract, FiBS, Placenta suspension and extract for injections, vitreous body, and others.

As previously noted, some patients continue to experience so-called post-trichomonal inflammatory symptoms even after successful etiological cure of trichomoniasis, which necessitates local treatment for resolution. Combined with high doses of tetracycline-class antibiotics, this therapy proves effective. Careful investigation has revealed that these so-called post-trichomonal processes were actually Chlamydia or Mycoplasma infections of the urogenital tract.

Treating trichomoniasis with protistocidal agents in combination with proteolytic enzymes achieves a positive clinical outcome in 98.1% of cases, compared to 88% without enzymes.

Given the high concentration of imidazole drugs in bile, the simultaneous administration of choleretic agents (e.g., allohol), hepatoprotectors (essentiale, karsil, etc.) is fully justified, particularly in individuals with various functional Disorders of the Liver and biliary tract.

Local treatment. In fresh, uncomplicated trichomonal infections, local treatment is unnecessary as systemic therapy is sufficient to eliminate inflammation. For torpid fresh inflammatory processes and chronic forms of trichomoniasis, local treatment is prescribed, typically beginning with urethral irrigation using potassium permanganate solutions; the more severe the process, the lower the concentration of these solutions should be. A large volume of irrigating fluid washes away the infectious agents, while potassium permanganate disinfects the urethra. If the infection is localized to the anterior urethra, anterior irrigations are prescribed; in cases of posterior urethritis, deep irrigations are performed. The water used for urethral irrigation must be boiled and kept between 37°C and 45°C. Warm solutions are better tolerated by patients and facilitate the relaxation of the external sphincter, allowing the solution to enter the bladder. The working solution is prepared from a 1% potassium permanganate stock solution: to obtain a 1:10,000 solution, 10 ml of the stock solution is added per 1 liter of water. Clinical practice commonly utilizes solutions of 1:12,000, 1:10,000, 1:6,000, etc. Irrigations are performed once daily. If urethral discharge persists despite irrigation with the aforementioned solution, the solutions should be changed and alternated. For this purpose, solutions of oxycyanide of mercury (1:10,000 to 1:7,000), furacilin (1:5,000), silver nitrate (1:4,000), zinc sulfate (1:4,000), hibitane (chlorhexidine) (1:1,000), ethonium (1:1,000), and others are used.

Topical treatment also includes urethral instillations with silver nitrate solutions every other day at a 0.25–0.5% concentration, protargol at 2%, or collargol at 1%. If urethroscopy reveals a soft infiltrate following post-trichomonal urethritis—which occurs in approximately 60% of cases—active local treatment must be initiated. This involves urethral blockade every other day followed by instillation of the aforementioned solutions. If the resolution of the infiltrate is delayed, Vashkevich urethral tamponade following preliminary bougienage is advisable. Tamponade is performed using rosehip oil, sea buckthorn oil, or glycerin pre-mixed with trichopolum powder. Daily urethral tamponades performed without prior bougienage using the following formula yield good results: 50% DMSO solution (10 ml), trichopolum (1 g pre-dissolved in 1 ml of distilled water), and glycerin (5 ml). The number of procedures ranges from 5 to 7. For transitional and hard urethral infiltrates, active nonspecific immunotherapy combined with physical therapy must be administered alongside the aforementioned local treatments.

For urethral adenitis, massage over a bougie is performed, along with Vashkevich urethral tamponade every other day alternating with instillations and irrigations, supplemented by physical therapy such as genital diathermy. Occasionally, diathermocoagulation of individual urethral glands is required. Urethral strictures are gradually dilated—without causing patient pain—using bougies of increasing diameter, followed by silver nitrate solution instillations, combined with nonspecific immunotherapy. Instead of glycerin, it is advisable to use 1% hydrocortisone ointment to lubricate the bougies during stricture dilation, followed by the insertion of a turunda soaked in 10 ml of a 30% DMSO solution containing 25 mg of a hydrocortisone suspension (1 ml of hydrocortisone acetate). To this same volume of DMSO, 64 IU of lidase or 40 mg of methylprednisolone (Medrol, Urbason) can be added. Hydrocortisone ointment may be substituted with Sinaflan.

Local treatments for prostatitis also include microclysters with a 2% calcium chloride solution, to which up to 5% amidopyrine can be added if pain is present. The microclyster should be administered at a temperature up to 47°C in a volume not exceeding 30 ml, 3 to 4 times a day. Mud packs, warm sitz baths, and rectal suppositories containing analgesic and anti-inflammatory agents are indicated. The injection of a mixture of antibiotics and corticosteroid Hormones into the prostate parenchyma, as proposed by some authors, is considered inadvisable because glucocorticoids induce Atrophy of the prostatic parenchyma. This local therapy is administered against the backdrop of aggressive nonspecific immunotherapy.

It is advisable to prescribe high doses of vitamin B₁ to patients with trichomoniasis, as evidence suggests it acts as an antagonist to trichomonads. Patients with acute epididymitis require inpatient treatment with scrotal immobilization using a suspensory and warming compresses. Autohemotherapy is also performed to relieve acute symptoms while simultaneously administering protistocidal agents. Novocaine blockades of both the affected and healthy Epididymis rapidly halt acute symptoms. Various thermal procedures are widely utilized.

For vulvitis, sitz baths with water temperatures up to 45°C, lead lotions, and compresses with 0.25–0.5% aqueous solutions of Burova's fluid or alum are employed. In chronic vulvitis, application of a 3% aqueous solution or a 1–3% alcoholic solution of methylene blue to the vulva is prescribed. Brilliant green (1–2% alcoholic or aqueous solutions) is used for the same purpose. Erosions on the labia are cauterized with a 2% silver nitrate solution once every 3 to 4 days. For bartholinitis, local autohemotherapy is performed (1–3 ml of blood is injected into the tissue surrounding the gland's excretory duct), with a total of 3–4 injections per treatment course administered every other day. If pus is discharged from the gland duct, it is irrigated every other day via a syringe with a blunted needle using up to 2% aqueous methylene blue or furacilin (1:5,000), for a course of 6–8 treatments. If a glandular abscess forms, it is surgically opened, the cavity is drained, and a tampon soaked in a 5% synthomycin emulsion supplemented with 0.2–0.3 g of osarsol is left in place. Inflamed paraurethral ducts are best destroyed using diathermocoagulation. For acute vaginitis, antiseptic douches are prescribed, and as the process subsides, vaginal tampons or pessaries containing osarsol, boric acid, and glucose (0.3 g each), streptocide (0.5 g), and cocoa butter as needed are inserted at night. As an adjunctive nonspecific therapy in women, paraffin vaginal tampons can be used, which exert a favorable effect on tissue trophism and increase resistance to harmful factors. Paraffin acts upon the vaginal mucosa, paravaginal tissue, urethra, Urinary Bladder, and rectum. Mud tampons made of silt or peat mud are also applied. Reports indicate that diathermy of the solar plexus enhances ovarian hormonal function and shifts the pH of vaginal secretions toward the acidic side. Inadequate or delayed treatment of urethritis frequently leads to post-trichomonal urethral strictures, which, according to literature, account for 8 to 10% of all strictures.

The treatment of post-trichomonal inflammatory processes depends on the etiological factor responsible and the degree of morphological Changes in the urogenital organs.

All of the above medications are prescribed following a 6–12 day preparatory period aimed at boosting the body's resistance. This includes administering pyrogenal, methyluracil, and levamisole. If scarring or dystrophic changes are present in the affected organs, acemin is added as an ointment or a 25% solution, preferably applied via gauze turundas. Additionally, hyaluronidase (lidase), vitreous body injections, aloe extract, or other biogenic stimulators are prescribed. If, despite this treatment, inflammation persists a few days after immunotherapy concludes, corticosteroids are indicated via urethral instillation or physical therapy modalities (phonophoresis). Local treatments are also used, such as urethral irrigation and instillations with resorptive agents combined with physical therapy. In the event of complications (prostatitis, vesiculitis, epididymitis, adnexitis, endometritis, or menstrual irregularities), targeted intervention is required using hydrocortisone phonophoresis or instillations into the prostatic urethra.

Laser therapy involves the use of optical quantum generators. A laser is a device that generates pulsed monochromatic coherent radiation within the optical range of the electromagnetic spectrum.

It has been noted that laser therapy helps suppress inflammatory processes, prolongs remission periods, and improves copulatory function. It stimulates the regeneration of urethral and prostatic tissues during inflammation. Laser radiation exerts antispasmodic, analgesic, and regenerative effects while enhancing Blood supply and microcirculation. Furthermore, it improves hematopoiesis, phagocytosis, and overall biological activity. Local application to organs and tissues triggers a systemic bodily response.

Magnetolaser therapy. Combining laser therapy with magnetic treatment increases the efficacy of procedures by accelerating metabolic processes. The outcome of this dual physical factor influence is the result of synergy, mutually enhancing their therapeutic effects.

To successfully eradicate post-trichomonal inflammation, it is essential to treat both sexual partners, as they share the same microbial flora in the urogenital tract, which is transmitted sexually and will not resolve spontaneously.

The disappearance of discharge in the patient, the absence of trichomonads upon repeated examinations following provocation (in both the urethra and accessory glands), the normalization of ureteroscopic findings, and the absence of relapses for 2 months indicate a successful cure for trichomoniasis. Individuals who have undergone treatment for trichomoniasis should be monitored for 2 months—or for 6 months if the source of infection cannot be eliminated—along with clinical and serological screening for syphilis, as protozoacidal agents possess treponemicidal properties.

To confirm the cure of trichomoniasis, the first follow-up is conducted 7–10 days after completing the course of protozoacidal drugs. Urethral smears are taken for staining and native preparation analysis, followed by a two-Glass urine test. The initial urine stream is collected in conical tubes and examined for trichomonads. The following day, if the urinalysis is unremarkable, the expressed prostatic secretion is examined for trichomonads. Next, a combined provocation test is performed, followed by smear evaluations for trichomonads and gonococci. Two weeks after these control smears, a repeat provocation is carried out, accompanied by new smears and culture seeding on artificial growth media. One month later, a control smear and urethroscopy are performed. One month after yet another provocation and subsequent smears, if results are favorable, patients are either discharged from follow-up or transferred to clinical and serological monitoring for an additional 4 months. In women, tests are performed during consecutive menstrual periods for 2 months, followed by clinical and serological monitoring for the subsequent 4 months if the source of infection is absent. If any pathology is detected during the post-treatment evaluation phase, appropriate etiotropic, pathogenetic, and symptomatic treatment is prescribed.

Relapses are usually caused by inadequate treatment of either the patient or their partner. Frequently, recurrences occur because subclinical foci of trichomoniasis in the paraurethral ducts, prostate gland, etc., were not identified and treated in a timely manner.

If trichomonads exhibit resistance to the administered treatments, the medication must be changed. Special emphasis should be placed on boosting the body's immune response, alongside a more extensive use of local therapies guided by ureteroscopic findings.