Clinical manifestations
1. The incubation period is 4 to 28 days. About 50% of female infections are symptomatic, while most male infections are asymptomatic.
The main symptoms are increased vaginal discharge, itching of vulva, burning, pain, painful intercourse, etc.
The discharge is typically thin and purulent, yellowish green, foamy and smelly.
4.If combined with urinary tract infection, there may be frequent and painful urination, and sometimes hematuria is seen.
5. Trichomonas vaginalis can engulf sperm and prevent lactic acid production, which can affect the survival of sperm in the vagina and cause infertility.
The examination shows that the vaginal mucosa is congested, and in severe cases there are scattered bleeding spots, and the cervix even has bleeding spots, forming a “strawberry-like” cervix, and there is a lot of leucorrhea in the posterior vault, which is grayish yellow, yellowish white thin liquid or yellowish green purulent discharge, often foamy. There is no abnormal change of vaginal mucosa in worm-carrying patients.
Auxiliary examination
The easiest method is the saline suspension method, which consists of placing a drop of warm saline on a slide, taking a typical discharge from the lateral wall of the vagina and mixing it with saline, and immediately looking for trichomonads under a low magnification light microscope. The sensitivity of this method is 60%-70%.
2. For patients with suspicion, if trichomonas is not found by the suspension method several times, it can be sent to culture with an accuracy of about 98%.
3. Polymerase chain reaction (PCR) has been reported abroad for the diagnosis of Trichomonas, and its sensitivity and specificity are similar to those of the culture method.
Vulvovaginal pseudomyxomycosis (VVC)
Clinical manifestations
1. The main manifestations are itching and burning pain in the vulva, and in severe cases, sitting and lying down with abnormal pain, also accompanied by frequent urination, painful urination and painful intercourse.
3. Some patients have increased vaginal secretions. The secretion is characterized by white thick curd or bean curd-like, as it consists of exfoliated epithelial cells and mycelium, yeast and pseudomycorrhizae.
In case of vulvovaginitis, the vulva is erythematous and edematous on gynecological examination, often accompanied by scratch marks. In case of vaginitis, the vaginal mucosa is edematous, erythematous, with white masses attached to the inner labia minora and vaginal mucosa, which can be removed to reveal the red and swollen mucosal surface.
Clinical classification of VVC
VVC is classified into simple vulvovaginal candidiasis and complicated vulvovaginal candidiasis according to the prevalence, clinical manifestations, microbiology, and host conditions, as shown in Table 3, where the degree of clinical manifestations is based on the scoring criteria in Table 4, and those with a score ≥7 are considered severe.
Auxiliary examination
1, wet film microscopy of vaginal secretions saw typical Candida budding spores and pseudomycorrhizae. Saline wet film method or 10% KOH wet film method or Gram staining can be used to examine the budding spores and mycelia in the secretion. Since 10% KOH can dissolve other cellular components, the detection rate of Candida is higher than that of saline.
2, if there are symptoms and repeated wet film examination is negative, or for persistent cases, in order to confirm the diagnosis of non-Candida albicans infection, the culture method can be used.
3. pH measurement is important for differentiation. If pH < 4.5, it may be simple Candida infection, if pH > 4.5 and there are a lot of white blood cells in the smear, there may be mixed infection.
Bacterial vaginosis (BV)
(I) Clinical manifestations
1. 10% to 40% of patients have no clinical symptoms, while those with symptoms mainly show increased vaginal discharge with fishy odor, especially after sexual intercourse, which may be accompanied by mild vulvar itching or burning sensation.
The discharge is grayish white, uniform, thin and often adheres to the vaginal wall, but the viscosity is very low and the discharge can be easily swabbed away from the vaginal wall.
(II) Diagnostic points
Bacterial vaginosis can be clinically diagnosed if 3 of the following 4 items are positive.
1. Homogeneous, thin, white vaginal discharge that often adheres to the vaginal wall.
2. Vaginal pH >4.5 (pH usually 4.7-5.7, mostly 5.0-5.5).
3. Positive amine odor test.
4. Positive clue cells.