Trichomonal Vaginitis is among the most common sexually transmitted infections. Risk factors include multiple sexual partners and not using condoms during sex.
Trichomoniasis (tric causes a foul-smelling vaginal discharge, genital itching and painful urination in women. Men typically have no symptoms. Complications include a risk of premature delivery for pregnant women.
Treatment involves both partners taking antibiotics.
How it spreads
By having unprotected vaginal, anal, or oral sex.
Trichomonal Vaginitis is caused by the sexually transmitted, flagellated parasite, trichomonas vaginalis. The transmission rate is high; 70% of males contract the disease after a single exposure to an infected female, which suggests that the rate of male-to-female transmission is even higher.
The parasite is an anaerobe that has the ability to generate hydrogen to combine with oxygen to create an anaerobic environment. It exists only in trophozoite form. Trichomonal vaginitis often accompanies Bacterial Vaginosis, which can be diagnosed in up to 60% of patients with trichomonal vaginitis.
Local immune factors and inoculum size influence the appearance of symptoms. Symptoms and signs may be much milder in patients with a smaller inoculum of trichomonads, and trichomonal vaginitis often is asymptomatic. Trichomonal vaginitis is associated with a profuse, purulent, malodorous vaginal discharge that may be accompanied by vulvar pruritus. Vaginal secretions may exude from the vagina. In patients with high concentrations of organisms, a patchy vaginal erythema and colpitis macularis (“strawberry” cervix) may be observed. The pH of the vaginal secretions is usually higher than 5.0. Microscopy of the secretions reveals motile trichomonads and increased numbers of leukocytes. Clue cells may be present because of the common association with BV. The whiff test may also be positive.
Treatment in Western Medicine:
Metronidazole (500 mg, twice, for 7 days) and the sexual partner should also be treated. Increasing resistance to nitroimidazole therapy makes it crucial to develop new drugs against trichomoniasis (https://www.ncbi.nlm.nih.gov/pubmed/29175675)
Etiology & Pathology in TCM
These kinds of vaginitis mainly manifest excessive vaginal discharge, pain, pruritus, and dyspareunia. Chinese medicine relies on the nature of the vaginal discharge as a diagnostic tool. A large amount of vaginal discharge signifies deficiency of the Kidney and Spleen. Smelling and whitish or yellowish color indicate dampness or dampness heat; green color indicate Liver constraint. Deficiency of the Kidney, Spleen and Liver leads to the production of internal heat and dampness, which pours downward into the reproductive tract. Usually it is Kidney and Liver deficiency that generates heat, while deficiency of the Spleen leads to dampness.
Differentiation includes Damp-heat in Liver channel, Spleen deficiency and damp downward, and Liver and Kidney insufficiency. Bacterial Vaginosis is damp-heat downward or wet-toxin disturbance. Trichomonal Vaginitis is damp-heat accumulation or worm invasion.
Treatment with Chinese Medicine
Both have serious pruritis vulva with excessive, foamy vaginal discharge and foul smell.
|Damp Heat Accumulation||With burning sensation, discharge is yellow-green and grey.||Reddish tongue, yellow coating, slippery-rapid pulse.||Modified Long Dan Xie Gan Tang|
|Worm Invasion||Also affects vagina, grey-yellow in colour or pus-like.||Red tongue, thin yellow coating, string-slippery pulse||modified Long Dan Xie Gan Tang + Ku Shen, Di Fu Zi|
- Trichomonal Vaginitis Damp-Heat Accumulation: serious pruritus vulvar, burning sensation, excessive vaginal discharge, yellow-green and grey color with foam, stink, reddish tongue yellow coating, slippery-rapid pulse.
- Herb: Modified Long Dan Xie Gan Tang
Long Dan Cao 6g, Chai Hu 10g, Zhi Zi 12g, Huang Qin 12g, Sheng Di Huang 20g, Gan Cao 10g, Zhe Xie 15g, Chen Qian Zi 15g, Dang Gui 10g. Worm Invasion: serious pruritus vaulvae and vagine, excessive vaginal discharge, grey-yellow color, or pus-like, with foam, stink small, red tongue, thin yellow coating, string-slippery pulse. • Herb: modified Long Dan Xie Gan Tang, add Ku Shen15g, Di Fu Zi 15g.
External Treatment • Fumigation & Washing
Cang Zhu10g, Huang Bai 10g, Nu Xi 10g, Ku Shen 10g, Yu Xing Cao 30g. cook for fumigation and washing and hip bath. Once a day, 7 days a course.
Ku Shen 60g, She Zhuang Zi, Huang Bai 30g for each, Mu Dan Pi 15g, Ai Yie 15g, add 1500ml water, cook 20 minutes, get 1000ml herb liquid, add pounded garlic 20-30g, white vinegar 15ml, fumigation, washing and hip bath.
Inserting method: Pig bile 50mg, Ku Fan proper amount, Bing Pian proper amount, make suppository, inserting to vagine, once every other day. 5 times a course.
Yuxiang Wang, R.Ac R. TCMP is dedicated to improving Chinese Medicine Gynecology in North America. She teaches in Toronto, Canada, Online, and leads a yearly intensive/beach holiday in Melaque, Mexico. Details about her course on Treating Menopause in May 2020 are available at learningonvacation.com