WS/T 567-2017Diagnosis of trichomoniasis vaginalis (English PDF)

Foreword

This standard was drafted in accordance with the rules given in GB/T 1.1-2009.

Drafting organizations of this standard. Institute of Parasitic Diseases, Zhejiang Academy of Medical Sciences, Chinese Center for Disease Control and Prevention, Institute of Parasitic Diseases, the Second Military Medical University of the Chinese People's Liberation Army, and the Jingning County Center for Disease Control and Prevention in Zhejiang Province.

1 Scope

This standard specifies the diagnosis basis, principles, diagnosis and differential diagnosis of vaginal trichomoniasis.

This standard applies to the diagnosis of vaginal trichomoniasis by medical institutions and disease prevention and control institutions at all levels across the country.

2 Terms and definitions

The following terms and definitions apply to this document.

Trichomonas vaginalis A flagella parasitic in the human genitourinary system, mainly in the female vagina and male urethra, can cause Trichomonas vaginalis infection or disease (see Appendix A).

Trichomonas vaginalis infection Microscopic examination of vaginal or prostate secretions and urine sediments revealed Trichomonas vaginalis trophozoites, but no corresponding clinical manifestations were found in infected patients.

Vaginal trichomoniasis Corresponding clinical manifestations appear in patients infected with Trichomonas vaginalis.

3 Diagnosis basis

4 Principles of diagnosis

Diagnosis is based on epidemiological history, clinical manifestations and laboratory test results.

5 Diagnosis

6 Differential diagnosis

Should be differentiated from candidal vaginitis, bacterial vaginitis, bacterial urethritis, gonorrhea urethritis, etc. (see Appendix E).

Appendix A

(Informative appendix) Etiology A.1 Pathogen Trichomonas vaginalis belongs to the phylum Carnigoflagellate, Motoflagellate, Trichomonas, Trichomonas, Trichomonas.

A.2 Form

Trichomonas vaginalis has only a trophozoite stage. The live worms are transparent, refractive, and changeable. They move forward with the help of flagella and use a fluctuating membrane.

The wave action revolving movement. After hematoxylin or Ji's staining, it is pear-shaped or oval, with a size of (7µm~32µm)×(5µm~12µm), Four anterior flagella and one posterior flagella can be seen in the hair basal body. There are undulating membranes and basal staining rods at the anterior 1/2 of the outer body. There are deeply stained particles in the cytoplasm, it is a unique hydrogenosome of this worm. The worms seen in fresh secretions are mostly free of bacteria and food bubbles, but the worms contain a lot of bacteria and Starch granules.

A.3 Life history

The life history is simple. The trophozoites parasitize the human genitourinary system, mainly in the female posterior fornix and male urethra or prostate.

Two-split method or multi-split method of reproduction. The most suitable temperature for survival and reproduction is 32°C~35°C, and the most suitable pH for survival and reproduction is 5.2~6.6.

Appendix B

(Informative appendix) Epidemiology B.1 Epidemic overview Trichomonas vaginalis infection is one of the most common sexually transmitted infections. There are about 180 million infected people worldwide, with the highest infection rate among women in the 20-40 year old age group.

B.2 Source of infection Patients with Trichomonas vaginalis infection or Trichomonas vaginalis.

B.3 Ways of transmission Spread through direct contact and indirect contact, the former is mainly through sexual transmission, and the latter is mainly through sharing sanitary ware and clothing and equipment.

B.4 Susceptible population the crowd is generally susceptible. Humans cannot form lasting immunity after infection, and they can still be infected repeatedly after being cured.

B.5 Popular factors

Trichomonas vaginalis has a strong adaptability to the external environment. It can survive for 14 hours to 20 hours in a semi-dry environment, and can survive in wet towels and clothes 23h, it can survive 102h in 40°C bath water, 65h in 2°C water, 7 h in -10°C environment, and 45 min in ordinary soapy water.

150min.

Trichomonas vaginalis infection is related to economic status, living conditions, sanitary facilities and living habits, etc., with low nutritional status and poor living conditions.

Poor hygiene, lack of sanitation facilities, and poor personal hygiene can all increase the infection rate. Trichomonas vaginalis is also a dangerous cause of HIV infection One of the elements.

Appendix C

(Informative appendix) Clinical manifestations C.1 Vaginal infection the incubation period is 4 to 28 days, the vaginal secretions increase greatly, and the leucorrhea increases, which is yellow foamy and has peculiar smell. When the vaginal mucosa is injured Erythrocytes may appear, such as secondary pyogenic bacteria infection may appear a lot of yellow purulent leucorrhea with foul smell. Often cause genital itching, burning sensation, sexual intercourse Pain etc. Vaginal examination has tenderness, and it can be seen that the vaginal mucosa and cervix are diffusely congested and swollen. In severe cases, there is bleeding and spots. Symptoms often follow the menstrual cycle fluctuates, and symptoms generally worsen after the menstrual period.

C.2 Urinary tract infection the symptoms of urinary system infections such as frequent urination, urgency, and dysuria. Most patients have fever, dysuria, burning pain at the urethral mouth, etc. less Several patients have interrupted urine line, urine retention, urethral swelling, hematuria, etc., which may be accompanied by local tenderness.

C.3 Prostate infection it is manifested by burning urethra, increased nocturia, and may be accompanied by symptoms such as frequent urination, urgency, and dysuria, dull pain in the perineum, swelling of the rectum, and localized Tenderness etc. There may be white cloudy secretions dripping out of the urethral opening at the end of urination.

Appendix D

(Normative appendix) Laboratory examination D.1 Direct smear method Apply vaginal or prostate secretions or urine sediments on a glass slide, add 1 drop of saline and check with a microscope, you can see vaginal hair Trichomonas flagella and fluctuating membrane activity. This method is the easiest way to check for Trichomonas vaginalis and is often used in outpatient clinics and population surveys. Because it can only be checked Live worms, so the specimens should be kept warm. It is easy to detect when the number of live insects in the secretion or sediment is >=10/mL, so the detection rate Low.

D.2 Staining method

Coat the vaginal or prostate secretions or urine sediments into thin slices, and stain them with Wright's or Ji's solution after they are naturally dried. The vaginal hair can be seen the shape and content of Trichomonas.

D.3 Culture method

Add vaginal or prostate secretions or urine sediments to liver infusion or egg yolk infusion culture medium, and incubate in a 37°C incubator for 48 hours, then take the culture Spread 1 drop of the mixing solution into thin slices, and stain it with Wright's or Ji's solution after natural drying. The shape and contents of Trichomonas vaginalis can be seen.

Appendix E

(Informative appendix) Differential diagnosis E.1 Candidal vaginitis the main symptoms are also increased leucorrhea and genital itching, but the leucorrhea is mostly watery or pus-like, mixed with cheese-like or tofu-like things. Vagina has White pseudomembrane, positive fungal test, smear staining microscopic examination or separation culture can make a clear diagnosis.

E.2 Bacterial Vaginitis the main clinical manifestation is that the abnormal vaginal discharge is obviously increased, which is thin or mushy, gray-white, gray-yellow or milky yellow, with Special fishy smell. The vaginal pH rises to 5.0-5.5, and clue cells can be found in the secretions.

E.3 Bacterial urethritis Mainly manifested as a small amount of urethral secretion, which is easy to be seen when there is no urination for a long time or no urination at night until the morning before urination.

Urine washed out. Amine tests are often positive, and pathogenic bacteria can be found in urine sediment smears or culture.

E.4 Gonorrheal urethritis in the acute phase, there are often serous or purulent secretions, pain during urination, but no urgency or frequent urination. Symptoms in the chronic phase are not obvious, and there are showers in the urine Silk may be the only clinical manifestation. Urine sediment smear or culture can be found in Gram-negative Gonorrhoeae.