Faculty of Midwifery, Babol University of Medical Sciences, Iran

Abstract

In order to compare the effect of thick salt water sitz bath with diluted vinegar –water sitz bath in treatment of trichomonas vaginitis, 60 pregnant ladies who were suffering from marked trichomonas vaginitis and showed positive to wet test, were randomly classified into two groups.

One of the said groups was undergone treatment by thick saltwater sitz bath and other by diluted vinegar-water sitz bath. Their husbands also received metronidazole.

In this research, the patients, ages, number of labors, abortion, pregnancy age, social and economic conditions, number of labors, abortion, pregnancy age, social and economic conditions, number of affection to the said disease and period of suffering from the said disease were similar. In this research, the both treatment methods had good effects on treatment of vaginal discharge, malodor, vulve itching, dysuria, vulvovaginitis and erythema after one week but had no effect on strawberry cervix sign.

The clinical effects of the both treatment methods were 100% after one week and there was no difference.

The direct wet smear test on the group who,were treated by thick salt water sitz bath showed 70% negative and on the group who were treated by diluted vinegar- water sitz bath showed 67.7% negative upon one week, so there was no significant difference between two groups in treatment from statistical points of view.

Introduction

Vaginitis due to trichomonas vaginalis (monocyte) is called trichomonas vaginitis that %50 of American women are affected by that. This infection is transmitted by sexual contact (6). Factors such as vaginal and flour are important in affecting of this parasite (4). Diagnosis is done on the basis of symptoms, but this diagnosis should be confirmed by laboratory. For diagnosing of Trichomonas, we have used wet smear for more than 150 years. This method is simple and it tacks a little time and time and also a little expense and its sensitivity is %60-92 by expert persons and with ordinary microscope.

Whenever a mobile existing is found, its sensitivity will be %100.

In U.S, 35 million of pregnant women do pop- smear for screening and by this way a symptomatic trichomonas vaginalis would be diagnosed which is %50 and will be treated during pregnancy.

Therefore prenatal and neonatal injuries and death will be decreased (11). Methronidozole is the only effective drug that is available for treating the disease. (10). Studies show that it cause motasion in bactria and in the animals cause abnormality in fetus (8). Since this drug passes from placenta, it shouldn’t be used during pregnancy (3).

Azar Fahimi (1) stated that Grinhell in shicago, for the first time, the patients who were affected by injection of Acid lactic %5, where as Wilson (12) suggested thick salt water sitz bath for treating of pregnant women who

are affected by tricomonas.

Method:

This clinical research was done on pregnant women who was referred to Imam clinic and result and No.8, health center in sari for complaining of vagina; discharge, vulvovaginal Irritation, itching and soon. The result of their laboratory microscopic wet smear was positive.

Questionnaire was completed by interview and observation and by considering mark 0-2, the results were registered. Mark 0 was given to absence of signs and symptoms and mark 1 to mild cases and mark 2 to sever cases.

In questionnaire we asked questions about using drugs during 2 parts weeks and multiple of husband. If patient hadn’t necessary conditions, she would omitted from study and then spouse of patients 14 tab metronidazole 250 mg, B.D for one week was administered 68 patients were divided in to two groups randomly. For one group was administered diluted vinegar-water sitz Bath (4 glasses’ water + 1 spoon white industrial vinegar) B.D, each time for to minutes for one week. The other group was administered thick salt-water sitz bath (4 glasses’ water +1 glass of ordinary salt). Also we emphasis that they use condom for coitus during treatment, one week after treatment, the patient was evaluated and questionnaire was completed and the result of examination and direct microscopic test were registered. 8 patients were omitted of study because they didn’t refer.

Result

For taking information, sampling was done for 6.5 months. There weren’t meaning full differences between signs and symptoms of disease before treatment in both groups and in study group 100% of persons have complains of sever vaginal discharge, malodor 51.7% vulva itching, 45 % dysparonia and 61.6% dysuria. In the above community 70% signs of distributed vaginal erythema, 80% vaginitis and 13.3% strawberry cervix were seen and also 10% husbands complained for dysuria and 90% of reminder hadn’t clinical sign of disease (table 1).

Table 1.: incidence of research units on the basis of complains and their signs before treatment.

All signs and symptoms of disease were decreased considerably one week after treatment or symptoms omitted that improving of each signs and symptoms were observed one week after treatment by Mcnemar’s Test, (except strawberry) cervix that diluted – vinegar water sitz bath wasn’t effective for it treatment) (Table.2)

Table 1.: incidence of research units on the basis of complains and their signs after treatment.

There weren’t meaningful differences for decreasing symptoms and signs after one week. The only exception of symptom of sever discharge that one week after treatment (P=0/0095). There were meaningful differences between two groups, in this way that thick salt-water sitz bath for removing c of vaginal discharge had more effect.

In each treatment group, the severity of signs and symptoms one week after treatment compared with before treatment show considerable differences (P=0.000). Both two of treatment methods were effected on signs and symptoms. In most patients vaginal discharge was watery and foamy and yellow-green that one-week after treatment became mucous (usual) and white.

Clinical treatment in each treatment group was 100% one week after treatment. From 60 direct wet smear one week after treatment, 19 test was positive that 9 positive (30%) test were related to diluted – vinegar water sitz bath that results show that the two methods for treating of trichomonas vaginitis hasn’t statistical meaningful differences.

Discussion

Trichomona vaginalis is common in vagina of women. This is estimated 15% or more (9). Clarck stuted that this parasite grows in PH 5-6 and in this and in this study of vagina was 5 or 6 in 80.1% of affected persons. Since, Growth of the trichomonas is be limited by PH factor. In this research, we were been changed PH by thick-salt water sitz bath and diluted- vinegar water sitz bath so that vaginal PH of 13 persons (43.3%) in thick-salt water sitz bath was one week after treatment that only one person of them had positive direct wet smear. Although PH was high, PH of vaginal discharge of 22 persons (73.3%) in diluted-vinegar water sitz bath was 3 or 4 that among them 4 persons had positive direct wet smear.

Schachter reported that diluted-vinegar water sitz bath removed the symptoms of infection by decreasing vaginal PH (9). This research shows that diluted-vinegar water sitz bath not only decrease or disappear the signs and symptoms of disease significantly, but also direct wet smear in 67.7% of infected persons became negative one week after treatment.

Azar Fahimi (1) stated that rozental use 12%-25 of sea salt solution in trichomonas vaginitis had 87% definite success. In this research, we observed that thick salt- water sitz bath decrease or disappear the clinical signs and also direct wet smear became negative one week after treatment in 70% of affected persons.

Havens stated that 1/3 of persons with abnormal vaginal discharge weren’t affected by vaginitis, but also the cause that is trichomonas cervisit (5).

Reference

1. Azar fahimi A. vaginal parasite diseases: specially trichomo- nas vaginalis, medical thesis, Tehran university of medical science 1956.

2. Clarke, Dawaod, Green’s, Pearson, Gynecology. Fourth edition, little Brown Company, 1990.

3. Cunnighan, Gant, Prentic. Basic Gynecology & Obstetrics. Prentic hall internation, 1993.

4. Graves, Gardner. “Pathogencicity of trichomonas vaginalis”, Clinical Obsterics & Gynecology.1993 (36) 1: 145-151.

5. Havens, Sullivan,Tilton. Manual of out patient gynecology, Second edition, Little brown, 1991.

6. Levinson J. Medical microbiology & immunology, Second edition, perntice hall internation Inc, 1992.

7. LossickJ.G, et al. Trichomoniasis: Trend in diagnosis and management”. American journal of obstetric & gynecology. 1991 (4) 2: 1217- 1227.

8. Paper, Loyce, el al’ “Prenatal use of metronidazole on birth defect: no association”, obstetrics & gynecology. 1993(82) 3:348-350,

9. Schaechter ME. Mechanism of microbial disease, second edition, Williams& Willkins, 1993.

10. Sullivan C. Smith L. “Mangement of vulvovaginitis in pregnancy”. Clinical obstetrics & gynecology.1993;(36) 1: 195-205.

11. Weinberger M, Harger J. Accuracy of Papanicolaou smear in the diagnosis of asymptomatic infection with trichomonas vaginalis”. Obstetric&gynecology,1993 (82) 3: 425-29.

12. Willson C. Obstetric & gynaecology, 16^th edition, Mosby Company, 1991.