Introduction

Trichomoniasis is one of the most common sexually transmitted infections (STIs) among the women of reproductive age worldwide, caused by a protozoa Trichomonas vaginalis.^[1]

WHO has estimated that, this infection accounts for almost half of all curable sexually transmitted infections. The actual burden of the disease remains unknown in India. As per published literature, the prevalence of Trichomonas vaginalis is 0.4 - 27.4% in women.^[2] Due to its high prevalence worldwide and the frequency of co-infection with other STI’s make Trichomonas is an important public health concern.^[3]

The classic symptoms associated with Trichomonas vaginalis includes greenish-yellow frothy discharge, pruritis, dysuria, dyspareunia and strawberry cervix, which is characterised by haemorrhagic lesions. The classic strawberry cervix is seen in approximately only 2% of patients, although this finding is uncommon, it is highly indicative of Trichomoniasis.

Accurate diagnosis is necessary, since it will lead to appropriate treatment and facilitates that control the spread of Trichomonas vaginalis infection. The consequences of untreated Trichomonas vaginalis infection may include pelvic inflammatory disease (PID) and adverse outcomes of pregnancy.^[4]

In Ayurveda classics, diseases of female reproductive system are explained mainly under the heading of “Yoni Vyapath”. Various vaginal infections are mentioned under different Yoni Vyapath’s such as Slaishmiki, Paittiki, Upaplutha and Pariplutha etc. Foul smelling infective yellowish-green vaginal discharge present in Trichomoniasis having close similarity with Peeta and Kunapa Srava mentioned under Paittiki and Pariplutha Yonivyapath.^[5]

Pruritis in Trichomoniasis can be considered as Yonikandu mentioned in Slaishmiki Yonivyapath.^[6] Strawberry cervix is due to tiny capillary haemorrhages, here Raktha get vitiated by vitiated Pitta. By considering these Lakshanas, we can conclude that Trichomonas vaginalis infection is a Kaphapitta predominant condition. So, both Sthanika and Shamana Chikitsa with Kaphapittagna, Sravagna, Kandugna, Krimighna, Vruna Shodana and Ropana properties play an important role in its management.

Contraceptive History:

Natural methods and OC pills

General Examination

Systemic Examination:

Sthanika Pariksha (Pelvic Examination):

Prayogashala Pareeksha (Investigations):

Cervical smear cytology (07/06/2024) (Fig. 1)

Smears are showing numerous acute inflammatory cells in the form of neutrophils. Few RBC’s are seen in the background.

No atypical squamous/glandular cells seen.
No dysplastic cells or malignant cells seen.

Figure 1

Figure 4

Discussion

In Ayurvedic classics, various conditions giving rise to Yonisrava /discharge per vaginum have been described. The treatment for any type of infective vaginal discharge is to cure the underlying disease and its cause. Yellowish white discharge per vaginum along with itching is mainly due to vitiated Kapha and Pitta dosha. For this Kaphapittagna, Sravagna, Kandugna, Sothagna, Vedanasthapana, Vrunaropana dravyas were advised.

Yoni Prakshalana: Panchavalkala Kashaya^[7] having Kaphapittagna, Yonidoshahara, Sthambana, Kandugna, Sothahara, Vruna Shodana and Ropana along with anti-inflammatory, anti-microbial, astringent, immune-modulatory, purifying and healing properties.^[8] These properties of Panchavalkala Kashaya helps in reducing the signs and symptoms like yellowish white discharge, itching, strawberry spots, bleed on touch and cervical congestion. It prevents the re-occurence this infection by restoring the normal vaginal flora and also inhibits the growth of pathogens.

Yoni Pichu: Jathyadi Taila^[9] having Tikta, Kashaya Rasa, Kaphapittagna, Sothahara, Rakthasthambaka, Vedanasthapana, Vruna Shodhana and Ropana Karma, it also possess anti-inflammatory, anti-septic, wound healing properties. The studies suggested that phytochemicals present in Jathyadi taila such as flavonoids, terpenoids, tannins, glycosides, steroids and alkaloids which helps in wound healing and re-epithelization.^[10] Hence it helps to reduce the inflammatory changes in the cervix and vagina such as cervical congestion, strawberry spots, bleed on touch and also to restore the normal cytology of reproductive tract.

Conclusion

Trichomoniasis is one of the curable sexually transmitted infections; its management aims to treat the infection and to prevent its reoccurrence. In the present case, the patient treated with both Sthanika and Shamana chikitsa with Kaphapittahara, Sravahara, Vruna Shodana, Ropana, Kandugna and Krimigna properties. Improvement was noted in signs and symptoms within short period of time. The study providing a promising option for managing Trichomoniasis by comprehensive Ayurvedic treatment modalities.

References