NEWS AND FILLER
|Year : 2010 | Volume
| Issue : 1 | Page : 58-60
Helminthiasis as impact factor of gynecological disorders
Center of Family Planning and Reproductive Health in Lviv, Department of Family Medicine, Danylo Halytskyi National Medical University of Lviv, Pekarska Str., 69, Lviv, Ukraine
|Date of Web Publication||3-Sep-2010|
Center of Family Planning and Reproductive Health in Lviv, Department of Family Medicine, Danylo Halytskyi National Medical University of Lviv, Pekarska Str., 69, Lviv
Source of Support: None, Conflict of Interest: None
|How to cite this article:|
Sklyarova V. Helminthiasis as impact factor of gynecological disorders. Indian J Sex Transm Dis 2010;31:58-60
| Introduction|| |
Helminthiasis is the most common parasitic infestation and the cause of severe diseases and significant economic waste. Current incidence of helminthiasis is 1333 cases per 100,000 of population with the annual number of new cases ranging from 400,000 to 600,000. Most widespread are helminthic infestations caused by enterobius vermicularis (pinworm), 75% and by ascarides, 20%. According to statistical data, in Ukraine the highest incidence of helminthiasis (over 60%) has been registered in Poltava, Sumy, and Chernihiv regions. 
On the whole, high incidence of helminthiasis is related to a number of factors and the most important of them are: insufficient public health education, poor personal and food hygiene, nonadherence to the rules of cattle-farming and keeping pets, and others. In the majority of cases, people are found unaware of risks and complications of helminthiasis, and means of prevention against helminthic infestation.
Helminthiases are difficult to identify since they are often manifested by nonspecific signs as: acne-form rash on the face,  stomachaches, pains in the epigastrium, evacuatory disorders (constipation or diarrhea), chronic fatigue syndrome, joint aches, dizziness, and others. , Parasitic diseases, if untreated, may develop severe complications: obturation of bile ducts, the abscesses of liver and pancreas, intestinal obstruction, appendicitis, rupture of intestines, affections of the central nervous system, anemia, and gynecological disorders whose etiology is difficult to determine. ,
Most common complaints of female patients suffering from persistent or chronic gynecologic disorders with concomitant helminthiasis are: unusual appearance, amount, and smell of vaginal discharge, and discomforts in the region of external genitalia (burning sensations, itching) which affect the well-being and sexual intercourse in female patients. Presence of helminthes and their eggs is an etiological factor of colpitis. ,, However, it is not a rare case when during gynecologic examination for relapsing colpitis and latent infections (chlamydiosis, mycoplasmosis, and ureaplasmosis), the possibility of causal relationship between gynecological symptoms and helminthiasis is overlooked by the examiner.
By the data of Center of Family Planning and Reproductive Health in Lviv, in the second quarter of 2008, 3267 women sought specialized medical advice in this clinic. Of them, 628 patients with relapsing colpitis and bacterial vaginitis were checked for helminths' eggs and laboratory investigations detected 318 cases (50.6%) of helminthic infestation: 212 (66.7%) caused by pinworms, and 106 (37%) by ascarides.
Parasitic infestations were determined to induce inflammatory processes of the vagina [[Figure 1]a,b] due to impact on the epithelial barrier exerted by both presence of parasites in the organ and by the influence of toxic substances produced by helminthes in the course of their vital activity.
|Figure 1 :Enterobius vermicularis on the exocervix and perianal region (a) Enterobius vermicularis on the perianal region (magnifi ed × 8), (b) Enterobius vermicularis on the exocervix (magnifi ed ×8)|
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Persistence of enterobius vermucularis in the vagina and eggs of helminthes in the vulva, vagina, and perineal area results in development of gynecologic disorders which present with a clinical picture of erythema, swelling, itching, unusual vaginal discharge, discomforts, painful sensations during sexual intercourse, and others.
However, most severe is the impact of helminthiasis on the status and functioning of immune system. Presence of parasites and their eggs and especially the toxic substances, produced by helminthes in the process of their vital activity, considerably inhibit resistance of the host's organism to parasitic infestation and invasion of other infectious agents.  Helmithic and parasitic diseases head the list of major causes of the secondary (acquired) immunodeficiency, whereas bacterial and viral invasions range second and third, respectively. 
Relapsing nonspecific diseases of female genital tract mostly occur at the background of chronic immunodeficiency of the vaginal endoecosystem associated with compromised barrier reserve mechanisms. Lacking efficacy of treatment for nonspecific gynecologic disorders may as well be attributed to the impact of parasitic infestation. This is also true of specific chronic inflammatory diseases caused by trachymonads, Chlamydia, and ureaplasma. Long-lasting persistence of parasites in female genitalia tends to induce chronic inflammatory processes of the organs of the true pelvis.  In case conventionally pathogenic flora gets concomitant with helminthic infestation, there develops gynecologic pathology with the clinical picture of colpitis or bacterial vaginosis.
Allergic reactions are also a manifestation of impaired immunity status. At the background of compromised immunity, incidence of a variety of allergic reactions has been noticed considerably higher. They are usually manifested by gastrointestinal, dermatologic, respiratory, and gynecological signs, as digestive disorders, rash of unidentified etiology, bronchial asthma, bronchitis with asthmatic component,  rhinitis, erythema, swelling, and itching of the external genitalia, etc. In helminthiasis, level of IgE increases, and indices of interleukin-12 (IL-12), gamma-interferon (IFN-gamma),  and tumor necrosis factor-alpha (TNF-α) decrease. In ascariasis and toxocarrosis, level of interleukin-5 (IL-5) is determined much higher than in the norm. 
Microbiocenoses of the vagina and the large intestine are closely interrelated. Content of lactobacteria in the large intestine and their content in the vagina of apparently healthy women are interrelated: prevalence of L. plantarum, L. delbreckii, L. salivariu, L. vaginalis in the large intestine directly correlates with the increased content of L. crispatus, L. acidophilus, L. coleohominis in the vagina. 
Dysbiosis of the large intestine occurring at the background of impaired endoecosystem of the organism due to parasitic infestation impairs balance between the number of lacto- and bifidobacteria in vagina. This imbalance results in excessive growth of streptococci and staphylococci and appearance of Gardnerella and Mobiluncus which present with specific clinical manifestations-characteristic "fishy" smell, dense, milky discharge, itching, erythema, and discomforts in the vagina and external genitalia. ,
Proceeding from the aforementioned, we consider it reasonable to recommend that during gynecologic examination for latent infections female patients should be checked for helminthiasis. Infestation with ascarides could easily be detected by an uncomplicated and effective method-analysis of feces for eggs of parasites. This laboratory investigation has to be performed three times and for the complete case history of all the family must be checked for helminthes. If the test is positive, course of antihelminthic treatment should be administered for each member of the family. Method used to determine immunoglobulins G to ascarides in combination with enzymatic immunoassay is more reliable than laboratory analysis of feces alone.
Treatment of helminthiasis is performed with antihelminthic preparations, ,, and most efficient for treatment of enterobiosis and ascariasis are albendazole, mebendazolepiperizadine, especially administered in combination with medicinal plants (Artemisia L., Chelidonium L., Hypericum L., Tanacetum vulgare) and hepatoprotective drugs, in particular, ursodeoxycholic acid, and preparations stimulating evacuatory function of the intestines.
Elimination of conventionally pathogenic flora allows for recovery of balance between bifido- and lactobacteria in the digestive system thereby preventing the risk of vaginal pathologies. It is a significant contributory factor for the therapeutic benefits of antihelminthic treatment.
Efficacy of complex therapy for inflammatory diseases of the lower genital tracts in female patients, if indicated, in combination with antiparasitic treatment has proved much higher: incidence of relapsing cases declined and duration and cost of therapy reduced, that allowed to gain recovery of patients' sexual health within a shorter period of time and improve their quality of life.
| Conclusions|| |
While performing gynecologic examination for nonspecific disorders of female genitourinary system, the examiner must be high suspicious of possible causal relationship between gynecological disorders and helminthiasis.
Presence of parasites and their eggs in vagina, and impact of toxic products of their vital activity cause changes of endoecology of the lower genital tracts in female patients and is an etiological factor for the development of colpitis.
Gynecologic examination in patients with relapsing colpites must include laboratory investigations for helminthes.
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