The Problem of Trichomoniasis of the Lower Genital Tract in the Female* By

Trichomonal infestation has spread in every continent, in every class, in every race and climate. It may be asked whether this is due to the misfortunes of war or to improved methods of detecting the organism. Does it affect the vagina or the whole uro-genital system? Is it acquired and transmitted solely by sexual contact? What are the different forms of T. vaginalis? Does the parasite infect the uro-genital system only, or does it sometimes give rise to serious general symptoms? Has the trichomonad an affinity with a follicular endocrinology, or with a lower sensitivity of the vaginal mucosa to oestrogen? Why does the parasite so rarely give rise to clinical symptoms in the male? What is the subjective and objective, local and general symptomatology of trichomonal vaginitis? This vast and complex problem with all its implications and varied interpretations was discussed at the first European symposium which was held at Rheims in May, 1957, and from the therapeutic point of view it still remains unsolved. The discovery of the flagellate in the vaginal secretion of the female and in the preputial sac in the male was reported by Donne (1836) who described it as follows: "Un animalcule particulier ... d'un volume plus que double d'un globule de sang humain . . . son corps est rond . . . est muni a sa partie anterieure d'un long appendice flagelliforme, d'une espece de trompe ... au dessous de cette trompe, plusieurs cils egalement tres fins . . . se rapproche des Monas par sa trompe et des Tricodes par ses cils . . . pourrait porter le nom de Trico-monas vaginale." Hoehne (1916) confirmed the pathogenicity of the parasite, described the acute type of vaginitis, and emphasized its resistance to treatment and the frequency of relapses. The trichomonad and its habits have been described in detail by various authors (Mandoul and Pestre, 1957; Powell, 1936; Chappaz, 1957; Kissling,