British Medical Journal

To the Editor


October 2nd 1989





Sir, - I would like  to point out my view of exposed problems after hysterectomy, in the article of Dr. Taylor and colleagues (1), as well as in comments to it (Correspondence, BMJ September 9th). During my gynaecological practice I have focused all my attention to the reaction of the organism to trichomoniasis. From literature (2) and personal experience, I have concluded that there existed a competition between genital and extragenital trichomoniasis. That competition is based on the existence of cross-immunity (3) for all recognised human trichomonal species. It can be frequently observed in the practice, that uterocervical pathologic processes, followed by mucus hyper secretion, are in association with infection by trichomonads in aflagellary form.


That infection elicits an immune response (non-sterile immunity), that explains the competition with extragenital trichomoniasis. Subclinical focus of trichomonal infection (most frequently in cervix) which is the initiator of immunity as well, is removed by total hysterectomy. It results in a decrease and even disappearance of anti-trichomonal immunity, enabling in that way infection of other predisposing organs (digestive and uro-tract).

As in the case of an acute or exacerbating trichomonal cervicevaginitis, various irritating manifestations can occur in vagina and on vulva, so in case of trichomoniasis of digestive and uro-tract, pathologic and dysfunctional equivalents may appear. It happens especially in acute phase of the infection, in immuno-compromised patients, or by reinfection with various antigenic batteries of these parasites.


The known favourable effect of preoperative usage of   metronidazole in hysterectomy and bowel surgery can not be due only to the regression of anaerobic bacteria, but also by suppression of trichomonads, so restoring immunity of immuno-compromised patients too (4).


Regarding bowel and urinary problems in connection to hysterectomy in the light of my experience, I firmly believe that in each case, before and/or after operation, attention must be paid to urogenital trichomoniasis, as well as to possible transfer of “stage” of host-parasite interaction.



Sukrija Krvavac


Women’s Health Institute

University and Medical Centre

71000 Sarajevo, Yugoslavia

Livanska 40





  1. Taylor T. Smith A. Fulton PM. Effect of hysterectomy on bowel function. Br. Med. J 1989; 299:300-1 (29 of July).
  2. Jirovec O. Petru H. Trichomonas vaginalis and trichomoniasis. Adv Parasitol 1968; 6: 117-88.
  3.  Honigberg B. M. Trichomonads of importance in human medicine. In Kreier J. P. ed.: Parasitic Protozoa, Vol 2  New York, San Francisco, London Academic Press Inc, , 1978. pp. 275-454.
  4.  Krvavac S. , Rustembegović A. Mteronidasole trichomoniasis eradication as possible potent immunity restoring procedure in AIDS. Abstracts, V Intern. Conference on AIDS, Montreal, 1989; p. 564.