Trichomonas vaginalis and trichomoniasis

Lactobacillus acidophilus contributes to a healthy environment for vaginal epithelial cells

Lactobacillus species in the female genital tract are thought to act as a barrier to infection. Several studies have demonstrated that lactobacilli can adhere to vaginal epithelial cells. However, little is known about how the adherence of lactobacilli to vaginal epithelial cells affects the acidity, cell viability, or proliferation of the lactobacilli themselves or those of vaginal epithelial cells. Lactobacillus acidophilus was co-cultured with immortalized human vaginal epithelial cells (MS74 cell line), and the growth of L. acidophilus and the acidity of the culture medium were measured. MS74 cell density and viability were also assessed by counting cell numbers and observing the cell attachment state. L. acidophilus showed exponential growth for the first 6 hr until 9 hr, and the pH was maintained close to 4.0-5.0 at 24 hr after culture, consistent with previous studies. The growth curve of L. acidophilus or the pH values were relatively unaffected by co-culture with MS74 cells, confirming that L. acidophilus maintains a low pH in the presence of MS74 cells. This co-culture model could therefore potentially be used to mimic vaginal conditions for future in vitro studies. On the other hand, MS74 cells co-cultured with L. acidophilus more firmly attached to the culture plate, and a higher number of cells were present compared to cells cultured in the absence of L. acidophilus. These results indicate that L. acidophilus increases MS74 cell proliferation and viability, suggesting that lactobacilli may contribute to the healthy environment for vaginal epithelial cells.

Can population differences explain the contrasting results of the Mwanza, Rakai, and Masaka HIV/sexually transmitted disease intervention trials?: A modeling study

OBJECTIVE

To determine whether population differences can explain the contrasting impacts on HIV observed in the Mwanza trial of sexually transmitted disease (STD) syndromic treatment (ST), the Rakai trial of STD mass treatment (MT), and the Masaka trial of information, education, and communication (IEC) with and without ST as well as to predict the effectiveness of each intervention strategy in each population.

METHODS

Stochastic modeling of the transmission of HIV and 6 STDs was used with parameters fitted to demographic, sexual behavior, and epidemiological data from the trials and general review of STD/HIV biology.

RESULTS

The baseline trial populations could be simulated by assuming higher risk behavior in Uganda compared with Mwanza in the 1980s, followed by reductions in risk behavior in Uganda preceding the trials. In line with trial observations, the projected HIV impacts were larger for the ST intervention in Mwanza than for the MT intervention in Rakai or the IEC and IEC + ST interventions in Masaka. All 4 simulated intervention strategies were more effective in reducing incidence of HIV infection in Mwanza than in either Rakai or Masaka.

CONCLUSIONS

Population differences in sexual behavior, curable STD rates, and HIV epidemic stage can explain most of the contrast in HIV impact observed between the 3 trials. This study supports the hypothesis that STD management is an effective HIV prevention strategy in populations with a high prevalence of curable STDs, particularly in an early HIV epidemic.

The interaction of trichomonas vaginalis with epithelial cells, polymorphonuclear leucocytes and erythrocytes on vaginal smears: light microscopic observation

In this study, vaginal smears taken from 400 patients were examined cytologically using the Papanicolaou technique. Twenty of the 400 patients were detected as harbouring Trichomonas vaginalis. The interactions of T. vaginalis with epithelial cells, polymorphonuclear leucocytes (PMNLs) and erythrocytes were determined at light microscopic level. It was observed that T. vaginalis were juxtaposed to the epithelial cells and changed shape according to the contours of the epithelial cell revealing the cytopathic effect of trichomonads on epithelial cells. Trichomonads attached to PMNLs produced pseudopodia to phagocytose the cells. Occasionally an amoeboid shaped T. vaginalis organism was seen trailed by a row of PMNLs. This light microscopic study supports the production by trichomonads of a chemotactic factor for PMNLs. Phagocytosed erythrocytes were also seen in the cytoplasm of T. vaginalis, suggesting the need for the patient to be tested for anaemia.

Clinical and microbiological aspects of Trichomonas vaginalis

Trichomonas vaginalis, a parasitic protozoan, is the etiologic agent of trichomoniasis, a sexually transmitted disease (STD) of worldwide importance. Trichomoniasis is the most common nonviral STD, and it is associated with many perinatal complications, male and female genitourinary tract infections, and an increased incidence of HIV transmission. Diagnosis is difficult, since the symptoms of trichomoniasis mimic those of other STDs and detection methods lack precision. Although current treatment protocols involving nitroimidazoles are curative, metronidazole resistance is on the rise, outlining the need for research into alternative antibiotics. Vaccine development has been limited by a lack of understanding of the role of the host immune response to T. vaginalis infection. The lack of a good animal model has made it difficult to conduct standardized studies in drug and vaccine development and pathogenesis. Current work on pathogenesis has focused on the host-parasite relationship, in particular the initial events required to establish infection. These studies have illustrated that the pathogenesis of T. vaginalis is indeed very complex and involves adhesion, hemolysis, and soluble factors such as cysteine proteinases and cell-detaching factor. T. vaginalis interaction with the members of the resident vaginal flora, an advanced immune evasion strategy, and certain stress responses enable the organism to survive in its changing environment. Clearly, further research and collaboration will help elucidate these pathogenic mechanisms, and with better knowledge will come improved disease control.

Protozoan infections in the male genital tract

PURPOSE

We reviewed the literature on protozoan infections in the male genital tract, with special reference to histopathological findings and their repercussions on different andrological functions.

MATERIALS AND METHODS

A literature search of the MEDLINE data base from 1966 to May 1995 was done and related articles were identified. The considered terms were parasitology and the male genital organs. Additional searches on infertility, semen and sexually transmitted diseases were performed.

RESULTS

Protozoan infections of the male genital tract are rare and only a few species of parasites are involved. Trichomonas vaginalis, Trypanosoma species, Leishmania donovani, Entamoeba histolytica, Acanthamoeba species, Toxoplasma gondii and Plasmodium falciparum have been described in the male genital tract as producing testicular damage or secondary hypogonadism via hypothalamic-hypophyseal axis alterations.

CONCLUSIONS

Topics of interest were the role of sexual transmission by some parasites, principally T. vaginalis, relationship with subfertility or infertility in the male subject, clinical significance in differential diagnosis with other inflammatory processes, and for some parasites the relationship with opportunistic behavior and immunodeficiency syndromes, including the acquired immunodeficiency syndrome.

A new method for identification of Trichomonas vaginalis by fluorescent DNA in situ hybridization

The protozoan flagellate Trichomonas vaginalis is responsible for human trichomoniasis, one of the most widespread sexually transmitted diseases in the world. Several methods are currently used for laboratory diagnosis, including direct microscopic observation, cell culture, immunological techniques, and more recently, DNA probing and gene amplification. This report describes an in situ hybridization technique with specific DNA probes labeled with either biotin, rhodamine, or fluorescein for detection of T. vaginalis with fluorescence microscopy. Repetitive DNA sequences were evident in the nuclei of the protozoa as intensively fluorescent regions, giving a spotted pattern. No cross-reactivity between the probes and the DNAs of mammalian cells, yeasts, or bacteria was noted. This technique is potentially useful for the diagnosis of human trichomoniasis in clinical samples.

Trichomonas vaginalis: strain differences in adhesion to plastic and virulence in vitro and in vivo

Trichomonas vaginalis isolated from clinical cases were grown axenically in TYI-S-33 medium. Various strains of this flagellate showed different adhesion characteristics in medium containing bovine serum or Cohn fractions thereof. These were not inversely related to the time in axenic culture. The adsorption of serum components to the parasites was assessed in relationship to adhesion but in many cases was probably not adhesion-related. All strains tested for virulence in vitro were almost equally cytotoxic for HeLa tissue cultures. However, in infectivity trials, one of these strains exhibited the highest adhesion capability and proved to be the most virulent for mice, and another (cloned) strain with the poorest adhesion capability failed to cause infection. Other strains exhibited lessened virulence following their extended axenic cultivation. It therefore appears that the in vivo pathogenic potential of the parasites growing in axenic culture is inherently strain-dependent. The findings suggest that although adhesion in whole serum-containing medium is sufficient to differentiate between various Trichomonas isolates, it is insufficiently sensitive to correlate adhesion with virulence. It apparently is important to identify the adhesion-mediating factor(s) in serum or in its Cohn fractions IV-1 and IV-4 and to use it (them) to elucidate the possible correlation between the parasite's capacity to adhere and its pathogenicity.

Pre-existing chronic infraepithelial Trichomonas invasion with consecutive immunodepression enables progression of human immunodeficiency virus: a new concept of acquired immunodeficiency syndrome pathogenesis

All three existing species of human trichomonads cause similar immune and histopathological host responses. The elicited crossimmunity causes interspecific competition of trichomonal infections in their typical localizations, which results in very rare simultaneous colonization of the same host by different species. This phenomenon points to the existence of a unique immune disorder or subclinical sensitization, regardless of which trichomonas species is in question. The total percentage of infestations in all three species points to the most widespread parasitosis, i.e. the immunodepression of human beings. Trichomonaemia has a very strong immunodepressive action. All the other agents, including viruses act only as opportunists.

Mouse intravaginal infection with Trichomonas vaginalis and role of Lactobacillus acidophilus in sustaining infection

Recent work with a mouse model of Trichomonas vaginalis infection indicated that only 25% of mice harbor Lactobacillus spp. and that T. vaginalis infection rates fall rapidly after 7 days postinfection. In women infected with T. vaginalis, there is a disruption of the Lactobacillus population, which usually predominates. In an attempt to establish a better mouse intravaginal infection that resembles human disease, we established Lactobacillus acidophilus in estrogenized BALB/c mice. T. vaginalis was then inoculated intravaginally into mice previously infected with L. acidophilus and into mice in an untreated group. From 52 mice, 50-microliters vaginal washes were collected, cultured, and examined daily for live trichomonads after inoculation. Although initial infectivity in the two groups was comparable (79 to 83%), L. acidophilus-infected mice showed greater duration of infection. At day 24 postinfection, 69% of L. acidophilus-infected mice were still infected with T. vaginalis compared with only 11% of untreated mice (P = 0.002). The addition of L. acidophilus did not significantly alter the resident mouse vaginal flora. By the addition of L. acidophilus, the mouse will be valuable for studying factors involved in T. vaginalis infectivity and pathogenicity.

Vaginal leukocyte characteristics in urogenital trichomoniasis

Morphological and functional characteristics of vaginal exudate leukocytes were examined in 47 patients with urogenital trichomoniasis. Electron microscopic morphology, viability, phagocytosis of Candida albicans blastospores and ability to undergo respiratory burst in the iodonitrotetrazolium reductase test were evaluated in these cells. Vaginal inflammatory leukocytes were almost exclusively polymorphonuclear neutrophils, and their concentration was positively correlated (r = 0.58; p less than 0.001) with the number of trichomonads in the exudate. Median leukocyte viability reached 39% and both phagocytic and tetrazolium reductase activities of these cells were significantly reduced in comparison with those of circulating polymorphonuclear leukocytes. Patients with a clinical picture of severe mucosal inflammation had significantly higher vaginal exudate leukocyte concentrations and viability than those without inflammatory signs. The possible role of vaginal leukocytes in the pathogenesis of urogenital trichomoniasis is discussed.

Molecular probe for identification of Trichomonas vaginalis DNA

Trichomoniasis is one of the most widespread sexually transmitted diseases in the world. Diagnosis can be achieved by several methods, such as direct microscopic observation of vaginal discharge, cell culture, and immunological techniques. A 2.3-kb Trichomonas vaginalis DNA fragment present in strains from diverse geographic areas was cloned and used as a probe to detect T. vaginalis DNA in vaginal discharge by a dot blot hybridization technique. This probe was specific for T. vaginalis DNA. It recognized strains from two regions in Italy (Sardinia, Piemonte) and from Mozambique (Africa). In addition, our probe did not cross-react with bacterial (Escherichia coli, Enterococcus spp., group B streptococci, Gardnerella vaginalis, Neisseria gonorrhoeae, Chlamydia trachomatis, and Lactobacillus spp.), viral (herpes simplex virus type 2), fungal (Candida albicans), protozoan (Entamoeba histolytica, Giardia lamblia, Plasmodium falciparum, Leishmania major, and Leishmania infantum), or human nucleic acids. The probe reacted with Pentatrichomonas hominis and Trichomonas foetus. The limit signal recognized by our probe corresponded to the DNA of 200 T. vaginalis isolates. The 2.3-kb probe was used in a clinical analysis of 98 samples. Of these, 20 samples were found to be positive both with the probe and by cell culture, and only 14 of these were positive by a standard wet mount method.

Characterization of Trichomonas vaginalis haemolysis

The haemolytic activity of live Trichomonas vaginalis organisms was investigated. Optimal haemolysis of human erythrocytes was observed at a parasite to erythrocyte ratio of 1:5 during a 2 h incubation period. No haemolytic activity was detected in concentrated culture supernatants after overnight growth of trichomonads or when parasites were separated from erythrocytes by a 3 microns filter, suggesting a contact-dependent mechanism for haemolysis. The haemolytic activity was temperature-dependent and maximal haemolysis occurred at 37 degrees C. Treatment of trichomonads with metronidazole reduced levels of haemolysis by greater than 50%. Maximal haemolysis occurred at the pH range of the vagina during trichomoniasis. N-alpha-tosyl-L-lysyl-chloromethyl ketone and iodoacetamide, inhibitors of trichomonad cysteine proteinases, reduced the haemolytic activity of live parasites.

Vulvovaginitis and cervicitis

Measures designed to reduce the incidence of cervicitis are those that make transmission of any STD less likely. Consistent and proper use of contraception, especially condoms, should be encouraged. Patients with a history of cervicitis or other STDs should be targeted for being at high risk and should have periodic screening tests to search for pathogens such as N. gonorrhoeae and C. trachomatis, even at times when they are asymptomatic. Other groups, including patients with multiple sexual partners, those with genitourinary symptoms, pregnant adolescents, and some adolescent clinic populations, also should be considered at increased risk and be monitored similarly. To be effective, encounters with adolescents around matters related to sexuality and STD must be done privately and with confidentiality assured. Special attention should be paid to the adolescent's family and cultural milieu, as well as to their level of psychosocial development, so that specific needs, fears, and misconceptions can be addressed. Cervicitis and other STDs are so common and have such important personal and public health implications that identification and effective treatment are of critical importance. The general tendency to be parsimonious when fitting together signs and symptoms into a medical diagnosis must be modified when dealing with STDs as multiple concomitant infections do occur routinely.

Venereal trichomoniasis: role of men

It has been suggested that high zinc concentrations found in men may prevent Trichomonas vaginalis from being established in the male reproductive tract. In this investigation T vaginalis was readily killed at concentrations of zinc that occur in the prostatic fluid of healthy men (minimum trichomonacidal concentration (MTC) of 6.4 mmol/l). T vaginalis was also shown to be killed by human prostatic extracts as well as by human seminal fluid, even when the zinc content was much lower than the MTC for T vaginalis. It seems likely, therefore, that there are at least two antitrichomonal mechanisms in the male reproductive tract, one being zinc dependent and the other not relating to zinc content. Tritrichomonas foetus, which causes venereal trichomoniasis in cattle, was unaffected by bovine seminal fluid and was killed by zinc only at concentrations far higher than those found in the prostatic fluid in the bull (MTC 200 mmol/l).

[Detection of IgG antibodies with immunofluorescent antibody technique in human trichomoniasis]

The indirect fluorescent antibody(IFA) test was used to detect serum IgG and IgM antibodies to Trichomonas vaginalis in 31 vaginal trichomoniasis, 7 candidiasis and in 20 non-infected healthy wonem with antigen prepared from axenic culture of Trichomonas vaginalis isolated from vulvovaginitis patient. The results were as follows: In 31 vaginal trichomoniasis the positive reactions of IgG antibody were 27 in the 1/8 dilution or higher and 4 in the 1/4 dilution whereas in healthy women the reaction showed signigicantly low as in the 1/4 dilution of below. The sensitivity and specificity of IFA test for IgG antibody to trichomonad antigen in this study were 87.1% and 100%, respectively. No significant difference of IgM antibody levels between vaginal trichomoniasis and healthy women was observed. No relation between the levels of IgG and IgM antibodies to trichomonad antigen by IFA test was observed. No relation between the time lapse and the level of serum IgG antibodies in IFA test of vaginal trichomoniasis was regarded. In conclusion the present study suggests that IFA test in trichomoniasis could be a useful tool for detection of anti-trichomonad IgG antibodies and applicable as an immundiagnostic method.

Growth and cytopathogenicity of Trichomonas vaginalis in tissue cultures

The primary purpose of this study was to identify the mammalian tissue cultures which were most suitable for investigations of the cytopathogenicity of Trichomonas vaginalis. A recently isolated strain of the organism was inoculated into 15 different tissue cultures which were maintained in an appropriately modified growth medium. Proliferation of the protozoon was accompanied by the progressive disintegration of cell culture monolayers. Initial focal lesions consisting of detached cells and an accumulation of trichomonads gradually enlarged until the entire monolayer was disrupted. When judged by the size of the inoculum required to obtain this effect, differences among the tissue cultures were noted. An inoculum of approximately 10(3) viable trichomonads was sufficient to completely disrupt monolayers of HeLa 229, HeLa, McCoy, HEp-2, and RK-13 cells. To obtain a comparable effect with other cells, 10- to 100-fold higher levels of inoculum were required. Polyethylene glycol concentrates from culture filtrates contained a cell-detaching factor (CDF) which caused detachment and clumping of susceptible cells. Freshly seeded cells in growth medium containing CDF failed to form a monolayer. Aggregates of cells maintained for up to 1 week in the presence of CDF remained viable and formed a monolayer after being washed and suspended in normal growth medium. The activity of the CDF was not lost during 1 week of contact with the cells. The CDF may contribute to the pathogenicity mechanisms of T. vaginalis.

Contact-dependent cytopathogenic mechanisms of Trichomonas vaginalis

The cytopathogenic mechanisms of Trichomonas vaginalis have been debated since the 1940s. We examined the following three proposed pathogenic mechanisms: contact-dependent extracellular killing, cytophagocytosis, and extracellular cytotoxins. Serial observations of Chinese hamster ovary (CHO) cell monolayers exposed to trichomonads revealed that (i) trichomonads form clumps, (ii) the clumps adhere to cells in culture, and (iii) monolayer destruction occurs only in areas of contact with T. vaginalis. Kinetic analysis of target cell killing by trichomonads revealed that the probability of CHO cell death was related to the probability of contact with T. vaginalis, supporting the observation by microscopy that trichomonads kill cells only by direct contact. Simultaneous studies of 111indium oxine label release from CHO cells and trypan blue dye exclusion demonstrated that T. vaginalis kills target cells without phagocytosis. Filtrates of trichomonad cultures or from media in which trichomonads were killing CHO cells had no effect on CHO cell monolayers, indicating that trichomonads do not kill cells by a cell-free or secreted cytotoxin. The microfilament inhibitor cytochalasin D (10 micrograms/ml) inhibited trichomonad killing of CHO cell monolayers by 80% (P less than 0.0001). In contrast, the microtubule inhibitor vinblastine (10(-6) M) caused only 17% inhibition of trichomonad destruction of CHO cell monolayers (P less than 0.020), whereas colchicine (10(-6) M) had no effect. T. vaginalis kills target cells by direct contact without phagocytosis. This event requires intact trichomonad microfilament function; microtubule function appears not to be essential.

Electrophoretic analysis of soluble proteins and esterase, superoxide dismutase and acid phosphatase isoenzymes of members of the protozoan family trichomonadidae

Polyacrylamide gel electrophoresis was used to compare the proteins and isoenzymes of esterase, superoxide dismutase, and acid phosphatase in soluble, whole-cell extracts of four strains of Trichomonas vaginalis, two strains of Trichomonas gallinae, and one strain each of Tritrichomonas foetus, Tritrichomonas augusta, Tetratrichomonas gallinarum, and Pentatrichomonas hominis. Intraspecific, interspecific, and intergeneric differences were found in protein and isoenzyme profiles. At least four to seven isoenzymes were detected among the ten strains for each of the three enzymes studied. Each strain usually contained one or two isoenzymes of both esterase and acid phosphatase, and two or three isoenzymes of superoxide dismutase.

Beta-hemolytic activity of Trichomonas vaginalis correlates with virulence

The reasons that some women develop symptomatic trichomonal vaginitis, whereas many other infected women remain asymptomatic, are unclear, but it has been suggested that Trichomonas vaginalis strains vary in their intrinsic virulence. We describe beta-hemolytic activity in T. vaginalis which correlates with virulence in patients as well as in an animal model and in tissue culture. Fresh T. vaginalis isolates from four women with severe, symptomatic trichomoniasis had high-level (86.3 +/- 6.6%) hemolytic activity, whereas isolates from three completely asymptomatic women had low-level (45.3 +/- 8.4%) hemolytic activity (P less than 0.001). Hemolytic activity also correlated with the production of subcutaneous abscesses in mice (r = 0.74) and with destruction of CHO cell monolayers (r = 0.94). All of the 20 clinical isolates of T. vaginalis tested possessed hemolytic activity. The beta-hemolysin may be a virulence factor for T. vaginalis.

Antibody to Trichomonas vaginalis in human cervicovaginal secretions

Human cervicovaginal secretions were obtained from patients at the Gynecology and Obstetrics Clinics at National Taiwan University Hospital and Cathay General Hospital, Republic of China. Among the 500 patients examined, 33 (6.6%) were infected with Trichomonas vaginalis as determined by the culture method. Secretions from 24 of the infected patients and 30 noninfected women were assayed for anti-T. vaginalis immunoglobulins by the indirect immunofluorescent antibody technique. A few serum samples from both infected and noninfected persons were also included in this study. Immunoglobulin G (IgG) antibody against T. vaginalis was detected in 17 (70.8%) secretions from the infected women. Among the 17 positive secretions, anti-parasite IgA was found in two specimens, IgE was found in three, and IgM was found in one. Of the 30 secretions, 7 (23.3%) from noninfected women also contained anti-parasite IgG. Low levels of natural anti-trichomonad IgG and IgM were detected in the sera of normal persons. Infection with T. vaginalis caused an increase in the serum IgG antibody titer. Cross-reaction between T. vaginalis and Pentatrichomonas hominis was also observed.

Trichomonas vaginalis: alternative pathway activation of complement

Serum from adult human donors lysed Trichomonas vaginalis. The lytic effect was eliminated by heat-inactivation of serum (56 degrees C, 30 min). No serum donor exhibited significantly increased antibody against the parasite as measured by indirect immunofluorescence. Treatment of serum with ethylene glycol-bis (B-aminoethyl ether)-N, N-tetraacetic acid to eliminate classical pathway complement activation did not prevent C3 leads to C3i conversion in serum incubated with T. vaginalis. Release of complement products during alternative pathway activation may contribute to pathogenesis of trichomonal vaginitis.