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Moghadamizad Z, Khalili JY, Olfatifar M, Badri M, Khazaei S. The prevalence of Trichomonas vaginalis infection among the female population of Iran: a systematic review and meta-analysis. Int Health 2024; 16:240-251. [PMID: 37555353 PMCID: PMC11062198 DOI: 10.1093/inthealth/ihad059] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/26/2023] [Revised: 07/18/2023] [Accepted: 07/24/2023] [Indexed: 08/10/2023] Open
Abstract
Trichomonas vaginalis is a protozoan parasite and probably one of the main causes of adverse birth outcomes. Still, there is a paucity of information regarding the burden of T. vaginalis infection in Iranian women. To address this gap, we conducted a systematic review and meta-analysis of studies on trichomoniasis among females in Iran from January 2000 to January 2023. We searched multiple electronic databases (PubMed, Science Direct, Scopus, ProQuest, Web of Science, Google Scholar, Scientific Information Database, Iran Medex, Magiran and Iran Doc) and identified 108 articles with a total of 200 728 women. Using a random effects model, we found a pooled prevalence of 4.30% (95% CI 3.23 to 5.52%). Subgroup analysis, also, demonstrated a statistically significant association between the T. vaginalis prevalence in Iranian women, and the age range, city, sample type, being in prison, sex working and symptomatic infections. Our findings provide important information for healthcare authorities and can inform prevention strategies against trichomoniasis in Iran.
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Affiliation(s)
- Zeinab Moghadamizad
- Department of Parasitology, Faculty of Medical Sciences, Tarbiat Modares University, Tehran, Iran
| | - Javad Yazdizadeh Khalili
- Department of Parasitology, Faculty of Medical Sciences, Tarbiat Modares University, Tehran, Iran
| | - Meysam Olfatifar
- Gastroenterology and Hepatology Diseases Research Center, Qom University of Medical Sciences, Qom, Iran
| | - Milad Badri
- Medical Microbiology Research Center, Qazvin University of Medical Sciences, Qazvin, Iran
| | - Sasan Khazaei
- Department of Parasitology, Faculty of Medical Sciences, Tarbiat Modares University, Tehran, Iran
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Bahreini MS, Sedghi S, Badalzadeh Y, Motazedian MH, Shirani M, Jahromi SS, Teimouri A, Agholi M, Asgari Q. Molecular diagnosis of Trichomonas vaginalis in liquid-based Papanicolaou samples in Shiraz, southern Iran. BMC Womens Health 2023; 23:6. [PMID: 36604666 PMCID: PMC9817326 DOI: 10.1186/s12905-022-02141-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/21/2022] [Accepted: 12/20/2022] [Indexed: 01/07/2023] Open
Abstract
BACKGROUND Trichomoniasis is a parasitic infection of the urinary and genital tract, caused by Trichomonas vaginalis. This study aimed to investigate the molecular diagnosis of T. vaginalis infection in liquid-based Papanicolaou samples in Shiraz, southern Iran. MATERIALS AND METHODS In this cross-sectional study, 534 liquid-based Papanicolaou samples were collected from women referring to the laboratory of Motahari Clinic of Shiraz University of Medical Sciences in 2021. Genomic DNA were extracted from the samples and examined for evidence of T. vaginalis using polymerase chain reaction (PCR) using TVK3 and TVK7 specific primers. RESULTS The mean age of participants was 39.28 ± 9.89 with a maximum age of 65 and a minimum age of 19 years. T. vaginalis DNA fragments were detected in 4.86% (26/534) of the cases. There was significantly higher prevalence in the age groups of 21 to 30 and 41 to 50 years (46.15%, p = 0.001 and 38.46%, p = 0.015, respectively). Furthermore, the results showed an association between a history of foamy discharge and Trichomonas positivity (p = 0.001). CONCLUSION T. vaginalis infection is common in liquid-based Papanicolaou samples of women who attended regular health check-ups in the study area. Screening for trichomoniasis in populations, particularly if using highly sensitive methods such as PCR, may lead to increased detection and treatment.
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Affiliation(s)
- Mohammad Saleh Bahreini
- grid.412571.40000 0000 8819 4698Department of Parasitology and Mycology, School of Medicine, Shiraz University of Medical Sciences, Shiraz, Iran
| | - Samaneh Sedghi
- grid.412571.40000 0000 8819 4698Department of Parasitology and Mycology, School of Medicine, Shiraz University of Medical Sciences, Shiraz, Iran
| | - Yalda Badalzadeh
- grid.412571.40000 0000 8819 4698Department of Parasitology and Mycology, School of Medicine, Shiraz University of Medical Sciences, Shiraz, Iran
| | - Mohammad Hossein Motazedian
- grid.412571.40000 0000 8819 4698Department of Parasitology and Mycology, School of Medicine, Shiraz University of Medical Sciences, Shiraz, Iran
| | - Manouchehr Shirani
- grid.412571.40000 0000 8819 4698Department of Parasitology and Mycology, School of Medicine, Shiraz University of Medical Sciences, Shiraz, Iran
| | - Sareh Sami Jahromi
- grid.412571.40000 0000 8819 4698Department of Pathology, School of Medicine, Shiraz University of Medical Sciences, Shiraz, Iran
| | - Aref Teimouri
- grid.412571.40000 0000 8819 4698Department of Parasitology and Mycology, School of Medicine, Shiraz University of Medical Sciences, Shiraz, Iran
| | - Mahmoud Agholi
- grid.411135.30000 0004 0415 3047Department of Parasitology and Mycology, School of Medicine, Fasa University of Medical Sciences, Fasa, Iran
| | - Qasem Asgari
- grid.412571.40000 0000 8819 4698Department of Parasitology and Mycology, School of Medicine, Shiraz University of Medical Sciences, Shiraz, Iran
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Turan Faraşat V, Balcıoğlu İC, Solmaz Hasdemir P, Gümüş E. Comparison of Diagnostic Methods for Detection of Trichomonas vaginalis in Prediagnosed Vaginitis Cases and Its Association with Various Pathogens. TURKIYE PARAZITOLOJII DERGISI 2022; 46:167-171. [PMID: 36094115 DOI: 10.4274/tpd.galenos.2022.02996] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/15/2023]
Abstract
OBJECTIVE Parasitological diagnostic methods such as direct microscopy, staining examination and culture methods are frequently used in the diagnosis of Trichomonas vaginalis (T. vaginalis). Though, nowadays, new diagnostic methods, especially DNA-based methods, are developing, enabling the simultaneous recognition of different pathogens. In our study, we evaluated whether the choice of multiplex polymerase chain reaction (PCR), in which T. vaginalis and different pathogens can be detected, is be an alternative to classical methods and to evaluate the possible coexistence of pathogens. METHODS In our study, swab samples taken during routine examination of 100 female patients who presented to Manisa Celal Bayar University and Manisa City Hospital Outpatient Clinics Obstetrics and Gynecology were evaluated. The presence of T. vaginalis was investigated in these samples by direct microscopy, Giemsa stain and culture. Besides T. vaginalis, other possible agents were also investigated by real-time multiplex PCR method. RESULTS At least one agent was detected in 85 (85%) of the 100 patient samples included in our study. T. vaginalis positivity was detected in 6 (6%) of the samples by parasitological diagnosis methods and in 10 (10%) of the samples by multiplex PCR. Additionally, with real-time multiplex PCR, Chlamydia trachomatis in 4 (4%), Neisseria gonorrhoeae in 3 (3%), Ureaplasma urealyticum/parvum in 68 (68%), Gardnerella vaginalis in 68 (68%) and Herpes simplex virus 1/2 in 1 (1%) of the sample positivity was found. Mycoplasma genitalium, another agent examined by multiplex PCR, was not found positive in any sample. The Kappa value of the culture that is a parasitological test and multiplex PCR for T. vaginalis showed moderate agreement with 59.5%. CONCLUSION It has been concluded that using real-time multiplex PCR method, which has high specificity and sensitivity, in addition to microscopy and culture methods in the diagnosis of T. vaginalis, could contribute to the correct and effective treatment by detecting multiple infections.
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Affiliation(s)
| | - İbrahim Cüneyt Balcıoğlu
- Manisa Celal Bayar Üniversitesi Tıp Fakültesi, Tıbbi Parazitoloji Anabilim Dalı, Manisa, Türkiye
| | - Pınar Solmaz Hasdemir
- Manisa Celal Bayar Üniversitesi Tıp Fakültesi, Kadın Hastalıkları ve Doğum Anabilim Dalı, Manisa, Türkiye
| | - Ertaç Gümüş
- Manisa Şehir Hastanesi, Kadın Hastalıkları ve Doğum Kliniği, Manisa, Türkiye
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Trichomonas vaginalis follow-up and persistence in Colombian women. Sci Rep 2021; 11:22597. [PMID: 34799668 PMCID: PMC8604905 DOI: 10.1038/s41598-021-02135-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/04/2021] [Accepted: 11/10/2021] [Indexed: 11/09/2022] Open
Abstract
Trichomonas vaginalis (TV), the most common non-viral sexually-transmitted infection is considered a neglected infection and its epidemiology is not well known. This study determined TV-infection dynamics in a retrospective cohort of Colombian women and evaluated associations between risk factors and TV-outcome. TV was identified by PCR. Cox proportional risk models were used for evaluating the relationship between TV-outcome (infection, clearance and persistence) and risk factors (sexually-transmitted infections and sociodemographic characteristics). Two hundred and sixty-four women were included in the study; 26.1% had TV at the start of the study, 40.9% suffered at least one episode of infection and 13.0% suffered more than one episode of TV during the study. Women suffering HPV had a greater risk of TV-infection (aHR 1.59), high viral-load (> 102) for HPV-16 being related to a greater risk of persistent parasite infection; a high viral load (> 102) for HPV-18 and -33 was related to a lower probability of TV-clearance. Ethnicity (afrodescendent/indigenous people: aHR 5.11) and having had more than two sexual partners (aHR 1.94) were related to greater risk of infection, contrasting with women having a background of abortions and lower probability of having TV (aHR 0.50). Women aged 35- to 49-years-old (aHR 2.08), increased years of sexual activity (aHR 1.10), multiple sexual partners (aHR 8.86) and multiparous women (aHR 3.85) led to a greater probability of persistence. Women whose cervical findings worsened had a 9.99 greater probability of TV-persistence. TV distribution was high in the study population; its coexistence with HPV and other risk factors influenced parasite infection dynamics. The results suggested that routine TV detection should be considered regarding populations at risk of infection.
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Bolumburu C, Zamora V, Muñoz-Algarra M, Portero-Azorín F, Escario JA, Ibáñez-Escribano A. Trichomoniasis in a tertiary hospital of Madrid, Spain (2013-2017): prevalence and pregnancy rate, coinfections, metronidazole resistance, and endosymbiosis. Parasitol Res 2020; 119:1915-1923. [PMID: 32405804 DOI: 10.1007/s00436-020-06688-2] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/26/2020] [Accepted: 04/07/2020] [Indexed: 01/31/2023]
Abstract
Trichomoniasis is the most prevalent curable sexually transmitted infection (STI) worldwide and a risk factor for the acquisition of other STIs and adverse pregnancy outcomes. The objectives of this study were to determine the prevalence of T. vaginalis and related coinfections in women attending a third-level hospital of Madrid (Spain). A retrospective study of 24,173 vaginal exudates from women with suspected vaginitis was conducted between 2013 and 2017. Likewise, among T. vaginalis positive samples, co-occurrence with gonorrhea, chlamydia, syphilis, VIH, Mycoplasma hominis, and Ureaplasma urealyticum was checked. Moreover, seven T. vaginalis isolates from 2017 were randomly collected for endobionts, drug resistance, and microsatellite (MS) instability determinations. The prevalence of T. vaginalis was 0.8% between 2013 and 2017. Less than 20% of patients with trichomoniasis were submitted to a complete screening for other genital pathogens. From that, two patients were coinfected with chlamydia and three with syphilis. Surprisingly, 6.4% of positive samples were diagnosed among pregnant women, showing an alarming increase from 3.2% (2014) to 10% (2017). Among the isolates randomly analyzed, five carried T. vaginalis virus, five harbored mycoplasmas, and one was metronidazole-resistant. The molecular genotyping showed a high variability in the three MS evaluated. To our knowledge, this is the first study in Spain that evaluates the prevalence of trichomoniasis in general and pregnant population and includes biomolecular determinations. These results warn about the increasing prevalence and highlight the importance of including T. vaginalis detection in routine gynecological revisions with special emphasis on childbearing age women and patients with previous STIs.
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Affiliation(s)
- Celia Bolumburu
- Departamento de Microbiología y Parasitología, Facultad de Farmacia, Universidad Complutense de Madrid, Madrid, Spain
| | - Vega Zamora
- Servicio de Microbiología y Parasitología Clínica, Hospital Universitario Puerta de Hierro-Majadahonda, Madrid, Spain
| | - María Muñoz-Algarra
- Servicio de Microbiología y Parasitología Clínica, Hospital Universitario Puerta de Hierro-Majadahonda, Madrid, Spain
| | - Francisca Portero-Azorín
- Servicio de Microbiología y Parasitología Clínica, Hospital Universitario Puerta de Hierro-Majadahonda, Madrid, Spain
| | - José Antonio Escario
- Departamento de Microbiología y Parasitología, Facultad de Farmacia, Universidad Complutense de Madrid, Madrid, Spain
| | - Alexandra Ibáñez-Escribano
- Departamento de Microbiología y Parasitología, Facultad de Farmacia, Universidad Complutense de Madrid, Madrid, Spain.
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Achdiat PA, Dwiyana RF, Feriza V, Rowawi R, Effendi RA, Suwarsa O, Gunawan H. PREVALENCE OF TRICHOMONIASIS IN ASYMPTOMATIC PREGNANT WOMEN POPULATION IN BANDUNG, WEST JAVA, INDONESIA. INDONESIAN JOURNAL OF TROPICAL AND INFECTIOUS DISEASE 2019. [DOI: 10.20473/ijtid.v7i4.8102] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
About 81% of pregnant women with trichomoniasis are asymptomatic, while trichomoniasis in pregnant women can increase the risk of complications, include premature rupture of membranes, preterm birth, and babies with low birth weight. Trichomoniasis can also increase the risk of other sexually transmitted infections (STIs) and human immunodeficiency virus (HIV) transmission. Trichomoniasis case in pregnant women could be influenced by demographic characteristics,, the sexual behavior, and also the diagnostic method used. Until now, there is no data about prevalence of trichomoniasis in pregnant women in Indonesia. The aim of this research was to determine the prevalence of trichomoniasis in pregnant women in Bandung, West Java, Indonesia. A descriptive cross-sectional study was performed in December 2016 until January 2017. The study participants were 50 pregnant women who visit antenatal care to Obstetric and Gynecology Clinic of ’Rumah Sakit Khusus Ibu dan Anak Kota Bandung’, and meet the inclusion and exclusion criteria, through consecutive sampling. The study participants had a history taking, venereological examination, and Trichomonas rapid test from vaginal swabs. Trichomoniasis in this study was diagnosed based on Trichomonas rapid test, a test that uses color immunochromatographic, capillary flow, dipstick technology, and has high sensitivity and specificity in diagnosing trichomoniasis. Almost all participants in this study were low risk pregnant women to have STI based on demographic characteristics and sexual behaviour. The positive Trichomonas rapid test result was found from one of 50 study participants. In conclusion, prevalence of trichomoniasis in pregnant women in Bandung was 2%. Trichomoniasis case in low-risk pregnant women population is still found.
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Huh S. Status of common parasitic diseases in Korea in 2019. JOURNAL OF THE KOREAN MEDICAL ASSOCIATION 2019. [DOI: 10.5124/jkma.2019.62.8.437] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022] Open
Affiliation(s)
- Sun Huh
- Department of Parasitology and Institute of Medical Education, College of Medicine, Hallym University, Chuncheon, Korea
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Joo SY, Goo YK, Ryu JS, Lee SE, Lee WK, Chung DI, Hong Y. Epidemiology of Trichomoniasis in South Korea and Increasing Trend in Incidence, Health Insurance Review and Assessment 2009-2014. PLoS One 2016; 11:e0167938. [PMID: 27936227 PMCID: PMC5148063 DOI: 10.1371/journal.pone.0167938] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/07/2016] [Accepted: 11/22/2016] [Indexed: 11/17/2022] Open
Abstract
Trichomoniasis, which is caused by Trichomonas vaginalis, is one of the most common non-viral sexually transmitted infections; however, limited population-based data are available that describe patterns and trends of the disease. We summarized insurance claims of trichomoniasis cases reported during 2009-2014 to South Korea Health Insurance Review and Assessment Service. The average annual incidence in South Korea was 276.8 persons per 100,000 population, and a substantial sex-associated variation was observed. The incidence rate among female subjects trended upward over 6 years, that is, it increased from 501 in 2009 to 625.8 in 2014 per 100,000 female population, which indicates a 25% overall increase. This trend was sharpest in the ≥60 years group of female population. However, a 66% decrease in incidence rates was observed among male subjects (23.7 in 2009 to 15.7 in 2014 per 100,000 male population). Further, substantial decrease was observed in the ≥40 years groups of male population. The incidence of trichomoniasis varied across regions and was the highest in Jeju province of South Korea. Overall, as the incidence of trichomoniasis appears to have increased in South Korea during 2009-2014, the disease burden is increasing; hence, there is a need to better understand the disease transmission.
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Affiliation(s)
- So-Young Joo
- Department of Parasitology and Tropical Medicine, Kyungpook National University School of Medicine, Daegu, Republic of Korea
| | - Youn-Kyoung Goo
- Department of Parasitology and Tropical Medicine, Kyungpook National University School of Medicine, Daegu, Republic of Korea
| | - Jae-Sook Ryu
- Department of Environmental Biology and Medical Parasitology, Hanyang University College of Medicine, Seoul, Republic of Korea
| | - Sang-Eun Lee
- Division of Malaria and Parasitic Diseases, Korea National Institute of Health, Korea Centers for Diseases Control and Prevention, Osong, Republic of Korea
| | - Won Kee Lee
- Medical Research Collaboration Center in KNUH, Kyungpook National University School of Medicine, Daegu, Republic of Korea
| | - Dong-Il Chung
- Department of Parasitology and Tropical Medicine, Kyungpook National University School of Medicine, Daegu, Republic of Korea
| | - Yeonchul Hong
- Department of Parasitology and Tropical Medicine, Kyungpook National University School of Medicine, Daegu, Republic of Korea
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Goo YK, Shin WS, Yang HW, Joo SY, Song SM, Ryu JS, Kong HH, Lee WK, Chung DI, Hong Y. Loop-Mediated Isothermal Amplification Targeting Actin DNA of Trichomonas vaginalis. THE KOREAN JOURNAL OF PARASITOLOGY 2016; 54:329-34. [PMID: 27417089 PMCID: PMC4977792 DOI: 10.3347/kjp.2016.54.3.329] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 03/20/2016] [Revised: 04/10/2016] [Accepted: 04/16/2016] [Indexed: 11/24/2022]
Abstract
Trichomoniasis caused by Trichomonas vaginalis is a common sexually transmitted disease. Its association with several health problems, including preterm birth, pelvic inflammatory disease, cervical cancer, and transmission of human immunodeficiency virus, emphasizes the importance of improved access to early and accurate detection of T. vaginalis. In this study, a rapid and efficient loop-mediated isothermal amplification-based method for the detection of T. vaginalis was developed and validated, using vaginal swab specimens from subjects suspected to have trichomoniasis. The LAMP assay targeting the actin gene was highly sensitive with detection limits of 1 trichomonad and 1 pg of T. vaginalis DNA per reaction, and specifically amplified the target gene only from T. vaginalis. Validation of this assay showed that it had the highest sensitivity and better agreement with PCR (used as the gold standard) compared to microscopy and multiplex PCR. This study showed that the LAMP assay, targeting the actin gene, could be used to diagnose early infections of T. vaginalis. Thus, we have provided an alternative molecular diagnostic tool and a point-of-care test that may help to prevent trichomoniasis transmission and associated complications.
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Affiliation(s)
- Youn-Kyoung Goo
- Department of Parasitology and Tropical Medicine, Kyungpook National University School of Medicine, Daegu 41944, Korea
| | - Won-Sik Shin
- Department of Obstetrics and Gynecology, Shinsegae Women's Hospital, Daegu 41535, Korea
| | - Hye-Won Yang
- Department of Parasitology and Tropical Medicine, Kyungpook National University School of Medicine, Daegu 41944, Korea
| | - So-Young Joo
- Department of Parasitology and Tropical Medicine, Kyungpook National University School of Medicine, Daegu 41944, Korea
| | - Su-Min Song
- Department of Parasitology and Tropical Medicine, Kyungpook National University School of Medicine, Daegu 41944, Korea
| | - Jae-Sook Ryu
- Department of Environmental Biology & Medical Parasitology, Hanyang University College of Medicine, Seoul 04763, Korea
| | - Hyun-Hee Kong
- Department of Parasitology, Dong-A University College of Medicine, Busan 49201, Korea
| | - Won-Ki Lee
- Center of Biostatistics, Kyungpook National University School of Medicine, Daegu 41944, Korea
| | - Dong-Il Chung
- Department of Parasitology and Tropical Medicine, Kyungpook National University School of Medicine, Daegu 41944, Korea
| | - Yeonchul Hong
- Department of Parasitology and Tropical Medicine, Kyungpook National University School of Medicine, Daegu 41944, Korea
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Kim SR, Kim JH, Gu NY, Kim YS, Hong YC, Ryu JS. Prevalence of Trichomoniasis by PCR in Women Attending Health Screening in Korea. THE KOREAN JOURNAL OF PARASITOLOGY 2016; 54:187-90. [PMID: 27180577 PMCID: PMC4870969 DOI: 10.3347/kjp.2016.54.2.187] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 02/24/2016] [Revised: 03/22/2016] [Accepted: 04/05/2016] [Indexed: 11/23/2022]
Abstract
Trichomoniasis is the most common curable sexually-transmitted infection (STI) worldwide. There are few reports on the prevalence of Trichomonas vaginalis in Korea. The purpose of this study was to examine the prevalence of trichomoniasis by PCR in Guri city, Korea. All adult women who visited Hanyang University Guri Hospital for health screening within the National Health Care Service were invited to participate in the study, and 424 women were enrolled between March and June 2011. PCR was used to detect Trichomonas vaginalis using primers based on a repetitive sequence cloned from T. vaginalis (TV-E650). Fourteen women (3.3%) were found to have T. vaginalis. All were over 50, and they were significantly older on average than the 410 Trichomonas-negative women (mean ages 63.4 vs 55.3 years). It seems that T. vaginalis infection is not rare in women receiving health screening, especially among those over 50.
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Affiliation(s)
- Seung-Ryong Kim
- Department of Obstetrics and Gynecology, Hanyang University Guri Hospital, College of Medicine, Guri 11923, Korea
| | - Jung-Hyun Kim
- Department of Environmental Biology and Medical Parasitology, Hanyang University College of Medicine, Seoul 04763, Korea
| | - Na-Yeong Gu
- Department of Environmental Biology and Medical Parasitology, Hanyang University College of Medicine, Seoul 04763, Korea
| | - Yong-Suk Kim
- Department of Biochemistry and Molecular Biology, Hanyang University College of Medicine, Seoul 04763, Korea
| | - Yeon-Chul Hong
- Department of Parasitology, School of Medicine, Kyungpook National University, Daegu 41944, Korea
| | - Jae-Sook Ryu
- Department of Environmental Biology and Medical Parasitology, Hanyang University College of Medicine, Seoul 04763, Korea
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