British Association for Sexual Health and HIV (BASHH) United Kingdom national guideline on the management of Trichomonas vaginalis 2021

The main objective of this guideline is to assist practitioners in managing individuals diagnosed with Trichomonas vaginalis (TV). It offers recommendations on the diagnostic tests, treatment regimens and health promotion principles needed for the effective management of TV. It covers the management of the initial presentation, as well as how to prevent transmission and future re-infection. It is aimed primarily at people aged 16 years or older presenting to health care professionals, working in departments offering specialist care in sexually transmitted infection (STI) management within the United Kingdom. However, the principles of the recommendations are applicable across all levels of STI care providers (N.B. non-specialist services may need to develop, where appropriate, local care pathways).

Outbreak of cryptosporidiosis in African penguins Spheniscus demersus

Cryptosporidium spp. are parasitic intracellular protozoa that infect the digestive, respiratory, and urinary tracts of vertebrates. The disease affects many different avian species across all continents, and >25 species and genotypes of Cryptosporidium have been documented infecting birds. We report on an outbreak of cryptosporidiosis in African penguin Spheniscus demersus chicks admitted to a rehabilitation center in South Africa from February 2012 to October 2013. Eighteen cases were confirmed through histopathology. The most frequent clinical signs were regurgitation (78%), dyspnea (72%), decreased weight gain or weight loss (72%), and lethargy (50%). Clinical signs began 8-46 d after hatching or admission (median: 13 d), and death followed 1-41 d after the onset of clinical signs (median: 13.5 d). The most frequent necropsy findings were stomach distended with undigested food or gas (78%), mildly reddened lungs (56%), spleen petechial hemorrhage (44%), and kidney congestion (39%). The most frequent histopathological findings were necrotic bursitis (89%), necrotic enteritis (83%), and bursal atrophy (67%). Small round or oval basophilic bodies (3-5 µm diameter) consistent with Cryptosporidium sp. were closely associated with the surface of the epithelial cells or in the lumen of the bursa (89%), large intestine (61%), small intestine (44%), trachea (22%), and ventriculus (6%). Transmission electron microscopy of 1 case confirmed that these organisms were Cryptosporidium sp. To our knowledge, this is the first report of cryptosporidiosis in penguins, raising concern of the potential implications for the conservation of these species.

Intravenous metronidazole, liquid tinidazole, and intra-vaginal boric acid to cure trichomonas in a patient with gastric bypass surgery

This study presents a case report of a female patient with symptomatic refractory Trichomonas vaginalis infection who was not able to clear her infection with high-dose oral metronidazole, oral tinidazole, intra-vaginal zinc sulfate, intra-vaginal metronidazole, intra-vaginal tinidazole, and intra-vaginal boric acid. She was unable to tolerate intra-vaginal paromomycin. A combination of intravenous metronidazole, oral tinidazole liquid suspension, and intra-vaginal boric acid for 14 days subsequently achieved a complete symptomatic and laboratory cure.

Large two-centre study into the prevalence of Mycoplasma genitalium and Trichomonas vaginalis in the Netherlands

Mycoplasma genitalium and Trichomonas vaginalis are common sexually transmitted infections (STIs). In the Netherlands, testing for M. genitalium and T. vaginalis is not recommended for first-line STI screening. Recent reports about the increasing antimicrobial resistance in M. genitalium raise concern about the adequacy of current empirical treatment regimens. It is necessary to have insight in the prevalence of M. genitalium and T. vaginalis in order to evaluate current first-line STI screening and treatment protocols. During a five-month period, samples sent to two large medical microbiology diagnostic centres in the Netherlands for STI screening (Chlamydia trachomatis and Neisseria gonorrhoeae) were retrospectively tested for the prevalence of M. genitalium and T. vaginalis using the Diagenode S-DiaMGTV kit. A total of 1569 samples from 1188 unique patients (55.4% female) were tested. M. genitalium was the second most prevalent STI detected (4.5% of the patients), after C. trachomatis (8.3%). T. vaginalis was detected in 1.4% of the patients, comparable to the prevalence of N. gonorrhoeae (1.3%). Dual infections were only detected in a small number of patients (1.0%). Incorporation of M. genitalium into routine STI screening should be considered, because of its relatively high prevalence, the consequences of its detection for antibiotic treatment and because of the availability of easy-to-use molecular diagnostic tests. For T. vaginalis, routine screening may be considered, depending on local prevalence and (sub)population.

A novel Sarcocystis neurona genotype XIII is associated with severe encephalitis in an unexpectedly broad range of marine mammals from the northeastern Pacific Ocean

Sarcocystis neurona is an important cause of protozoal encephalitis among marine mammals in the northeastern Pacific Ocean. To characterise the genetic type of S. neurona in this region, samples from 227 stranded marine mammals, most with clinical or pathological evidence of protozoal disease, were tested for the presence of coccidian parasites using a nested PCR assay. The frequency of S. neurona infection was 60% (136/227) among pinnipeds and cetaceans, including seven marine mammal species not previously known to be susceptible to infection by this parasite. Eight S. neurona fetal infections identified this coccidian parasite as capable of being transmitted transplacentally. Thirty-seven S. neurona-positive samples were multilocus sequence genotyped using three genetic markers: SnSAG1-5-6, SnSAG3 and SnSAG4. A novel genotype, referred to as Type XIII within the S. neurona population genetic structure, has emerged recently in the northeastern Pacific Ocean and is significantly associated with an increased severity of protozoal encephalitis and mortality among multiple stranded marine mammal species.