Association of Trichomonas vaginalis with sociodemographic factors and other STDs among female inmates in Lisbon

A study on STDs was conducted among 211 female inmates in a prison in Lisbon, Portugal, in order to establish possible associations between Trichomonas vaginalis infection, sociodemographic factors and other STDs. T. vaginalis was found in 31.2% of the women, from whom only 65.1% presented symptoms. It was more frequently isolated in the 20–40 year age group. On univariate analysis there was an association, although not statistically significant, between the existence of T. vaginalis, multiple sexual partners, drug addiction and no condom use. A statistically significant association was found between trichomoniasis, prostitution and other STDs. These were found in 87% of all women. T. vaginalis was detected alone in 23.8% (15/63) of all women with trichomoniasis, while 76.2% (48/63) of them had multiple infections with trichomonas and other STDs. A statistically significant association was present between trichomoniasis and Mycoplasma hominis and infection with Treponema pallidum. This study showed that the prevalence of T. vaginalis is as high as that of multiple infections with other STDs. Therefore, our findings seem to confirm that trichomoniasis serves as a marker for other STDs. Screening for STDs should then be offered to Portuguese inmates, or, at least, these women should be screened for T. vaginalis, as a marker for the other STDs.

Vaginal infections update

Vaginal symptoms are one of the leading reasons that women visit their health care providers. Women often self-diagnose and may treat themselves inappropriately. This article describes the etiology, risk factors, symptoms, diagnosis, and treatment of the 3 most common vaginal infections: bacterial vaginosis, trichomoniasis, and vulvovaginal candidiasis.

[The relation between trichomoniasis and contraceptive methods]

Trichomoniasis is a sexually transmitted disease caused by Trichomonas vaginalis (T. vaginalis) infecting the urogenital system. In this study, the relation between different contraceptive methods used and T. vaginalis infection was investigated. A total of 253 women (aged from 20-48 years) with abnormal vaginal discharges who applied to the Obstetrics and Gynecology outpatient clinic were enrolled in the study. T. vaginalis was diagnosed by microscopic examination of direct and Giemsa stained preparations. In addition, contraceptive methods, such as an intrauterine device (IUD), coitus interruptus (CI), oral contraceptive (OC), condoms, and injection that had been used, were recorded in the patients' questionnaire forms. Of the 253 women, 207 were using one of the contraceptive methods and a total of 22 (8.69%) trichomoniasis cases were observed. T. vaginalis was detected in 13 of 114 IUD users (14.70%), 5 of 34 CI (11.40%) cases, 3 of 31 (9.67%) condom users, 1 of 46 (2.17%) nonusers. There was no relation between women using the method of OC and T. vaginalis infection. T. vaginalis is the cause of vulvovaginitis and women with abnormal vaginal discharges should be investigated for possible trichomoniasis. In this study, detection of a higher rate of T. vaginalis infection in IUD users means that IUD usage might increase the risk of Trichomonas infection.

Aetiological agents of vaginitis in Nigerian women

This study focuses on the identification of aetiological agents of vaginitis in Nigerian women. Study subjects are drawn from patients presenting with lower abdominal pain, vaginal discharge and itching at the gynaecology clinic of Lagos University Teaching Hospital and at the Clinical Centre of the Nigerian Institute of Medical Research, Yaba, Lagos, between January 2001 and July 2002. A total of 250 patients gave informed consent to participate in the study. The patients also had pre- and post-test human immunodeficiency virus (HIV) counselling. Each patient completed a questionnaire in order to provide biographical data, past clinical history and socio-economic background information. A cervical swab (CS) and a high-vaginal swab (HVS) were obtained from each patient. Swab samples were examined for pH and under light microscopy by Gram's stain and as wet preparations in 10% potassium hydroxide. Subsequently, samples were cultured on appropriate media at optimal conditions and a drug sensitivity profile for all isolates was determined by standard methods. Blood samples were screened and confirmed for HIV antibodies. Bacterial, fungal and parasitic pathogens were identified or isolated in samples from 241 (96.4%) of the women. Bacterial agents (Neisseria, Streptococcus and Staphylococcus species) were predominant in 128 (51.2%) patients, followed by fungi in 108 (43.2%) and parasites (Trichomonas vaginalis) in five (2.0%). Sensitivity to ciprofloxacin was seen in 40% of Staphylococcus species and in 90% of Neisseria species. Positive HIV serology was seen in 25 (10%) of the 250 women studied, 20 (80%) of which had concurrent microbial infections. Overall, a broad spectrum of microbial agents were shown to be responsible for vaginitis in the group of patients studied.

A Community-based study of risk factors for Trichomonas vaginalis infection among women and their male partners in Moshi urban district, northern Tanzania

OBJECTIVE

The objective of this study was to determine predictors of Trichomonas vaginalis among women and their partners in Moshi, Tanzania.

STUDY DESIGN

Women (N = 1440) and their partners (N = 588) were interviewed and specimens for detection of T. vaginalis and sexually transmitted infections (STIs) were collected.

RESULTS

Prevalence of T. vaginalis was 10.7% in women and 6.3% in men. Having a partner with T. vaginalis was the strongest risk factor in women (adjusted odds ratio [OR], 19.44; 95% confidence interval [CI], 7.84-48.25) and men (adjusted OR, 19.01; 95% CI, 6.8-52.40). Risk of T. vaginalis infection was increased in subjects with less education. Other risk factors in women were daily alcohol consumption, being separated, reporting infertility problems, having a partner who had children with other women, and other STIs; and in men, the risk factor was having no income. T. vaginalis was not associated with HIV-1 in women and men.

CONCLUSIONS

Prevention of T. vaginalis and other STIs among couples is a major priority. Reduction of alcohol consumption in women is an important intervention.

Sexually transmitted infections among pregnant women attending an antenatal clinic in Fuzhou, China

OBJECTIVE

To determine the prevalence of sexually transmitted infections (STIs) among women attending an antenatal clinic in urban China and to show whether reported symptoms and findings on clinical examination predicted STIs in this population.

STUDY DESIGN

Cross-sectional descriptive study was conducted among 504 pregnant women attending an antenatal clinic in Fuzhou, China. Structured questionnaires were used to collect demographic and behavioral information, and clinical and gynecologic examinations were performed to detect clinical signs of STIs. Blood samples, vaginal swabs, and cervical swabs were collected, respectively, to test for antibodies to syphilis, culture Trichomonas vaginalis (T. vaginalis), and perform PCR to detect Chlamydia trachomatis (C. trachomatis) and Neisseria gonorrhoeae (N. gonorrhoeae).

RESULTS

C trachomatis was detected in 51 (10.1%), N gonorrhoeae in 4 (0.8%), T vaginalis in 16 (3.2%), and syphilis in 1 (0.2%) of the 504 pregnant women. Fifty-two (73%) of 71 women with any STI were asymptomatic. Multiple logistic regression analysis indicated that age <or=25 years (OR=2.72) and monthly income >RMB 2000 yuan (OR=3.57) were significant independent risk factors for chlamydial infection (P<0.05). The reported symptom of vaginal discharge or the clinical sign of either vaginal or cervical discharge poorly predicted infection with C trachomatis, N gonorrhoeae, or T vaginalis, with a positive predictive value <25% for each STI.

CONCLUSION

A substantial prevalence of STIs, including a large proportion of asymptomatic infections, was found among pregnant women in the study area. These results support a strategy of screening pregnant women for bacterial STIs (followed by treatment of infections), which could be integrated into routine pregnancy care in China.

Dealing with trichomoniasis

Trichomoniasis is a common but less well known sexually transmitted infection affecting men and women. In men it is often asymptomatic and goes undetected. In women it can produce a profuse, frothy, unpleasant-smelling vaginal discharge with pruritus and soreness which is sometimes confused with vulvo-vaginal candidiasis (thrush) and bacterial vaginosis. Women often mistakenly treat themselves for thrush with no result. Diagnosis is by laboratory culture and treatment is with metronidazole. Partner notification and treatment should be undertaken. Trichomoniasis often coexists with chlamydia and gonorrhoea. It can have consequences for reproduction, including low birth weight and preterm labour, and has been found to be a co-factor in the transmission of HIV. It is therefore mandatory to ensure prompt and appropriate treatment for all patients diagnosed with trichomoniasis.

The prevalence of chlamydia, gonorrhea, and trichomonas in sexual partnerships: implications for partner notification and treatment

BACKGROUND

Treatment of sex partners by patient-delivered partner therapy (PDPT) may prove to be an effective strategy in reducing reinfection and preventing the sequelae of sexually transmitted infections (STIs). However, limited data exists regarding STIs within sexual partnerships (dyads).

OBJECTIVE

The objective of this study was to determine the prevalence of Chlamydia trachomatis (CT), Neisseria gonorrhoeae (GC), and Trichomonas vaginalis (TV) in sexual dyads to estimate the potential yield and limitations of PDPT.

METHODS

Male and female STI clinic attendees were invited to participate. Index subjects and partners were interviewed and tested for CT, GC, and TV. All partners were sought regardless of infection status of the index subject.

RESULTS

Of 210 dyads, the prevalence in index subjects was CT, 46%; GC, 18%; and TV, 14%. Considering the partners of 72 CT-only-infected index subjects, 57% had CT, 6% had GC, and 11% had TV. Considering the partners of 35 index subjects with GC or GC-CT coinfection, 57% had GC and/or CT; however, in 20% of partners, unsuspected TV was present. Among 74 dyads with uninfected index subjects, 26% of partners had an STI. Among the partners of 19 index subjects with TV only, 11% had CT, 5% had GC, and 37% had TV.

CONCLUSION

In our clinic population, a substantial number of partners had infections different from or in addition to those infections in the index. Many of these infected partners would not be diagnosed and treated using PDPT. Partners of index attendees without detected infection were at high risk (26%) for STI, mostly CT.

[Analysis on the relative factors of trichomonal vaginitis in married childbearing age women in rural impoverished area]

OBJECTIVE

To investigate the status and relative factors of trichomonal vaginitis among married childbearing age women in rural impoverished area of the northwestern part of China and hence identify the risk factors and provide a basis for the prevention and treatment of trichomonal vaginitis.

METHODS

Questionnaire investigation, gynecological and laboratory examination were carried out in 480 women who had been selected by multi-stage cluster sampling in rural impoverished area of Bao Ji in ShannXi province. A case-control study was conducted to analyze the relative factors of trichomonal vaginitis and other reproductive tract infection (RTI) complications.

RESULTS

The prevalence rate of trichomonal vaginitis was 12.9%, and 64.5% of the cases were complicated with chronic cervicitis, 17.7% were complicated with adnexitis. Uni-variated and multi-variated logistic regression analyses revealed that lack of reproductive health knowledge, bath with polluted water, washing vulva or penis with polluted water before sexual intercourse, having intercourse during menstrual period, having past history of trichomonal vaginitis, as well as no-income woman's and husband's negative attitude towards wife's RTIs were risk factors of trichomonal vaginitis and complicating chronic cervicitis or adnexitis. And lack of reproductive health knowledge, bath with polluted water, washing penis with polluted water before sexual intercourse, past history of trichomonal vaginitis, husband's negative attitude to wife's RTIs were relative factors of trichomonal vaginitis and complicating chronic cervicitis or adnexitis revealed by the binary logistic regression analysis. The less score of reproductive health knowledge, the more risk of suffering from trichomonal vaginitis complicating chronic cervicitis.

CONCLUSION

Compositive and successive prevention and treatment scheme should be used to control trichomonal vaginitis and other RTI complications in rural impoverished area of northwestern China. The scheme should be focused on four ways, including improving sanitation behaviors in couples, insisting on normative treatment, generalizing reproductive health knowledge and mobilizing husbands to pay attention.

Targeted Screening for Trichomonas vaginalis with Culture Using a Two-Step Method in Women Presenting for STD Evaluation

OBJECTIVES

Trichomonas vaginalis is the most common nonviral sexually transmitted pathogen. Wet mount microscopy performs poorly compared with culture; however, universal screening using culture would be cost-prohibitive.

GOAL

The goal of this study was to develop a predictive model for wet mount-negative women who may benefit from targeted use of culture for T. vaginalis detection.

STUDY

Women presenting for sexually transmitted disease evaluation were prospectively screened for trichomoniasis using wet mount and culture. Multivariate logistic regression was used to identify predictors of culture-proven trichomoniasis among wet mount-negative women.

RESULTS

A total of 2194 women were screened for trichomoniasis; overall, the prevalence of T. vaginalis was 17.5%. Three predictors (any drug use, contact to trichomoniasis, and African-American race) provided the most specific model (100%); any 1 predictor, the most sensitive model (97.8%).

CONCLUSIONS

Given the public health impact of trichomoniasis, we recommend using any 1 of 3 predictors to identify women who would benefit from targeted culture for T. vaginalis.

Production of interleukin-8 by human neutrophils stimulated with Trichomonas vaginalis

Neutrophils are the predominant inflammatory cells found in the vaginal discharges of patients infected with Trichomonas vaginalis. Although chemoattractants, such as leukotriene B(4) and interleukin-8 (IL-8), are found in the vaginal discharges of symptomatic trichomoniasis patients, little is known about the mechanism of how neutrophils accumulate or mediate initial inflammatory response after acute T. vaginalis infection. We examined IL-8 production in neutrophils activated by T. vaginalis and evaluated the factors involved in T. vaginalis adherence that might affect IL-8 production. When human neutrophils were stimulated with live trophozoites, T. vaginalis lysate, or T. vaginalis excretory-secretory products, the live trichomonads induced higher levels of IL-8 production than the lysate or products did. When live trichomonads were pretreated with various inhibitors of proteinase, microtubule, microfilament, or adhesin (which are all known to participate in the adherence of T. vaginalis to vaginal epithelial cells), IL-8 production significantly decreased compared with the untreated controls. Furthermore, an NF-kappaB inhibitor (pyrrolidine dithiocarbamate), a mitogen-activated protein (MAP) kinase (MEK) inhibitor (PD98059), and a p38 MAP kinase inhibitor (SB203580) significantly suppressed IL-8 synthesis in neutrophils. These results suggest that live T. vaginalis, particularly adherent trophozoites, can induce IL-8 production in neutrophils and that this action may be mediated through the NF-kappaB and MAP kinase signaling pathways. In other words, T. vaginalis-induced neutrophil recruitment may be mediated via the IL-8 expressed by neutrophils in response to activation by live T. vaginalis.

Predictive value of the clinical diagnosis of lower genital tract infection in women

OBJECTIVE

We hypothesized that diagnostic approaches to lower genital tract infections are inaccurate and proposed this study to evaluate typical approaches.

STUDY DESIGN

Clinical diagnoses were made with symptoms, direct observation, wet mount, vaginal pH, and amines in 598 women with genital complaints. Laboratory testing for N gonorrhoeae, yeast, T vaginalis, C trachomatis, and bacterial vaginosis by Gram stain.

RESULTS

The most frequent symptoms were vaginal discharge (64%), change in discharge (53%), malodor (48%), and pruritus (32%). The infection rates were 46% bacterial vaginosis, 29% yeast, 12% trichomoniasis, 11% chlamydia or gonorrhea; 21% of the patients had no infection. The symptoms did not predict laboratory diagnosis. Clinical signs and symptoms with office-based tests and microscopy improved the accuracy of diagnoses. Amsel's clinical diagnosis of bacterial vaginosis was the most sensitive at 92%. The sensitivity of wet mount diagnosis of trichomoniasis was 62%, of yeast by microscopy was 22%, and of mucopus for the prediction of gonorrhea and/or chlamydia was 30%.

CONCLUSION

Symptoms alone should not be used to direct treatment in instances in which resources permit more complete evaluation with office-based testing that includes microscopy. Treatment failures or diagnostic uncertainty should prompt specific laboratory testing.

Trichomonas vaginalis Among HIV-Infected Women

BACKGROUND AND OBJECTIVES

Trichomonas vaginalis (Tv) is a common sexually transmitted disease (STD) among HIV-infected populations. The relationship between Tv and immune status and HIV viral load as affected by protease inhibitor (PI) use has not been well examined.

GOAL

The goals were to evaluate the association between Tv and both immune status and PI use among HIV-infected women, and to characterize factors associated with Tv among HIV-infected women.

STUDY DESIGN

We used a retrospective cohort study conducted between 1990 and 2000.

RESULTS

Of 1578 women, the majority was under 35 years, black (AA), and infected heterosexually or with unidentified risk. Thirty percent (30.2%) had Tv at least once, and 36.9% had at least one subsequent positive test; Tv was more common than chlamydia, gonorrhea, genital warts, or syphilis. After adjusting for follow-up time, young age, AA race, substance use, and other sexually transmitted diseases (STDs) were associated with initial Tv infection, but pregnancy, immune status, and PI use were not associated. After adjusting for follow-up time, having other STDs was associated with and pregnancy was protective of subsequent Tv positivity, but immune status and PI use were not associated; neither were age, race, or substance use.

CONCLUSION

Tv is a common STD among HIV-infected women and does not appear to be associated with immune status or PI use. Aggressive screening might represent a means of reducing the incidence and prevalence of Tv.

Sexually transmitted infections among female sex workers in Kupang, Indonesia: searching for a screening algorithm to detect cervical gonococcal and chlamydial infections

BACKGROUND AND GOAL

Notifications of HIV infection in Indonesia are increasing, but there are few data on other sexually transmitted infections (STIs), especially in the eastern islands of Indonesia. We aimed to measure the prevalence of STIs among female sex workers (FSWs) in Kupang, West Timor, and to develop screening algorithms to detect cervical infections with Neisseria gonorrhoeae and/or Chlamydia trachomatis (NG/CT).

STUDY DESIGN

During 6 months in 1999, we recruited all the FSWs at Kupang's only brothel complex and a smaller number of independent FSWs. The women were examined at dedicated clinics and most laboratory tests were performed at provincial laboratories. Algorithms based on the strongest associations of variables with NG/CT were compared with the laboratory diagnoses.

RESULTS

We recruited 288 women. The prevalence of N gonorrhoeae infection was 31%, that of C trachomatis infection was 24%, that of Trichomonas vaginalis infection was 5%, and that of syphilis was 13%. No case of HIV infection was detected. Few women had symptoms of STI. The only variables significantly associated with NG/CT after logistic regression analysis were the presence of cervical discharge (either yellow or clear) and a high count of polymorphonuclear leukocytes on gram-stained endocervical smear. Several algorithms to screen for NG/CT achieved high (>80%) sensitivity, but the highest specificity among these was only 50%.

CONCLUSIONS

Although several of the generated algorithms may be useful in the absence of simple, accurate, affordable diagnostic tests, the high rates of STIs in this population could justify a more aggressive strategy incorporating periodic presumptive treatment to rapidly reduce prevalence.

Military women's risk factors for and symptoms of genitourinary infections during deployment

Symptoms of vaginitis and urinary tract infections are miserable, distracting, and significantly affect women's quality of life. Among civilian women, these symptoms account for 10.5 million office visits per year. To examine the scope of the problem for military women during deployment situations, surveys were sent to randomly selected Army and Navy units. Of 841 women who completed the anonymous survey and had been deployed, vaginal infections were experienced by 30.1% and urinary tract infections by 18.4% of them during deployment. Vaginal symptoms were consistent with symptoms associated with the three most common vaginal infections (candida, bacterial, and trichomonas vaginitis). A variety of risk factors, both behavioral and situational, significantly differentiated women with and without infections. Urinary tract infections and vaginal infections are common during deployment situations where resources for self-care and appropriate primary health care for women are scarce or unavailable. One solution is a self-diagnosis and treatment kit for deployed military women.

High prevalence of Neisseria gonorrhoeae and multiple sexually transmitted diseases among rural women in the Eastern Highlands Province of Papua New Guinea, detected by polymerase chain reaction

BACKGROUND

In a previous community-based study among rural women in the Eastern Highlands Province (EHP) of Papua New Guinea we determined that the prevalences of Trichomonas vaginalis infection, Chlamydia trachomatis infection, and syphilis were 46%, 26%, and 4%, respectively. Surprisingly, however, the prevalence of Neisseria gonorrhoeae infection was only 1%, which we considered low in consideration of the high prevalence of other sexually transmitted diseases (STDs). The aim of the current study was to reexamine samples that were collected in that survey and retest them with use of polymerase chain reaction (PCR).

STUDY DESIGN

Using a cluster-sampling method, we surveyed 201 women aged 15 to 45 years in a population of approximately 19,000 people. In addition, 243 other women living in the same area who wished to be screened for STDs were included in the study.

METHODS

Endocervical samples that were stored frozen at -80 degrees C were retested with multiplex PCR (M-PCR) for the detection of both N gonorrhoeae and C trachomatis and with a separate PCR for the detection of T vaginalis.

RESULTS

A total of 373 samples that were still available were analyzed. The prevalences of T vaginalis, C trachomatis, and N gonorrhoeae infections were 42.6%, 26.5%, and 18.2%, respectively; 59.8% of the women had at least one STD, while 21.7% had mixed infections, 5.9% of them with all three pathogens.

CONCLUSIONS

STDs are very common among rural women in the EHP of Papua New Guinea and often present as multiple infections.

Risk factors for vaginal trichomoniasis among women in Basra, Iraq

We investigated Trichomonas vaginalis infection among 352 women with vaginal discharge, 46 were found to be infected, an infection rate of 13%. There were no significant differences in the isolation rate of T. vaginalis in women according to occupation, educational level, economic status, age, marital status, parity, menstrual status and contraception use. The difference in the isolation rates of T. vaginalis in women with a history of abortion (7.6%) and in women with no history of abortion (15.7%) was statistically significant.

Vaginal infections in pregnant women in Jamaica: prevalence and risk factors

Trichomoniasis, bacterial vaginosis (BV) and candidiasis are reproductive tract infections (RTIs) of the vagina. We conducted a cross-sectional study in 4 prenatal clinics in Kingston, Jamaica, to estimate the prevalence of these infections and the risk factors that may facilitate their transmission among pregnant women. Of the 269 women studied, 18.0% had culture-positive trichomoniasis, 44.1% had BV (Nugent score > or = 7) and 30.7% were positive for candidiasis by wet mount. A multiple logistic regression analysis showed that having a malodorous discharge was associated with trichomoniasis (odd ratios [OR]=3.9, confidence intervals [CI]=1.04-14.7) and BV (OR=3.4, CI=1.3-8.7). Women who took action to prevent HIV infection had lower BV prevalence (OR=0.34, CI=0.12-0.98). Women who were employed were less likely to have any of the infections (OR=0.61, CI=0.36-1.03). The strong association of a symptomatic presentation with trichomoniasis and BV suggests the merit of considering syndromic management of vaginitis in this population.

Rates of and risk factors for trichomoniasis among pregnant inmates in New York City

BACKGROUND

Trichomonas vaginalis is a common pathogen that is associated with adverse pregnancy outcomes and may serve as a cofactor in human immunodeficiency virus (HIV) transmission.

GOAL

To define the epidemiology of trichomoniasis in a population of newly incarcerated pregnant women in New York City.

STUDY DESIGN

Prospective study of 213 pregnant prisoners attending prenatal clinic. Patients participated in an interview regarding sexual and drug-related behaviors, and underwent direct culture for T. vaginalis in addition to routine testing for syphilis, gonorrhea, and chlamydia.

RESULTS

The prevalence of trichomoniasis was 46.9%. On univariate analysis, there was a significant association between trichomoniasis and older age, crack use, prostitution, known HIV infection, and positive serological test for syphilis. Multivariate analysis showed a significant association of trichomoniasis with crack use and positive serological test for syphilis.

CONCLUSION

Trichomoniasis is highly prevalent in pregnant prisoners in New York City. The extent of disease observed may justify a formal program of testing and treatment and emphasizes the urgent need for harm reduction education and expanded HIV counseling and testing services in this high-risk population.

Trichomonas vaginalis: in vitro phagocytosis of lactobacilli, vaginal epithelial cells, leukocytes, and erythrocytes

This paper explores the interaction of two strains of Trichomonas vaginalis, of high and low virulence, with the cell types present in the microenvironment of the parasite during human infections. With the use of transmission and scanning electron microscopy the sequence of internalization by T. vaginalis of Döderlein's lactobacilli, and of vaginal epithelial cells, leukocytes, and erythrocytes was documented. Furthermore, the degradation of ingested material by colocalization of acid phosphatase activity in phagocytic vacuoles was demonstrated. Phagocytosis of all cell types analyzed was found in both strains studied, although the highly virulent strain internalized target cells more rapidly than the less virulent one. Ultrastructural evidence indicated that phagocytosis takes place through two distinct mechanisms, only one involving the formation of a phagocytic stoma, characteristic of professional phagocytes. T. vaginalis phagocytosis may be both an efficient means of obtaining nutrients for the parasite and a significant factor in the pathogenesis of trichomonal infections of the human genitourinary tract.

Growth and survival of Trichomonas vaginalis

This study confirmed that Feinberg and Whittington medium was suitable for the cultivation and detailed study of the growth cycle of two clinical strains of Trichomonas vaginalis under anaerobic conditions. Both strains showed a similar growth pattern characterised by early but slow growth, extended duration of the logarithmic phase and limited survival never exceeding 144 h. Duration of survival and growth rate were inversely proportional to the inoculum density. Growth rate was pH dependent; pH values in the range 6.9-6.5 delayed the initiation of growth of T. vaginalis for at least 48 h. On the other hand, pH values of 6.4-4.5 were indifferent or slightly favourable for growth during the logarithmic and survival in the early decline phase. Normal saline and Ringer's solution exerted an early and progressively lethal effect on trichomonads and led to the disappearance of protozoa suspended in them in 150 min. In general, these in-vitro results shed light on some aspects of the biology of T. vaginalis and contribute to a better understanding of the epidemiology and clinical manifestations of the infection.

Epidemiology of trichomonas vaginalis. A prospective study in China

BACKGROUND AND OBJECTIVES

Trichomonas vaginalis infection is probably one of the most common sexually transmitted diseases. The epidemiology of this disease has long been ignored, and not much is known about its natural history and risk factors.

GOALS

The authors conducted this study to define the incidence rates of T. vaginalis infection and to investigate risk factors for the infection.

STUDY DESIGN

A prospective study was carried out on a cohort of 16,797 women followed up from 1974 to 1985 within the framework of a cervical screening program in Jingan, China. Personal interviews were conducted by trained interviewers.

RESULTS

A total of 1489 new cases of T. vaginalis infection were diagnosed with 132,946 person-years of observation. In a multivariate analysis, the increased risk was associated with multiple sexual partners (P = 0.0124) and greater number of induced abortions (P = 0.0028). The relative risks were 1.3 (95% confidence interval [CI], 1.1 to 1.5) for smokers and 1.5 (95% CI, 1.2 to 2.0) for those who drink alcohol. An inverse relationship was observed in older women and in women with cervical atrophy.

CONCLUSIONS

This study confirmed the relationship between T. vaginalis and multiple sexual partners and suggests that the risk for T. vaginalis also may be related to life-style risk factors.

Vaginal yeast infections in diabetic women

Two hundred and three diabetic women (89 with and 114 without genital symptoms) were examined for the presence of yeasts and Trichomonas vaginalis. Yeasts were isolated from the vaginas of 35.5% of patients and were more common in the symptomatic group (48.0%) than the asymptomatic group (25.4%; P < 0.05). Candida albicans was isolated from 12.8% of all patients and showed a significant association with pruritus vulvae (P < 0.05). A significant association was also shown between the presence of yeasts in the rectum and in the vagina. C. glabrata (Torulopsis glabrata) was the commonest yeast species isolated (50.0%), with C. albicans the next most frequent (36.1%). T. vaginalis infection was present in 14.3% of all subjects.

Trichomonas vaginalis haemolysis: evidence of functional pores formation on red cell membranes

We have investigated the mechanisms used by Trichomonas vaginalis to damage cellular membranes, using human erythrocytes as target cells. Haemolysis is a contact- and temperature-dependent phenomenon, and is inhibited in 4 mM EGTA. Osmotic protection experiments using carbohydrates with different molecular diameters as protectants demonstrated that the cytolytic activity of T. vaginalis is inhibited in 75 mM stachyose. On the basis of our data, we hypothesize a cytopathic mechanism mediated by the formation of functional pores into the target membrane. Some of the Trichomonas protein involved in haemolysis have been immunologically characterized.

Recurrent bacterial vaginosis: association with vaginal sponge use

A hypothesis-generation study was conducted to examine risk factors for bacterial vaginosis recurrences among women participating in a randomized controlled trial of male sexual partner treatment. Of the 140 women enrolled in the trial, 72 had a normal vaginal gram-stained slide at the first follow-up visit and were included in this analysis. Nineteen of the 72 (26.2%) women developed a bacterial vaginosis recurrence documented by a vaginal gram-stained slide during the 6-week follow-up period. Of the 19 women, 4 of 6 sponge users (66%) developed a bacterial vaginosis recurrence (RR 2.93, 95% CI: 1.43-6.02). Logistic regression analysis supported the association between sponge use and bacterial vaginosis recurrences (adjusted RR 2.71, 95% CI: 1.06-6.99) but revealed that an apparent protective effect of diaphragm use was due to the confounding effect of sexual partner treatment. Our hypothesis is that bacterial vaginosis recurrences may be due to factors other than sexual transmission, such as sponge use. Further studies are needed to examine risk factors for bacterial vaginosis recurrences. In the interim, physicians might suggest another form of contraception to their sponge-using patient with frequent bacterial vaginosis infections.

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.

Sexually transmitted diseases in postpubertal female rape victims

Seventy-six postpubertal women were referred from a municipal hospital emergency room within 60 h of sexual assault for evaluation. Of the 76 victims, 20 (26%) had active Chlamydia trachomatis infection detected by culture (11 subjects), a fourfold serologic titer rise (6), or both (3). The risk of acquiring C. trachomatis infection after sexual assault was 3%-16%. Pelvic inflammatory disease was detected in 8 (11%) of the 76 victims. Bacterial vaginosis was diagnosed in 38 women (50%), at least 8 of whom appeared to have been infected during the assault. Trichomoniasis was found in 17 victims (22%), at least 5 of whom may have acquired the infection at the time of the assault. In view of the high rates of these infections and the poor compliance with follow-up (76% [58/76] kept their appointments), all postpubertal victims of sexual assault should be offered treatment with ceftriaxone, 250 mg intramuscularly, followed by 100 mg of oral doxycycline and 500 mg of oral metronidazole twice daily for 7 days.

Nonbarrier contraceptives and vaginitis and vaginosis

Within the limitations of the available data, it has been reported that oral contraceptive use versus other contraceptive methods is associated with a greater or similar frequency of candidiasis, increased numbers of anaerobic microorganisms, an increased or similar frequency of chlamydia trachomatis, and a reduced frequency of bacterial vaginosis and trichomoniasis. The impact of contraceptive steroids on cellular and humoral immunologic factors may explain these observations. Intrauterine contraceptive device use is reported to be associated with an increased rate of bacterial vaginosis and anaerobic organism recovery from the vagina regardless of symptoms. Patients having a contraceptive vaginal ring were found to have the same number and types of vaginal organisms as oral contraceptive users. Levonorgestrel-releasing subdermal implant (Norplant, Wyeth-Ayerst, Philadelphia, Pa.) users have been reported to have approximately half the rate of vaginitis and vaginosis compared with that of Copper T-200 intrauterine device users.

Effect of beta-estradiol on production of the cell-detaching factor of Trichomonas vaginalis

Despite over 40 years of study, the pathogenetic mechanisms of Trichomonas vaginalis are just starting to be elucidated. We have recently reported that T. vaginalis produces a virulence factor, cell-detaching factor (CDF), that likely causes the cell sloughing seen in clinical disease. This 200-kDa glycoprotein is acid and heat labile and correlates with clinical symptoms. We applied a McCoy cell culture system to study the effects of various concentrations of beta-estradiol (10(-6) to 10(-10) M) on T. vaginalis growth and CDF production. T. vaginalis growth was unaffected by the different concentrations of beta-estradiol studied, in comparison with the growth of control cultures without beta-estradiol. However, beta-estradiol significantly diminished the activity of CDF at all concentrations and did so most profoundly at 10(-7) and 10(-8) M (P less than 0.0001). This suggests that the symptoms of T. vaginalis infection may be influenced by the vaginal concentration of estrogens, and further studies of the interactions between T. vaginalis and estrogens are warranted.

Association of production of cell-detaching factor with the clinical presentation of Trichomonas vaginalis

Recent work has shown that Trichomonas vaginalis produces a cell-detaching factor (CDF) that causes detachment of monolayer cells in vitro. To study the role of CDF as a pathogenic marker of disease, we studied the production of CDF in 12 clinical isolates of T. vaginalis. These isolates were also utilized in the mouse subcutaneous assay of Honigberg, which is the standard for pathogenicity of T. vaginalis. The isolates were divided into three groups based on clinical presentation (asymptomatic [n = 4], moderate [n = 4], and severe symptoms [n = 4]). CDF was assessed by harvesting the supernatant from the growth of T. vaginalis in cell culture and filtering the supernatant through a 0.45-microns-pore-size filter. The filtrate was applied in a microtiter cytotoxicity assay. The mouse subcutaneous assay did not significantly differentiate among the isolates. However, CDF was strongly associated with clinical presentation by two-way, repeated-measure analysis of variance (P = 0.025). Thus, CDF appears to correlate with clinical presentation and may be an important virulence marker in T. vaginalis pathogenesis.

Cytomegalovirus infection among women attending a sexually transmitted disease clinic: association with clinical symptoms and other sexually transmitted diseases

The prevalence rates of cytomegalovirus, Neisseria gonorrhoeae, Chlamydia trachomatis, Trichomonas vaginalis, and herpes simplex virus infection were determined for 247 women attending a sexually transmitted disease clinic in Halifax, Nova Scotia between July 1983 and December 1985. Isolation rates were 8.5%, 32.8%, 27.1%, 7.3%, and 6.5% for the five infectious agents, respectively. With multiple logistic regression analysis, the presence of cervical cytomegalovirus infection was independently associated with age less than 23 years and with gonococcal infection. Factors predictive of C. trachomatis infection included age less than 23 years, gonococcal infection, oral contraceptive use, and purulent discharge. Number of lifetime sexual partners was statistically associated only with herpes simplex virus infection. N. gonorrhoeae, C. trachomatis, and T. vaginalis were all independently associated with purulent discharge. Cytomegalovirus, N. gonorrhoeae, and C. trachomatis were statistically more likely to be present concurrently with other organisms than to be present as a single infection. Women with another genital infection were 6.5 times more likely to have cytomegalovirus than were women with no other genital infection. Of the 21 women with cytomegalovirus, only two had no other sexually transmitted disease. These findings suggest that N. gonorrhoeae and other sexually transmitted diseases may play a role in either the sexual transmission of or the reactivation of cervical cytomegalovirus infection.

An immunofluorescent study of the microtubule organization in Trichomonas vaginalis using antitubulin antibodies

The flagellated protozoon Trichomonas vaginalis, parasite of the human urogenital tract, possesses a well developed microtubule system organized in highly differentiated structures. We have shown by immunoblotting that monospecific anti-sheep brain tubulin antibodies are able to react with the microtubular tubulin of T. vaginalis. These antibodies were used to study the microtubular system of T. vaginalis both in interphase and mitosis by indirect immunofluorescence. The interphase microtubular pattern, characterized by an axostyle, a pelta, four anterior flagella, and a recurrent flagellum, displayed remarkable changes at the onset of mitosis: the axostyle disappeared, and two pole bodies connected by a short spindle became evident; chromosomal fibers arose while pole-to-pole fibers elongated. The last phases of mitosis were marked by the disappearance of chromosomal fibers, the appearance of two small axostyles, and the depolymerization of the pole-to-pole bundle. At the end of mitosis, the normal interphase microtubule pattern was observed.

[Actinomyces-like organisms in users of intrauterine contraception]

Actinomyces-like organisms (ALO) were found in 6.9% of cervical smears in 2133 IUD users. The chance of having co-infection with Trichomonas vaginalis was 2.7 times higher in women with ALO than in ALO negative women. The proportion of IUD users with ALO in cervical smears increased with the duration of the IUD use. A total of 108 IUD users with ALO were compared with the same number of IUD users without ALO in cervical smears. The women in the two groups were matched for the duration of the IUD use. During the IUD use the women with ALO had PID and vaginitis significantly more frequently than ALO negative women. No difference was found regarding the type of the IUD used in women with ALO in cervical smears compared to controls.