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PubMed1998

Cysteine proteases of Trichomonas vaginalis degrade secretory leukocyte protease inhibitor.

Sexually transmitted diseases, including trichomoniasis, are risk factors for acquisition of human immunodeficiency virus (HIV) infection. Enhancement mechanisms are unknown. Secretory leukocyte protease inhibitor (SLPI) from saliva appears to prevent transmission of HIV through inhibition of virus entry into monocytic cells in vitro. This study was undertaken to determine if secreted cysteine proteases of Trichomonas vaginalis degrade SLPI and render it nonfunctional. It was determined if SLPI levels were decreased in vaginal fluids from pregnant women infected with T. vaginalis. Isolated proteases were incubated with recombinant human SLPI, and the degradation was followed by Western analysis with SLPI antiserum. SLPI levels were measured by ELISA in vaginal fluids from women infected with T. vaginalis and uninfected controls. Cysteine proteases cleaved SLPI and rendered it nonfunctional. Median levels of SLPI from infected patients were 26% of those of controls (P <.005). The degradation of SLPI in association with trichomonal infection may increase the risk of HIV acquisition.

Animals↗
PubMed1997

Polymerase chain reaction analysis of distal vaginal specimens: a less invasive strategy for detection of Trichomonas vaginalis.

We compared polymerase chain reaction (PCR) analysis of specimens obtained from the distal vagina with wet mount microscopy and culture of specimens from the posterior vaginal fornix. One or all three techniques revealed that 61 (20.3%) of 300 women tested were positive for Trichomonas vaginalis. PCR analysis of distal vaginal specimens detected 56 (91.8%) of 61 infections, while wet mount microscopy and culture detected 49 (80.3%) of 61 infections. Results of this study may impact the approach to testing for T. vaginalis by eliminating the requirement of a vaginal speculum examination. The distal vagina is an appropriate testing site for T. vaginalis by PCR analysis.

Animals↗
PubMed1987

An agar culture technique to quantitate Trichomonas vaginalis from women.

In subjects with trichomoniasis the number of Trichomonas vaginalis in vaginal discharges or secretions is unknown. The presence of T. vaginalis was evaluated in 177 consecutive female patients attending an inner city sexually transmitted disease clinic by patient history, wet mount, and broth culture. T. vaginalis was quantitated by a novel agar culture technique. Of the 177 women, 86 (49%) were positive for T. vaginalis by either wet mount or culture. Clinical symptoms were not reliable for making an accurate diagnosis of trichomoniasis. Culture on modified Diamond's medium was more sensitive (98%) than the wet mount method (38%) in detecting T. vaginalis. Of the 86 patients who were positive for trichomoniasis, quantitation was obtained for 81 patients, with 70% yielding greater than 10(4) colony-forming units (cfu)/ml. The number of T. vaginalis ranged from 40 to greater than 10(6) cfu/ml. The wet mount method was very insensitive for detecting T. vaginalis and was positive only in patients yielding greater than 10(5) cfu/ml.

Adolescent↗
PubMed1990

Characteristics of Trichomonas vaginalis isolates from women with and without colpitis macularis.

Colpitis macularis, the most specific clinical sign for diagnosis of trichomoniasis, was detected by colposcopy in 52 of 118 infected women. Patients with colpitis macularis had a mean (+/- SD) of 18 +/- 20 Trichomonas vaginalis organisms/field (x 400 magnification) compared with 7 +/- 17 in patients with colpitis macularis (P less than .003). To compare possible virulence markers in isolates from women with and without colpitis macularis, isolates were analyzed for hemolytic activity, abscess production in an animal model, and adherence to cells in tissue culture. The mean hemolytic activity (relative to complete hemolysis) was 84% for 22 isolates from women with and 78% for 29 isolates from women without colpitis macularis. After subcutaneous injections in mice, abscesses were produced by 70% of isolates from patients with and 68% from patients without colpitis macularis. After a 15-min exposure, 39% of radiolabeled isolates from women with or without colpitis macularis adhered to HeLa cell monolayers. Purulent discharge, the second most useful sign for clinical diagnosis, was associated with colpitis macularis and with the number of organisms per high-power field on wet mount (P less than .01 for each comparison) but was not correlated with any experimental assay. Thus, no experimental characteristic of T. vaginalis isolates was associated with colpitis macularis or purulent vaginal discharge.

Abscess↗
PubMedDate not supplied

Screening for Trichomonas vaginalis infection by use of acridine orange fluorescent microscopy.

The acridine orange test for detection of Trichomonas vaginalis in smears has been adapted for delayed examination of specimens. Mailed-in slides stained by acridine orange were compared with on-site wet mounts; the acridine orange test detected 96% of all positives, whereas only 76% were detected by wet mounts. In a similar comparison with Papanicolaou smears, the acridine orange test detected 89% as compared with 67% detected by Papanicolaou smears.

Acridine Orange↗
PubMedDate not supplied

Trichomonas vaginalis associated with nongonococcal urethritis and prostatitis.

Trichomonas vaginalis was recovered from three (1.7%) of 179 men with nongonococcal urethritis. Prostatitis was found in 11 (8%) of 138 of these men who had prostatic examinations; T. vaginalis was recovered from two of the 11. Serologic evidence (an indirect hemagglutination titer of greater than or equal to 1:80) was found in 20 (14%) of 146 men; four of the 20 had prostatitis and two of these had prostatitis associated with T. vaginalis. In a group of 26 men with urethritis and prostatitis associated with T. vaginalis, the typical clinical presentation was persistent urethritis and/or prostatitis due to an antibiotic-resistant agent.

Adult↗
PubMedDate not supplied

The clinical and laboratory diagnosis of Trichomonas vaginalis infection.

One hundred consecutive female patients attending an inner-city clinic for treatment of sexually transmitted diseases were evaluated for the presence of Trichomonas vaginalis by history, physical examination, 0.85% NaCl wet mount, Papanicolaou smear, and culture. Of the 100 women, 54 were found to be harboring the parasite, as determined by one or more positive diagnostic tests. This prevalence corresponds with that reported previously. The information gained from the history (symptoms and phase of menstrual cycle) and physical examination correlated poorly with results of cultures for T. vaginalis; the organism was isolated more often than symptoms or physical findings would have indicated. Culture was the most sensitive of diagnostic techniques; 48 (89%) of the 54 patients were identified by this method. The Papanicolaou smear detected 35 infections (65%), and the 0.85% NaCl wet mount, 28 (59%). The simplest and most efficient technique for screening women for infection with T. vaginalis may be the Papanicolaou smear, since it is part of the annual physical examination.

Adolescent↗
PubMedDate not supplied

Trichomonas vaginalis infection of the median raphe of the penis.

A case of trichomonas vaginalis infection involving the median raphe of the penis is presented. The infection was contracted after sexual exposure. The patient had no urethral discharge but had a penile swelling tht discharged pus. Microscopic examination and culture of the discharge showed the presence of T. vaginalis. Treatment with metronidazole (250 mg thrice daly for seven days) eradicated the infection, but the swelling remained and a cyst was excised. One month after the surgical procedure, the patient was clinically normal and cured of the infection.

Adult↗
PubMedDate not supplied

Susceptibility of Trichomonas vaginalis strains to metronidazole: response to treatment.

The effect of the susceptibility of Trichomonas vaginalis strains to metronidazole on response to treatment was determined from minimal inhibitory concentrations (MICs) for organisms isolated during a clinical trial in which single 1- and 2-g doses of metronidazole were compared. Fifty-seven strains were isolated from patients receiving 1 g of metronidazole, and 75 from those receiving 2 g. The mean MIC for all strains was 1.50 microgram/ml (range, 0.5-4.5 microgram/ml) and was similar in both groups. The mean MICs for isolates from patients who were cured were significantly less than the mean MICs of isolates from those who were treatment failures. The cure rates, compared to the MICs for the strains isolated, varied from 84% (MIC, 0.5 microgram/ml) to 16% (MIC, greater than or equal to 3.0 microgram/ml) for the group given the single 1-g dose and from 94% (MIC, 0.5 microgram/ml) to 43% (MIC, greater than or equal to 3.0 micrograms/ml) for those given the 2-g dose. The data demonstrate a direct relationship between susceptibility of T. vaginalis isolates and response to treatment with single-dose regimens of metronidazole.

Clinical Trials as Topic↗
PubMedDate not supplied

In vitro susceptibility of Trichomonas vaginalis to metronidazole and treatment outcome in vaginal trichomoniasis.

We have identified Trichomonas vaginalis strains resistant in vitro to metronidazole, especially under aerobic conditions. Since little is known about the relationship of treatment outcome to metronidazole susceptibility of T. vaginalis, we studied the aerobic and anaerobic susceptibility to metronidazole of 310 clinical isolates of T. vaginalis. Of 199 patients with known outcomes after metronidazole treatment for vaginal trichomoniasis, the geometric mean minimal lethal concentration (MLC) under aerobic conditions for trichomonads associated with cases cured by a single 2-g dose was 24.1 micrograms/ml (n = 146), while that of treatment-resistant isolates (n = 53) was 195.5 micrograms/ml. The corresponding mean anaerobic MLC values were 1.6 and 5.05 micrograms/ml, respectively. The average aerobic:anaerobic MLC ratio was about twofold higher for the resistant isolates. Treatment resistance was more frequent at aerobic MLC values of greater than 25 micrograms/ml or anaerobic values of greater than 1.6 micrograms/ml. Although there was overlap of the metronidazole susceptibility distribution of susceptible and resistant isolates, significant resistance to treatment was common when isolates of T. vaginalis had aerobic MLC values of greater than 100 micrograms/ml or anaerobic MLC values of greater than 3.1 micrograms/ml.

Adult↗
PubMedDate not supplied

Difference in effect of dog seminal fluid and human seminal fluid and semen on in vitro survival of Trichomonas vaginalis.

The authors examined the ability of dog seminal fluid to serve as an animal model in order to study survival of Trichomonas vaginalis in human urogenital secretions. Two strains were used: SVI-1, a recent isolate from a male patient, and ATCC 30001, a strain that has been cultured for many years. The authors incubated the T. vaginalis strains in dog seminal fluid, human seminal fluid, and human semen, at 37 degrees C for 6, 12, and 24 hrs. For both strains, survival in dog seminal fluid was much poorer than that in human semen and seminal fluid, zero survival being noted at 24 hrs. The SVI-1 strain survived significantly better than ATCC 30001 in all secretions. Data from experiments using isolates from two female patients, but incubated in human seminal fluid alone, agreed with results obtained with SVI-1. Dog seminal fluid may not be a suitable substitute for human secretions in T. vaginalis studies, and long-term culture may decrease the ability of T. vaginalis to survive in the male urogenital tract.

Aged↗
PubMed2000

Comparative prevalence of infection with Trichomonas vaginalis among men attending a sexually transmitted diseases clinic.

OBJECTIVE: Although established in women as a common cause of vaginal discharge, the prevalence of Trichomonas vaginalis (TV) in men compared with other classic urethral pathogens has not been well characterized. To assess this issue, the authors compared the prevalence of Neisseria gonorrhoeae (GC), Chlamydia trachomatis (CT), and TV in consecutive men attending a sexually transmitted diseases (STD) clinic. METHODS: From June 1, 1998 to July 27, 1998, 454 consecutive men presenting to the Denver Metro Health Clinic with a new problem were tested for GC by urethral swab culture, for CT by polymerase chain reaction of urine, and for TV by urine sediment culture. RESULTS: GC, CT, and TV were detected in 23 (5.1%), 34 (7.5%), and 13 (2.8%) of men, respectively. There were significant differences by age for both CT (11.3% in men younger than 30 years versus 3.3% in men 30 years and older, P < 0.05) and TV (0.8% in men younger than 30 years versus 5.1% in men 30 years and older, P < 0.05). In 50 men 30 years or older with symptoms of urethral discharge, TV prevalence (12.0%) rivalled that of GC (12.0%) and CT (14.0%). In 45 men 30 years and older with nongonococcal urethritis, the prevalence of TV and CT were each 13.3%. Multivariate logistical regression analysis showed the presence of discharge and nongonococcal urethritis in men 30 years and older to be an independent predictor of TV. CONCLUSIONS: TV is common in men attending sexually transmitted disease clinics, especially in those 30 years or older, in whom it may account for as much urethritis as GC or CT. These findings suggest that in older men with nongonococcal urethritis, diagnostic evaluation, empiric treatment, and partner management should include the possibility of TV infection.

Adult↗
PubMed2000

Incidence and predictors of reinfection with Trichomonas vaginalis in HIV-infected women.

BACKGROUND AND OBJECTIVES: The presence of sexually transmitted infections (STIs) may facilitate transmission of HIV to uninfected partners. GOAL: To describe the incidence of reinfection with Trichomonas vaginalis in HIV-infected women and to assess predictors of reinfection. STUDY DESIGN: A retrospective cohort study using data abstracted from medical records of HIV-infected women with at least one diagnosis of trichomoniasis. RESULTS: Approximately one third (36%) of the study population was reinfected with T vaginalis during the follow-up period, with an incidence of 16.4 reinfections per 100 person years. Significant predictors of reinfection included history of another STI (hazard ratio, 1.52; 95% CI, 1.08-2.14) and becoming pregnant during the follow-up period (hazard ratio, 0.59; 95% CI, 0.39-0.87). CONCLUSIONS: There is a high rate of reinfection with T vaginalis in HIV-infected women. Further research that includes information on sexual partners should be conducted to better describe the reinfection patterns of trichomoniasis.

Adult↗
PubMed2004

Treatment of metronidazole-resistant Trichomonas vaginalis with tinidazole: case reports of three patients.

Metronidazole-resistant Trichomonas vaginalis has been reported across the United States. Some reports have suggested that clinically resistant cases could be increasing. Currently, metronidazole is the only drug available to treat trichomoniasis, including resistant cases. In such cases, treatment usually consists of giving higher and more prolonged doses of metronidazole, which patients are often unable to tolerate. Tinidazole, a second-generation nitroimidazole currently under development in the United States, has been shown to be an effective therapy in resistant T. vaginalis. Tinidazole appears to have several advantages over metronidazole, including greater in vitro potency against both sensitive and resistant strains of T. vaginalis, a more prolonged duration of action, and improved patient tolerability. This report describes the successful use of tinidazole in 3 cases of clinically metronidazole-resistant trichomoniasis.

Administration, Oral↗
PubMed2003

Trichomonas vaginalis among HIV-Infected women: are immune status or protease inhibitor use associated with subsequent T. vaginalis positivity?

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.

Adolescent↗
PubMed2004

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.

Adolescent↗
PubMed2005

Vaginal swabs versus lavage for detection of Trichomonas vaginalis and bacterial vaginosis among HIV-positive women.

OBJECTIVES: Cervicovaginal lavage (CVL) is often used for research and may be easier and more accurate than vaginal swabs as a specimen collection method. GOAL: The goal of this study was to compare (CVL) with vaginal swabs for the detection of bacterial vaginosis (BV) and Trichomonas vaginalis (TV). STUDY: CVL and vaginal swabs were collected from 216 HIV-infected women. Clinical assessments were made using wet mount for TV and Amsel's criteria for BV through CVL and swab collection methods. Laboratory gold standards used were Nugent's criteria for BV and InPouch (Biomed Diagnostics, San Jose, CA) culture for TV collected by swab. RESULTS: The prevalence by gold standards for BV was 49.3% and for TV was 25.2%. Sensitivities for direct microscopy versus culture for TV were 72.2 for CVL and 52.8 for vaginal swab (P <0.05). Sensitivities for Amsel's versus Nugent's criteria for BV were 36.2 for CVL and 34.0 for vaginal swab (P <0.80). Kappa scores of agreement between CVL and vaginal swabs for BV and TV were excellent for both. CONCLUSION: CVL was comparable to vaginal swabs as a specimen collection method for these 2 lower genital tract infections and may be superior for the diagnosis of TV.

Adult↗
PubMed2005

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.

Adolescent↗