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Hamar B, Teutsch B, Hoffmann E, Hegyi P, Váradi A, Nyirády P, Hunka Z, Ács N, Lintner B, Hermánné RJ, Melczer Z. Trichomonas vaginalis infection is associated with increased risk of cervical carcinogenesis: A systematic review and meta-analysis of 470 000 patients. Int J Gynaecol Obstet 2023; 163:31-43. [PMID: 37010897 DOI: 10.1002/ijgo.14763] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/22/2023] [Revised: 03/07/2023] [Accepted: 03/13/2023] [Indexed: 04/04/2023]
Abstract
BACKGROUND Trichomonas vaginalis infection is the most prevalent non-viral sexually transmitted infection (STI) in women and has been suggested as a risk factor for developing cervical cancer. OBJECTIVE We aimed to investigate the associations between T. vaginalis infection and cervical carcinogenesis. SEARCH STRATEGY A comprehensive systematic search was conducted in five databases on 21 October 2021. SELECTION CRITERIA Studies assessing the relationship between T. vaginalis infection, HPV co-infections, cervical dysplasia, and cervical cancer were found eligible. DATA COLLECTION AND ANALYSIS Summary estimates for pooled odds ratios (ORs) and their 95% confidence intervals (CIs) were calculated with a random-effects model. Statistical heterogeneity was measured with I2 and Cochran's Q tests. MAIN RESULTS The 29 articles included 473 740 women, of whom 8518 were T. vaginalis-positive. Our results showed that T. vaginalis-infected women had 1.79 times higher odds of being diagnosed with HPV co-infection (95% CI 1.27-2.53; I2 95%). We also found that T. vaginalis infection was associated with high-grade squamous intraepithelial lesion diagnosis (OR 2.34, 95% CI 1.10-4.95; I2 75%) and cervical cancer (OR 5.23, 95% CI 3.03-9.04; I2 3%). CONCLUSIONS Our results showed an association between T. vaginalis and cervical carcinogenesis in sexually active women.
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Affiliation(s)
- Balázs Hamar
- Center for Translational Medicine, Semmelweis University, Budapest, Hungary
- Department of Obstetrics and Gynecology, Semmelweis University, Budapest, Hungary
| | - Brigitta Teutsch
- Center for Translational Medicine, Semmelweis University, Budapest, Hungary
- Institute for Translational Medicine, Medical School, University of Pécs, Pécs, Hungary
| | - Eszter Hoffmann
- Center for Translational Medicine, Semmelweis University, Budapest, Hungary
- Department of Obstetrics and Gynecology, Semmelweis University, Budapest, Hungary
| | - Péter Hegyi
- Center for Translational Medicine, Semmelweis University, Budapest, Hungary
- Institute for Translational Medicine, Medical School, University of Pécs, Pécs, Hungary
- Institute of Pancreatic Diseases, Semmelweis University, Budapest, Hungary
| | - Alex Váradi
- Center for Translational Medicine, Semmelweis University, Budapest, Hungary
| | - Péter Nyirády
- Center for Translational Medicine, Semmelweis University, Budapest, Hungary
- Department of Urology, Semmelweis University, Budapest, Hungary
| | - Zsombor Hunka
- Center for Translational Medicine, Semmelweis University, Budapest, Hungary
- Department of Obstetrics and Gynecology, Semmelweis University, Budapest, Hungary
| | - Nándor Ács
- Center for Translational Medicine, Semmelweis University, Budapest, Hungary
- Department of Obstetrics and Gynecology, Semmelweis University, Budapest, Hungary
| | - Balázs Lintner
- Center for Translational Medicine, Semmelweis University, Budapest, Hungary
- Department of Obstetrics and Gynecology, Semmelweis University, Budapest, Hungary
| | | | - Zsolt Melczer
- Center for Translational Medicine, Semmelweis University, Budapest, Hungary
- Department of Obstetrics and Gynecology, Semmelweis University, Budapest, Hungary
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Muzny CA, Van Gerwen OT, Kaufman G, Chavoustie S. Efficacy of single-dose oral secnidazole for the treatment of trichomoniasis in women co-infected with trichomoniasis and bacterial vaginosis: a post hoc subgroup analysis of phase 3 clinical trial data. BMJ Open 2023; 13:e072071. [PMID: 37550019 PMCID: PMC10407359 DOI: 10.1136/bmjopen-2023-072071] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/02/2023] [Accepted: 07/21/2023] [Indexed: 08/09/2023] Open
Abstract
OBJECTIVES Bacterial vaginosis (BV) and trichomoniasis are the most common causes of vaginitis. Both infections are associated with increased risk of acquisition and transmission of HIV and other sexually transmitted infections as well as adverse reproductive health outcomes. Co-infection is common, with rates ranging from 60% to 80%. We evaluated the efficacy of single-dose oral secnidazole 2 g for the treatment of trichomoniasis in a subgroup of women co-infected with BV and trichomoniasis. DESIGN Post hoc analysis of data from a phase 3 randomised, double-blind, placebo-controlled, delayed-treatment study. SETTING 10 centres in the USA. PARTICIPANTS Subgroup of women (aged ≥12 years) with a confirmed diagnosis of Trichomonas vaginalis and co-infection with BV clinically diagnosed using Amsel's criteria. INTERVENTION Single dose of secnidazole 2 g or placebo. OUTCOME MEASURES The primary efficacy outcome was the microbiological cure (negative culture for T. vaginalis) at the test of cure (TOC) visit 6-12 days after dosing in the modified intent-to-treat population (mITT). At TOC, participants received the opposite treatment. RESULTS Of the 131 T. vaginalis-infected participants in the mITT, 79 (60.3%) met ≥3 Amsel's criteria for BV at enrolment. Microbiological cure rates for trichomoniasis at TOC among this subgroup of women were 97.7% (42/43) for secnidazole and 0% (0/36) for placebo. CONCLUSION Single-dose oral secnidazole 2 g was highly efficacious in curing trichomoniasis in women co-infected with BV. Appropriate and effective treatment options for co-infection are essential for reducing transmission and reinfection. Secnidazole is the only single-dose medication approved by the Food and Drug Administration for the treatment of BV in women and trichomoniasis in women and men. TRIAL REGISTRATION NUMBER ClinicalTrials.gov, NCT03935217; post-results.
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Affiliation(s)
- Christina A Muzny
- Division of Infectious Diseases, University of Alabama at Birmingham, Birmingham, Alabama, USA
| | - Olivia T Van Gerwen
- Division of Infectious Diseases, University of Alabama at Birmingham, Birmingham, Alabama, USA
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Huang SH, Hsu HC, Lee TF, Fan HM, Tseng CW, Chen IH, Shen H, Lee CY, Tai HT, Hsu HM, Hung CC. Prevalence, Associated Factors, and Appropriateness of Empirical Treatment of Trichomoniasis, Bacterial Vaginosis, and Vulvovaginal Candidiasis among Women with Vaginitis. Microbiol Spectr 2023; 11:e0016123. [PMID: 37052487 PMCID: PMC10269550 DOI: 10.1128/spectrum.00161-23] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/12/2023] [Accepted: 03/26/2023] [Indexed: 04/14/2023] Open
Abstract
Trichomoniasis (TV), bacterial vaginosis (BV), and vulvovaginal candidiasis (VVC) are the most common causes of vaginitis. This study investigated the prevalence of these diagnoses, their associated factors, and the appropriateness of the empirical treatment. From March 25, 2019, to June 17, 2022, 429 women with symptoms or signs of vaginitis were enrolled in a hospital in northern Taiwan with 438 episodes of vaginitis. Vaginal swabs were collected for Gram's staining, in vitro cultures for Trichomonas vaginalis, bacteria, and yeasts, and multiplex PCR assay for TV, BV, and VVC. Their empirical treatments were recorded. Factors associated with different etiologies of vaginitis were sought in multivariable logistic regression models. The prevalence of TV, BV, and VVC were 2.1%, 22.8%, and 21.7%, respectively, while coinfections of BV and VVC, TV and BV, TV and VVC, and triple infection occurred in 5.0%, 0.2%, 0.2%, and 0.7%, respectively. Multivariable analyses revealed that having multiple sexual partners was associated with TV and BV (adjusted odds ratio [aOR] 9.756 and 3.246, respectively), while menopausal women were less likely to have VVC (aOR 0.184). Moreover, dysuria was associated with TV (aOR 4.981), vaginal itch and pelvic pain with VVC (aOR 3.223 and 0.425, respectively), and discharge pH > 4.5 with BV (aOR 1.767). Other clinical symptoms and pelvic examination features had limited value for differential diagnosis. Among the 78 empirical antifungal and metronidazole prescriptions, 55.2% were ineffective or unnecessary. Our study highlights the importance to integrate appropriate diagnostic tools into the clinical care of women with vaginitis. IMPORTANCE Vaginal complaints are widespread among women and are associated with emotional, physical, and economic burdens with challenges in their diagnosis and management. In this survey, we identified that 40% of vaginitis in Taiwan was caused by either trichomoniasis, bacterial vaginosis, vulvovaginal candidiasis, or a combination of these infections. Our data suggested that typical physical findings appeared infrequently among women with these infections and their empirical treatments were frequently inappropriate. Our findings highlighted the importance of integrating proper diagnostic tools into clinical practice to improve the diagnosis and management of vaginitis, as recommended by national and international guidelines.
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Affiliation(s)
- Sung-Hsi Huang
- Department of Internal Medicine, National Taiwan University Hospital Hsin-Chu Branch, Hsinchu, Taiwan
- Department of Tropical Medicine and Parasitology, National Taiwan University College of Medicine, Taipei, Taiwan
| | - Heng-Cheng Hsu
- Department of Obstetrics and Gynecology, National Taiwan University Hospital and National Taiwan University College of Medicine, Taipei, Taiwan
- Department of Surgery, National Taiwan University Cancer Center, Taipei, Taiwan
- Graduate Institute of Clinical Medicine, National Taiwan University College of Medicine, Taipei, Taiwan
| | - Tai-Fen Lee
- Department of Laboratory Medicine, National Taiwan University Hospital and National Taiwan University College of Medicine, Taipei, Taiwan
| | - Hui-Min Fan
- Department of Laboratory Medicine, National Taiwan University Hospital Hsin-Chu Branch, Hsinchu, Taiwan
| | - Chi-Wei Tseng
- Department of Internal Medicine, National Taiwan University Hospital Hsin-Chu Branch, Hsinchu, Taiwan
| | - I-Hui Chen
- Department of Obstetrics and Gynecology, National Taiwan University Hospital Hsin-Chu Branch, Hsinchu, Taiwan
| | - Hung Shen
- Department of Obstetrics and Gynecology, National Taiwan University Hospital Hsin-Chu Branch, Hsinchu, Taiwan
| | - Chia-Yi Lee
- Department of Obstetrics and Gynecology, National Taiwan University Hospital Hsin-Chu Branch, Hsinchu, Taiwan
| | - Hui-Ting Tai
- Department of Internal Medicine, National Taiwan University Hospital Hsin-Chu Branch, Hsinchu, Taiwan
| | - Hong-Ming Hsu
- Department of Tropical Medicine and Parasitology, National Taiwan University College of Medicine, Taipei, Taiwan
| | - Chien-Ching Hung
- Department of Tropical Medicine and Parasitology, National Taiwan University College of Medicine, Taipei, Taiwan
- Department of Internal Medicine, National Taiwan University Hospital and National Taiwan University College of Medicine, Taipei, Taiwan
- Department of Internal Medicine, National Taiwan University Hospital Yunlin Branch, Yunlin, Taiwan
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Tjagur S, Mändar R, Punab M. Profile of sexually transmitted infections causing urethritis and a related inflammatory reaction in urine among heterosexual males: A flow-cytometry study. PLoS One 2020; 15:e0242227. [PMID: 33264307 PMCID: PMC7710099 DOI: 10.1371/journal.pone.0242227] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/26/2020] [Accepted: 10/28/2020] [Indexed: 12/29/2022] Open
Abstract
BACKGROUND Information about the use of flow cytometry in the diagnosis of male urethritis is scarce. The current study aims to evaluate the performance of flow cytometry on first-voided urine in males with infectious urethritis (Chlamydia trachomatis, Neisseria gonorrhoeae, Mycoplasma genitalium and Trichomonas vaginalis). METHODS Male patients of the Andrology Centre (Tartu University Hospital, Estonia) were recruited during the period March 2015 -January 2018. Cases included 306 patients with infectious urethritis caused by Chlamydia trachomatis, Neisseria gonorrhoeae, Mycoplasma genitalium and/or Trichomonas vaginalis. The control group consisted of 192 patients without uro-genital complaints, negative tests for C. trachomatis, N. gonorrhoeae, M. genitalium and T. vaginalis from first-voided urine and no inflammation in first-voided urine, mid-stream urine and urine after prostate massage. C. trachomatis, N. gonorrhoeae, M. genitalium and T. vaginalis were detected from first-voided urine using polymerase chain reaction (PCR) method. First-voided urine was analysed using urine particle analyzer Sysmex UF-500i. RESULTS The most prevalent infection was chlamydia (64.1%), followed by Mycoplasma genitalium (20.9%), gonorrhoea (7.8%) and trichomoniasis (1.6%). Gonorrhoea caused the highest flow-cytometric leucocyte/bacteria count, followed by chlamydia and Mycoplasma genitalium. Trichomonas vaginalis showed nearly absent inflammation in first-voided urine. Using an empiric flow-cytometry diagnostic threshold for urethritis in first-voided urine (leucocytes ≥ 15/μl and bacteria ≥ 20/μl) the total calculated sensitivity was over 90%. However, when applying such criteria for deciding whether to perform first-voided urine PCR for C. trachomatis, N. gonorrhoeae, M. genitalium and T. vaginalis or not, we could miss 23 cases with infectious urethritis that makes up 7,5% of all proven cases. CONCLUSIONS Flow cytometry of first-voided urine can be considered as a rapid and objective screening method in case of suspected male infectious urethritis.
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Affiliation(s)
- Stanislav Tjagur
- Andrology Centre, Tartu University Hospital, Tartu, Estonia
- Faculty of Medicine, University of Tartu, Tartu, Estonia
- * E-mail:
| | - Reet Mändar
- Department of Microbiology, Institute of Biomedicine and Translational Medicine, Faculty of Medicine, University of Tartu, Tartu, Estonia
- Competence Centre on Health Technologies, Tartu, Estonia
| | - Margus Punab
- Andrology Centre, Tartu University Hospital, Tartu, Estonia
- Institute of Clinical Medicine, Faculty of Medicine, University of Tartu, Tartu, Estonia
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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: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [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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Abstract
Vaginitis presents with vaginal discharge, odor, pruritis, and/or discomfort and affects up to 75% of girls and women over the course of their lifetimes, with most women experiencing their first episode during adolescence. Given the prevalence of this disorder, this article aims to provide an overview of vaginitis for the general pediatrician. We start with prepubertal etiologies of vaginitis, then discuss pubertal and normal physiologic discharge, and then focus on the most common etiologies of adolescent vulvovaginitis. The three most common microbial etiologies of vaginitis (bacterial vaginosis, vulvovaginal candidiasis, and trichomonas) are addressed, as well as their diagnosis and treatment in adolescents. [Pediatr Ann. 2020;49(4):e170-e175.].
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Han IH, Song HO, Ryu JS. IL-6 produced by prostate epithelial cells stimulated with Trichomonas vaginalis promotes proliferation of prostate cancer cells by inducing M2 polarization of THP-1-derived macrophages. PLoS Negl Trop Dis 2020; 14:e0008126. [PMID: 32196489 PMCID: PMC7138318 DOI: 10.1371/journal.pntd.0008126] [Citation(s) in RCA: 45] [Impact Index Per Article: 11.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/05/2018] [Revised: 04/07/2020] [Accepted: 02/10/2020] [Indexed: 12/12/2022] Open
Abstract
Trichomonas vaginalis (Tv), a protozoan parasite causing sexually-transmitted disease, has been detected in tissue of prostatitis, benign prostatic hyperplasia (BPH) and prostate cancer (PCa). IL-6, a mediator of chronic inflammation, induces the progression of prostate cancer, and influences the polarization of M2 macrophages, which are the main tumor-associated macrophages. We investigated whether IL-6 produced by human prostate epithelial cells stimulated with Tv induces the M2 polarization of THP-1-derived macrophages, which in turn promotes the progression of PCa. Conditioned medium was prepared from Tv-infected (TCM) and uninfected (CM) prostate epithelial cells (RWPE-1). Thereafter conditioned medium was prepared from macrophages after incubation with CM (M-CM) or TCM (M-TCM). RWPE-1 cells infected with Tv produced IL-6 and chemokines such as CCL2 and CXCL8. When human macrophages were treated with conditioned medium of RWPE-1 cells co-cultured with Tv (TCM), they became polarized to M2-like macrophages as indicated by the production of IL-10 and TGF-β, and the expression of CD36 and arginase-1, which are M2 macrophage markers. Moreover, proliferation of the M2-like macrophages was also increased by TCM. Blockade of IL-6 signaling with IL-6 receptor antibody and JAK inhibitor (Ruxolitinib) inhibited M2 polarization of THP-1-derived macrophages and proliferation of the macrophages. To assess the effect of crosstalk between macrophages and prostate epithelial cells inflamed by Tv infection on the growth of prostate cancer (PCa) cells, PC3, DU145 and LNCaP cells were treated with conditioned medium from THP-1-derived macrophages stimulated with TCM (M-TCM). Proliferation and migration of the PCa cells were significantly increased by the M-TCM. Our findings suggest that IL-6 produced in response to Tv infection of the prostate has an important effect on the tumor microenvironment by promoting progression of PCa cells following induction of M2 macrophage polarization. In male, T. vaginalis infection have been proposed to involve in several prostate diseases such as prostatitis, benign prostatic hyperplasia and prostate cancer. However, studies for these mechanisms have been rare. We have previously reported that T. vaginalis induce the production of inflammatory cytokines in prostate cells. Among these cytokines, IL-6 have been reported to play an important role in M2 macrophage polarization, which lead to formation of tumor microenvironment in various cancers. Here we show that IL-6 produced by T. vaginalis infection in prostate epithelial cells induces M2 polarization of macrophages and these macrophages promote proliferation of prostate cancer cells. These findings suggest that T. vaginalis indirectly induces progression of prostate cancer by creating a tumor microenvironment through an inflammatory response.
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Affiliation(s)
- Ik-Hwan Han
- Department of Environmental Biology and Medical Parasitology, Hanyang University College of Medicine, Seoul, Korea
| | - Hyun-Ouk Song
- Department of Parasitology, School of Medicine, Catholic University of Daegu, Daegu, Korea
| | - Jae-Sook Ryu
- Department of Environmental Biology and Medical Parasitology, Hanyang University College of Medicine, Seoul, Korea
- * E-mail:
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Langston ME, Bhalla A, Alderete JF, Nevin RL, Pakpahan R, Hansen J, Elliott D, De Marzo AM, Gaydos CA, Isaacs WB, Nelson WG, Sokoll LJ, Zenilman JM, Platz EA, Sutcliffe S. Trichomonas vaginalis infection and prostate-specific antigen concentration: Insights into prostate involvement and prostate disease risk. Prostate 2019; 79:1622-1628. [PMID: 31376187 PMCID: PMC6715535 DOI: 10.1002/pros.23886] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/31/2019] [Accepted: 07/08/2019] [Indexed: 01/10/2023]
Abstract
BACKGROUND The protist Trichomonas vaginalis causes a common, sexually transmitted infection and has been proposed to contribute to the development of chronic prostate conditions, including benign prostatic hyperplasia and prostate cancer. However, few studies have investigated the extent to which it involves the prostate in the current antimicrobial era. We addressed this question by investigating the relation between T. vaginalis antibody serostatus and serum prostate-specific antigen (PSA) concentration, a marker of prostate infection, inflammation, and/or cell damage, in young, male, US military members. METHODS We measured T. vaginalis serum IgG antibodies and serum total PSA concentration in a random sample of 732 young, male US active duty military members. Associations between T. vaginalis serostatus and PSA were investigated by linear regression. RESULTS Of the 732 participants, 341 (46.6%) had a low T. vaginalis seropositive score and 198 (27.0%) had a high score, with the remainder seronegative. No significant differences were observed in the distribution of PSA by T. vaginalis serostatus. However, slightly greater, nonsignificant differences were observed when men with high T. vaginalis seropositive scores were compared with seronegative men, and when higher PSA concentrations were examined (≥0.70 ng/mL). Specifically, 42.5% of men with high seropositive scores had a PSA concentration greater than or equal to 0.70 ng/mL compared with 33.2% of seronegative men (adjusted P = .125). CONCLUSIONS Overall, our findings do not provide strong support for prostate involvement during T. vaginalis infection, although our suggestive positive findings for higher PSA concentrations do not rule out this possibility entirely. These suggestive findings may be relevant for prostate condition development because higher early- to mid-life PSA concentrations have been found to predict greater prostate cancer risk later in life.
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Affiliation(s)
- Marvin E. Langston
- Division of Public Health Sciences, Department of Surgery, Washington University School of Medicine, St. Louis, MO
| | - Ankita Bhalla
- Division of Public Health Sciences, Department of Surgery, Washington University School of Medicine, St. Louis, MO
- School of Dentistry, University of California, San Francisco, San Francisco, CA
| | - John F. Alderete
- School of Molecular Biosciences, College of Veterinary Medicine, Washington State University, Pullman, WA
| | - Remington L. Nevin
- Department of Mental Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD
- The Quinism Foundation, White River Junction, VT
| | - Ratna Pakpahan
- Division of Public Health Sciences, Department of Surgery, Washington University School of Medicine, St. Louis, MO
| | - Johannah Hansen
- Division of Public Health Sciences, Department of Surgery, Washington University School of Medicine, St. Louis, MO
- Los Angeles County Department of Public Health, Los Angeles, CA
| | - Debra Elliott
- Department of Pathology, Johns Hopkins University School of Medicine, Baltimore, MD
| | - Angelo M. De Marzo
- Department of Pathology, Johns Hopkins University School of Medicine, Baltimore, MD
- Department of Urology and the James Buchanan Brady Urological Institute, Johns Hopkins University School of Medicine
- Sidney Kimmel Comprehensive Cancer Center at Johns Hopkins, Baltimore, MD
| | - Charlotte A. Gaydos
- Division of Infectious Diseases, Department of Medicine, Johns Hopkins University School of Medicine, Baltimore, MD
| | - William B. Isaacs
- Department of Urology and the James Buchanan Brady Urological Institute, Johns Hopkins University School of Medicine
- Sidney Kimmel Comprehensive Cancer Center at Johns Hopkins, Baltimore, MD
| | - William G. Nelson
- Department of Pathology, Johns Hopkins University School of Medicine, Baltimore, MD
- Department of Urology and the James Buchanan Brady Urological Institute, Johns Hopkins University School of Medicine
- Sidney Kimmel Comprehensive Cancer Center at Johns Hopkins, Baltimore, MD
- Department of Pharmacology, Johns Hopkins University School of Medicine, Baltimore, MD
| | - Lori J. Sokoll
- Department of Pathology, Johns Hopkins University School of Medicine, Baltimore, MD
- Department of Urology and the James Buchanan Brady Urological Institute, Johns Hopkins University School of Medicine
- Sidney Kimmel Comprehensive Cancer Center at Johns Hopkins, Baltimore, MD
| | - Jonathan M. Zenilman
- Division of Infectious Diseases, Department of Medicine, Johns Hopkins University School of Medicine, Baltimore, MD
| | - Elizabeth A. Platz
- Department of Urology and the James Buchanan Brady Urological Institute, Johns Hopkins University School of Medicine
- Sidney Kimmel Comprehensive Cancer Center at Johns Hopkins, Baltimore, MD
- Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD
| | - Siobhan Sutcliffe
- Division of Public Health Sciences, Department of Surgery, Washington University School of Medicine, St. Louis, MO
- Alvin J. Siteman Cancer Center and the Department of Obstetrics and Gynecology, Washington University School of Medicine, St. Louis, MO
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Jang KS, Han IH, Lee SJ, Yoo J, Kim YS, Sim S, Ryu JS. Experimental rat prostatitis caused by Trichomonas vaginalis infection. Prostate 2019; 79:379-389. [PMID: 30488471 DOI: 10.1002/pros.23744] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/08/2018] [Accepted: 11/01/2018] [Indexed: 11/09/2022]
Abstract
BACKGROUND Trichomonas vaginalis (T. vaginalis) is the most common sexually transmitted parasite. It has been detected in prostatic tissue of patients with prostatitis and reported to be associated with chronic prostatitis and benign prostatic hyperplasia as well as prostate cancer. Recently, experimental rodent models of prostatitis induced by pathogen infection have been developed. However, there have so far been no reports of prostatitis caused by T. vaginalis infection in animals. Here, we investigated whether infection with T. vaginalis via the rat urethra could cause prostatitis. METHODS T. vaginalis was injected into prostate through urethra of rat (Wistar rats), and the rats were killed 1, 2, or 4 weeks later. The presence of T. vaginalis trophozoites in the rat prostates was examined by immunohistochemistry, and pathological changes of the prostate were observed by hematoxylin-eosin staining and evaluated by grading from 0 to 5 for inflammatory cell infiltration, acinar changes, and interstitial fibrosis. Infiltrated mast cells were observed by toluidine blue staining of rat prostate tissue. Chemokine C-C motif ligand 2 (CCL2) levels of the rat prostates were measured by ELISA. RESULTS T. vaginalis trophozoites were observed in acini in the prostates of the injected rats. The prostate tissues had higher pathological scores, and 83% (5/6) and 100% (6/6) of the ventral and dorsolateral lobes (n = 6), respectively, were inflamed. Infiltration and degranulation of mast cells were observed at higher rates in prostate sections of the T. vaginalis-infected rats. Also, prostate tissues of the injected rats had increased CCL2 levels. CONCLUSIONS Injection of T. vaginalis in rats caused prostatitis as revealed by pathologic changes, mast cell infiltration and increased CCL2 production. Therefore, this study provides the first evidence that T. vaginalis infection in rats causes prostatitis.
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Affiliation(s)
- Ki-Seok Jang
- Department of Pathology, Hanyang University College of Medicine, Seoul, Korea
| | - Ik-Hwan Han
- Department of Environmental Biology and Medical Parasitology, Hanyang University College of Medicine, Seoul, Korea
| | - Seung-Ju Lee
- Department of Urology, Saint Vincent's Hospital, The Catholic University of Korea, Suwon, Korea
| | - Jin Yoo
- Department of Biomedical Science, Graduate School, Kyung Hee University, Seoul, Korea
| | - Ye-Seul Kim
- Department of Pathology, Hanyang University College of Medicine, Seoul, Korea
| | - Seobo Sim
- Department of Environmental and Tropical Medicine, Research Institute of Medical Science, Konkuk University School of Medicine, Seoul, Korea
| | - Jae-Sook Ryu
- Department of Environmental Biology and Medical Parasitology, Hanyang University College of Medicine, Seoul, Korea
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10
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Vallely LM, Toliman P, Ryan C, Rai G, Wapling J, Gabuzzi J, Allen J, Opa C, Munnull G, Kaima P, Kombuk B, Kumbia A, Kombati Z, Law G, Kelly-Hanku A, Wand H, Siba PM, Mola GDL, Kaldor JM, Vallely AJ. Performance of syndromic management for the detection and treatment of genital Chlamydia trachomatis, Neisseria gonorrhoeae and Trichomonas vaginalis among women attending antenatal, well woman and sexual health clinics in Papua New Guinea: a cross-sectional study. BMJ Open 2017; 7:e018630. [PMID: 29288183 PMCID: PMC5778337 DOI: 10.1136/bmjopen-2017-018630] [Citation(s) in RCA: 30] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Abstract
OBJECTIVE Papua New Guinea (PNG) has among the highest estimated prevalences of genital Chlamydia trachomatis (CT), Neisseria gonorrhoeae (NG) and Trichomonas vaginalis (TV) of any country in the Asia-Pacific region. Diagnosis and treatment of these infections have relied on the WHO-endorsed syndromic management strategy that uses clinical presentation without laboratory confirmation to make treatment decisions. We evaluated the performance of this strategy in clinical settings in PNG. DESIGN Women attending antenatal (ANC), well woman (WWC) and sexual health (SHC) clinics in four provinces were invited to participate, completed a face-to-face interview and clinical examination, and provided genital specimens for laboratory testing. We estimated the performance characteristics of syndromic diagnoses against combined laboratory diagnoses. RESULTS 1764 women were enrolled (ANC=765; WWC=614; SHC=385). The prevalences of CT, NG and TV were highest among women attending ANC and SHC. Among antenatal women, syndromic diagnosis of sexually transmitted infection had low sensitivity (9%-21%) and positive predictive value (PPV) (7%-37%), but high specificity (76%-89%) and moderate negative predictive value (NPV) (55%-86%) for the combined endpoint of laboratory-confirmed CT, NG or TV. Among women attending WWC and SHC, 'vaginal discharge syndrome' had moderate to high sensitivity (72%-78%) and NPV (62%-94%), but low specificity (26%-33%) and PPV (8%-38%). 'Lower abdominal pain syndrome' had low sensitivity (26%-41%) and PPV (8%-23%) but moderate specificity (66%-68%) and high NPV (74%-93%) among women attending WWC, and moderate-high sensitivity (67%-79%) and NPV (62%-86%) but low specificity (26%-28%) and PPV (14%-33%) among SHC attendees. CONCLUSION The performance of syndromic management for the detection and treatment of genital chlamydia, gonorrhoea and trichomonas was poor among women in different clinical settings in PNG. New diagnostic strategies are needed to control these infections and to prevent their adverse health outcomes in PNG and other high-burden countries.
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Affiliation(s)
- Lisa M Vallely
- Public Health Interventions Research Group, Kirby Institute, UNSW Sydney, Sydney, New South Wales, Australia
| | - Pamela Toliman
- Public Health Interventions Research Group, Kirby Institute, UNSW Sydney, Sydney, New South Wales, Australia
| | - Claire Ryan
- The Macfarlane Burnet Institute for Medical Research and Public Health, Burnet Institute, Melbourne, Victoria, Australia
| | - Glennis Rai
- School of Medicine and Health Sciences, University of Papua New Guinea, Boroko, Papua New Guinea
| | - Johanna Wapling
- The Macfarlane Burnet Institute for Medical Research and Public Health, Burnet Institute, Melbourne, Victoria, Australia
| | - Josephine Gabuzzi
- Sexual and Reproductive Health Unit, Papua New Guinea Institute of Medical Research, Boroko, Papua New Guinea
| | - Joyce Allen
- Sexual and Reproductive Health Unit, Papua New Guinea Institute of Medical Research, Boroko, Papua New Guinea
| | - Christine Opa
- Sexual and Reproductive Health Unit, Papua New Guinea Institute of Medical Research, Boroko, Papua New Guinea
| | - Gloria Munnull
- Sexual and Reproductive Health Unit, Papua New Guinea Institute of Medical Research, Boroko, Papua New Guinea
| | - Petronia Kaima
- Tininga clinic, Mt Hagen General Hospital, Mount Hagen, Papua New Guinea
| | - Benny Kombuk
- Obstetrics and Gynaecology, Mt Hagen General Hospital, Mount Hagen, Papua New Guinea
| | - Antonia Kumbia
- Obstetrics and Gynaecology, Eastern Highlands Provincial Hospital, Goroka, Papua New Guinea
| | - Zure Kombati
- Department of Pathology, Mt Hagen General Hospital, Mt Hagen, Papua New Guinea
| | - Greg Law
- Sexual Health and Disease Control Branch, National Department of Health, Poert Moresby, Papua New Guinea
| | - Angela Kelly-Hanku
- Sexual and Reproductive Health Unit, Papua New Guinea Institute of Medical Research, Boroko, Papua New Guinea
| | - Handan Wand
- Biostatistics and Database Program, Kirby Institute, UNSW Sydney, Sydney, New South Wales, Australia
| | - Peter M Siba
- Former Director, Papua New Guinea Institute of Medical Research, Port Moresby, Papua New Guinea
| | - Glen D L Mola
- School of Medicine and Health Sciences, University of Papua New Guinea, Boroko, Papua New Guinea
| | - John M Kaldor
- Public Health Interventions Research Group, Kirby Institute, UNSW Sydney, Sydney, New South Wales, Australia
| | - Andrew J Vallely
- Public Health Interventions Research Group, Kirby Institute, UNSW Sydney, Sydney, New South Wales, Australia
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11
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Ghosh I, Muwonge R, Mittal S, Banerjee D, Kundu P, Mandal R, Biswas J, Basu P. Association between high risk human papillomavirus infection and co-infection with Candida spp. and Trichomonas vaginalis in women with cervical premalignant and malignant lesions. J Clin Virol 2017; 87:43-48. [PMID: 27992790 DOI: 10.1016/j.jcv.2016.12.007] [Citation(s) in RCA: 28] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/30/2016] [Revised: 11/09/2016] [Accepted: 12/11/2016] [Indexed: 02/07/2023]
Abstract
BACKGROUND Human papillomavirus (HPV) is the necessary cause of cervical cancer. Cervico-vaginal infection with pathogens like Chlamydia is a likely cofactor. The interactions between HPV, Trichomonas vaginalis (TV) and Candida spp. are less understood, though inflammation induced by these pathogens has been demonstrated to facilitate oncogenesis. OBJECTIVE Our study aimed to evaluate the association between Candida spp. and TV co-infection with HPV in cervical oncogenesis. STUDY DESIGN Women with normal cervix who were high-risk HPV-negative (N=104) and HPV-positive (N=105); women with CIN 1 (N=106) and CIN 2/CIN 3 (N=62) were recruited from a community based cervical cancer screening program. Cervical cancer patients (N=106) were recruited from a tertiary care oncology clinic. High-risk HPV was detected by Hybrid Capture II technique; Candida spp. and TV were detected by culturing the high vaginal swabs followed by microscopic examination in all. The disease status was established by histopathology in all the women. RESULT HPV-positive women had significantly higher risk of having precursor lesions (of any grade) and cancer compared to HPV-negative women. Candida spp. or TV infection did not alter the risk of low grade or high grade lesions among HPV- positive women. HPV positive women co-infected with TV had higher risk of cervical cancer but not those co-infected with Candida spp. CONCLUSION The higher risk of cancer observed in the women co-infected with HPV and TV without any enhanced risk of CIN 3 suggests secondary infection of the malignant growth by TV rather than any causal role. Co-infection with Candida spp. and/or TV infection did not increase the carcinogenic effect of HPV on cervix.
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Affiliation(s)
- Ishita Ghosh
- Chittaranjan National Cancer Institute, Kolkata, West Bengal, India
| | - Richard Muwonge
- Screening Group, Early Detection and Prevention Section, International Agency for Research on Cancer, Lyon, France
| | - Srabani Mittal
- Chittaranjan National Cancer Institute, Kolkata, West Bengal, India
| | | | - Pratip Kundu
- Chittaranjan National Cancer Institute, Kolkata, West Bengal, India
| | - Ranajit Mandal
- Chittaranjan National Cancer Institute, Kolkata, West Bengal, India
| | - Jaydip Biswas
- Chittaranjan National Cancer Institute, Kolkata, West Bengal, India
| | - Partha Basu
- Screening Group, Early Detection and Prevention Section, International Agency for Research on Cancer, Lyon, France.
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12
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Bugg CW, Taira T, Zaurova M. Pelvic inflammatory disease: diagnosis and treatment in the emergency department [digest]. Emerg Med Pract 2016; 18:S1-S2. [PMID: 28745849] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/07/2023]
Abstract
Pelvic inflammatory disease is a common disease that is associated with significant complications including infertility, chronic pelvic pain, ruptured tubo-ovarian abscess, and ectopic pregnancy. The diagnosis may be delayed when the presentation has nonspecific signs and symptoms. Even when it is properly identified, pelvic inflammatory disease is often treated suboptimally. This review provides evidence-based recommendations for the diagnosis, treatment, disposition, and follow-up of patients with pelvic inflammatory disease. Arranging follow-up of patients within 48 to 72 hours and providing clear patient education are fundamental to ensuring good patient outcomes. Emerging issues, including new pathogens and evolving resistance patterns among pelvic inflammatory disease pathogens are reviewed. [Points & Pearls is a digest of Emergency Medicine Practice].
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Affiliation(s)
- Charles Walter Bugg
- Postgraduate Physician, LAC + USC Department of Emergency Medicine, Los Angeles, CA
| | - Taku Taira
- Assistant Professor, Associate Program Director, LAC + USC Department of Emergency Medicine, Los Angeles, CA
| | - Milana Zaurova
- Department of Emergency Medicine, Icahn School of Medicine at Mount Sinai, New York, NY
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13
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Kalra S, Chawla A. Diabetes and balanoposthitis. J PAK MED ASSOC 2016; 66:1039-1041. [PMID: 27524547] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/06/2023]
Abstract
This review describes the association of balanoposthitis with diabetes. It reviews the multifaceted relationship of both conditions, and summarizes the etiology, clinical features and treatment options for this condition. The commonest etiology of balanoposthitis in males with diabetes is Candida, and the mainstay of treatment is maintenance of hygiene, euglycaemia, and eradication of infection. The review sensitizes diabetes care providers to take a history and perform a physical examination in persons with penile symptoms, and also encourages dermatology care providers to screen for diabetes in such persons.
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Affiliation(s)
- Sanjay Kalra
- Department of Endocrinology, Bharti Hospital, Karnal, New Delhi, India
| | - Aastha Chawla
- Department of Diabetology, North Delhi Diabetes Centre, New Delhi, India
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14
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Shui IM, Kolb S, Hanson C, Sutcliffe S, Rider JR, Stanford JL. Trichomonas vaginalis infection and risk of advanced prostate cancer. Prostate 2016; 76:620-3. [PMID: 26818005 PMCID: PMC5002353 DOI: 10.1002/pros.23153] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/20/2015] [Accepted: 01/05/2016] [Indexed: 01/07/2023]
Abstract
BACKGROUND The epidemiologic evidence for an association of Trichomonas vaginalis (Tv) with overall prostate cancer is mixed, but some studies suggest Tv may increase risk of more aggressive disease. The aim of this study was to assess whether Tv serostatus is associated with advanced or fatal prostate cancer. METHODS A total of 146 men with advanced (metastatic or fatal) prostate cancer and 181 age-matched controls were selected from two prior population-based, case-control studies. Tv serostatus was determined with the same laboratory methods used in previous epidemiologic studies. Odds ratios (OR) and 95% confidence intervals (CI) were calculated using multivariable logistic regression to compare Tv serostatus in prostate cancer cases and controls adjusted for potential confounders. RESULTS The seroprevalence of Tv in controls was 23%. Tv serostatus was not associated with an increased risk of metastatic or fatal prostate cancer (ORs < 1). CONCLUSIONS Our study does not support an increased risk of advanced or fatal prostate cancer in men seropositive for Tv.
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Affiliation(s)
- Irene M Shui
- Division of Public Health Sciences, Fred Hutchinson Cancer Research Center, Seattle, Washington
- Department of Epidemiology, Harvard TH Chan School of Public Health, Boston, MA
| | - Suzanne Kolb
- Division of Public Health Sciences, Fred Hutchinson Cancer Research Center, Seattle, Washington
| | - Christi Hanson
- Division of Public Health Sciences, Fred Hutchinson Cancer Research Center, Seattle, Washington
| | - Siobhan Sutcliffe
- Division of Public Health Sciences and the Alvin J Siteman Cancer Center, Department of Surgery, Washington University School of Medicine, St. Louis, MO
| | - Jennifer R Rider
- Department of Epidemiology, Harvard TH Chan School of Public Health, Boston, MA
- Department of Epidemiology, Boston University School of Public Health, Boston, MA
| | - Janet L Stanford
- Division of Public Health Sciences, Fred Hutchinson Cancer Research Center, Seattle, Washington
- Department of Epidemiology, School of Public Health, University of Washington, Seattle, Washington
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15
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Buisson Y. [Congrès de la Société de pathologie exotique : parasitoses, mycoses et cancer 18 novembre 2015, Institut Pasteur, Paris]. Bull Soc Pathol Exot 2016; 109:46-50. [PMID: 26746316 DOI: 10.1007/s13149-015-0464-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/05/2023]
Affiliation(s)
- Y Buisson
- Société de pathologie exotique, Hôpital de la Pitié Salpêtrière, Pavillon Laveran, 47/83, boulevard de l'hôpital, 75013, Paris, France.
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16
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Abstract
Trichomonas vaginalis is one of the most common human parasitic infections in the United States, as well as the most prevalent non-viral sexually transmitted infection. However, it has long received much less consideration than other parasitic and sexually transmitted diseases. Much of this inattention can be attributed to a poor understanding of the public health impact of trichomoniasis. Increasing recognition of the sequelae of infection, including increased risk of infection with human immunodeficiency virus and adverse outcomes of pregnancy, has led to increased interest in T. vaginalis. Recent innovations include development of diagnostic tests that could improve detection of the parasite. A number of important questions, such as the epidemiology among men and women, the true public health burden of symptomatic and asymptomatic T. vaginalis infections, and whether current treatments will be adequate to reduce the substantial health disparities and costs associated with trichomoniasis, need consideration to remedy neglect of this important disease.
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Affiliation(s)
- W. Evan Secor
- *Address correspondence to W. Evan Secor, Division of Parasitic Diseases and Malaria, Centers for Disease Control and Prevention, 1600 Clifton Road NE, Mailstop D-65, Atlanta, GA 30333. E-mail:
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17
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Twu O, Dessí D, Vu A, Mercer F, Stevens GC, de Miguel N, Rappelli P, Cocco AR, Clubb RT, Fiori PL, Johnson PJ. Trichomonas vaginalis homolog of macrophage migration inhibitory factor induces prostate cell growth, invasiveness, and inflammatory responses. Proc Natl Acad Sci U S A 2014; 111:8179-84. [PMID: 24843155 PMCID: PMC4050605 DOI: 10.1073/pnas.1321884111] [Citation(s) in RCA: 116] [Impact Index Per Article: 11.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/19/2022] Open
Abstract
The human-infective parasite Trichomonas vaginalis causes the most prevalent nonviral sexually transmitted infection worldwide. Infections in men may result in colonization of the prostate and are correlated with increased risk of aggressive prostate cancer. We have found that T. vaginalis secretes a protein, T. vaginalis macrophage migration inhibitory factor (TvMIF), that is 47% similar to human macrophage migration inhibitory factor (HuMIF), a proinflammatory cytokine. Because HuMIF is reported to be elevated in prostate cancer and inflammation plays an important role in the initiation and progression of cancers, we have explored a role for TvMIF in prostate cancer. Here, we show that TvMIF has tautomerase activity, inhibits macrophage migration, and is proinflammatory. We also demonstrate that TvMIF binds the human CD74 MIF receptor with high affinity, comparable to that of HuMIF, which triggers activation of ERK, Akt, and Bcl-2-associated death promoter phosphorylation at a physiologically relevant concentration (1 ng/mL, 80 pM). TvMIF increases the in vitro growth and invasion through Matrigel of benign and prostate cancer cells. Sera from patients infected with T. vaginalis are reactive to TvMIF, especially in males. The presence of anti-TvMIF antibodies indicates that TvMIF is released by the parasite and elicits host immune responses during infection. Together, these data indicate that chronic T. vaginalis infections may result in TvMIF-driven inflammation and cell proliferation, thus triggering pathways that contribute to the promotion and progression of prostate cancer.
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Affiliation(s)
| | - Daniele Dessí
- Dipartimento di Scienze Biomediche, Università degli Studi di Sassari, 07100 Sassari, Italy; and
| | - Anh Vu
- Department of Microbiology, Immunology, and Molecular Genetics, and
| | - Frances Mercer
- Department of Microbiology, Immunology, and Molecular Genetics, and
| | - Grant C Stevens
- Department of Microbiology, Immunology, and Molecular Genetics, and
| | - Natalia de Miguel
- Instituto de Investigaciones Biotecnológicas-Instituto Tecnológico de Chascomús, 1650 Chascomús, Argentina
| | - Paola Rappelli
- Dipartimento di Scienze Biomediche, Università degli Studi di Sassari, 07100 Sassari, Italy; and
| | - Anna Rita Cocco
- Dipartimento di Scienze Biomediche, Università degli Studi di Sassari, 07100 Sassari, Italy; and
| | - Robert T Clubb
- Department of Chemistry and Biochemistry, University of California, Los Angeles, CA 90095
| | - Pier Luigi Fiori
- Dipartimento di Scienze Biomediche, Università degli Studi di Sassari, 07100 Sassari, Italy; and
| | - Patricia J Johnson
- Molecular Biology Institute,Department of Microbiology, Immunology, and Molecular Genetics, and
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18
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Groom HCT, Warren AY, Neal DE, Bishop KN. No evidence for infection of UK prostate cancer patients with XMRV, BK virus, Trichomonas vaginalis or human papilloma viruses. PLoS One 2012; 7:e34221. [PMID: 22470540 PMCID: PMC3314598 DOI: 10.1371/journal.pone.0034221] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/22/2011] [Accepted: 02/24/2012] [Indexed: 02/07/2023] Open
Abstract
The prevalence of specific infections in UK prostate cancer patients was investigated. Serum from 84 patients and 62 controls was tested for neutralisation of xenotropic murine leukaemia virus-related virus (XMRV) Envelope. No reactivity was found in the patient samples. In addition, a further 100 prostate DNA samples were tested for XMRV, BK virus, Trichomonas vaginalis and human papilloma viruses by nucleic acid detection techniques. Despite demonstrating DNA integrity and assay sensitivity, we failed to detect the presence of any of these agents in DNA samples, bar one sample that was weakly positive for HPV16. Therefore we conclude that these infections are absent in this typical cohort of men with prostate cancer.
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Affiliation(s)
- Harriet C. T. Groom
- Division of Virology, MRC National Institute for Medical Research, London, United Kingdom
| | - Anne Y. Warren
- Department of Pathology, University of Cambridge, Cambridge, United Kingdom
| | - David E. Neal
- Department of Oncology, University of Cambridge, Cambridge, United Kingdom
| | - Kate N. Bishop
- Division of Virology, MRC National Institute for Medical Research, London, United Kingdom
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19
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Tolbert M, Leutenegger C, Lobetti R, Birrell J, Gookin J. Species identification of trichomonads and associated coinfections in dogs with diarrhea and suspected trichomonosis. Vet Parasitol 2011; 187:319-22. [PMID: 22264747 PMCID: PMC7130802 DOI: 10.1016/j.vetpar.2011.12.031] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/04/2011] [Revised: 12/15/2011] [Accepted: 12/21/2011] [Indexed: 11/15/2022]
Abstract
Trichomonads have been infrequently reported in the feces of dogs where their pathogenicity remains uncertain. It is currently unknown whether Tritrichomonas foetus or Pentatrichomonas hominis is identified more commonly in dogs with trichomonosis or how often these infections are accompanied by concurrent enteric infectious agents. The objective of this study was to determine the identity of trichomonads present in a series of 38 unsolicited canine diarrheic fecal samples submitted for T. foetus diagnostic polymerase chain reaction (PCR) testing between 2007 and 2010. We also examined each fecal sample for an association of trichomonosis with concurrent infection using a convenient real-time PCR panel for nine gastrointestinal pathogens. P. hominis, T. foetus, or both were identified by PCR in feces of 17, 1, and 1 dogs respectively. Feces from the remaining 19 dogs were PCR negative for T. foetus, P. hominis and using broader-spectrum Trichomonadida primers. The total number and specific identities of concurrent enteropathogens identified did not differ between fecal samples from dogs that were or were not identified by PCR as infected with trichomonads. These results suggest that P. hominis infection is more frequently identified than T. foetus infection in diarrheic dogs with trichomonosis and that concurrent enteropathogen infection is common in this population.
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Affiliation(s)
- M.K. Tolbert
- Department of Clinical Sciences, College of Veterinary Medicine, North Carolina State University, Raleigh, NC, United States
| | | | - R. Lobetti
- Bryanston Veterinary Hospital, Bryanston, South Africa
| | - J. Birrell
- South African Police Services Veterinary Hospital, Roodeplaat, South Africa
| | - J.L. Gookin
- Department of Clinical Sciences, College of Veterinary Medicine, North Carolina State University, Raleigh, NC, United States
- Corresponding author. Tel.: +1 919 513 6295; fax: +1 919 513 6336.
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20
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Kissinger P, Mena L, Levison J, Clark RA, Gatski M, Henderson H, Schmidt N, Rosenthal SL, Myers L, Martin DH. A randomized treatment trial: single versus 7-day dose of metronidazole for the treatment of Trichomonas vaginalis among HIV-infected women. J Acquir Immune Defic Syndr 2010; 55:565-71. [PMID: 21423852 PMCID: PMC3058179 DOI: 10.1097/qai.0b013e3181eda955] [Citation(s) in RCA: 54] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
OBJECTIVE To determine if the metronidazole (MTZ) 2-gm single dose (recommended) is as effective as the 7-day 500 mg twice a day dose (alternative) for treatment of Trichomonas vaginalis (TV) among HIV+ women. METHODS Phase IV randomized clinical trial; HIV+ women with culture confirmed TV were randomized to treatment arm: MTZ 2-gm single dose or MTZ 500 mg twice a day 7-day dose. All women were given 2-gm MTZ doses to deliver to their sex partners. Women were recultured for TV at a test-of-cure (TOC) visit occurring 6-12 days after treatment completion. TV-negative women at TOC were again recultured at a 3-month visit. Repeat TV infection rates were compared between arms. RESULTS Two hundred seventy HIV+/TV+ women were enrolled (mean age = 40 years, ±9.4; 92.2% African American). Treatment arms were similar with respect to age, race, CD4 count, viral load, antiretroviral therapy status, site, and loss-to-follow up. Women in the 7-day arm had lower repeat TV infection rates at TOC [8.5% (11 of 130) versus 16.8% (21 of 125) (relative risk: 0.50, 95% confidence interval = 0.25, 1.00; P < 0.05)] and at 3 months [11.0% (8 of 73) versus 24.1% (19 of 79) (relative risk: 0.46, 95% confidence interval = 0.21, 0.98; P = 0.03)] compared with the single-dose arm. CONCLUSIONS The 7-day MTZ dose was more effective than the single dose for the treatment of TV among HIV+ women.
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Affiliation(s)
- Patricia Kissinger
- Department of Epidemiology, Tulane University School of Public Health and Tropical Medicine, New Orleans, LA 70112, USA.
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21
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Fan L, Zou LY, Wu YM, Zhang WY. [Factors associated with abnormal cervical cytology in pregnant women]. Zhonghua Fu Chan Ke Za Zhi 2010; 45:109-113. [PMID: 20420780] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 05/29/2023]
Abstract
OBJECTIVE To investigate the risk factors associated with abnormal cervical cytology findings in pregnant women. METHODS From Sep. 2007 to Sep. 2008, 12,112 pregnant women who underwent their antenatal examinations at 12-36 gestational weeks in Beijing Obstetrics and Gynecology Hospital were enrolled in this study. They were all excluded from the following pathologic obstetrics factors including threatened abortion, premature rupture of membranes or placental previa. Thinprep cytology test (TCT) were given at their first examination, meanwhile, a personal clinic file was established to record her occupation, education, address, family income, nationality, age of first intercourse, number of sex partners, contraception, marriage and pregnancy, current gynecologic diseases, family history of gynecologic tumors, history of gynecologic diseases and smoking and result of pelvic examination. Those risk factors leading to abnormal cervical cytology were analyzed. RESULTS The complete clinical data were collected from 11 906 cases (98.30%, 11,906/12,112). It was found that 10,354 women were shown with normal TCT result, however, 1134 women (9.52%, 1134/11,906) with atypical squamous cells of undetermined significance (ASCUS), 112 women (0.94%, 112/11,906) with atypical glandular cells of undetermined significance (AGUS), 229 women (1.92%, 229/11,906) with low grade squamous intraepithelial (LSIL), 74 women (0.62%, 74/11,906) with high grade squamous intraepithelial (HSIL). Multiple factorial non-conditioned logistic regression analysis showed that age of first sexual intercourse (OR(ASCUS) = 2.90, OR(AGUS) = 7.32), number of sex partners (OR(ASCUS) = 1.49, OR(AGUS) = 2.02), number of abortion (OR(ASCUS) = 1.68, OR(AGUS) = 3.50) were correlated with ASCUS and AGUS. In LSIL group and HSIL group, age of first sexual intercourse (OR(LSIL) = 6.34, OR(HSIL) = 9.26), number of sex partners (OR(LSIL) = 1.69, OR(HSIL) = 1.65), number of abortion (OR(LSIL) = 1.53, OR(HSIL) = 5.33), smoking (OR(LSIL) = 1.84, OR(HSIL) = 1.77) were remarkable variables. The infection of human papilloma virus (HPV) and trichomonas vaginitis were correlated with abnormal cervical cytology (including ASCUS, AGUS, LSIL and HSIL) significantly (P < 0.01). Columnar epithelium dystopia were also significantly correlated with abnormal cervical cytology (chi(2) = 43.269, P = 0.000). However, abnormal cervical cytology was uncorrelated with degrees of Columnar epithelium dystopia. CONCLUSIONS The risk factors associated with abnormal cervical cytology in pregnant women were the same with those of non-pregnant women.
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Affiliation(s)
- Ling Fan
- Department of Obstetrics, Beijing Obstetics and Gynecology Hospital, Capital Medical University, Beijing 100026, China
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Henderson H. Mississippi HIV clinic is home to an active research program. HIV Clin 2008; 20:5. [PMID: 18574886] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 05/26/2023]
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Abstract
In the past several years, the collective understanding of cervicitis has extended beyond the recognition of Chlamydia trachomatis and Neisseria gonorrhoeae as the prime etiologic suspects. Trichomonas vaginalis and herpes simplex virus cause cervicitis, and both Mycoplasma genitalium and bacterial vaginosis have emerged as new candidate etiologic agents or conditions. However, major gaps in our knowledge of this common condition remain. Putative etiologic agents have not been identified in many women with cervicitis. Moreover, cervicitis occurs in a relatively small proportion of women with chlamydia or gonorrhea. Finally, scant research has addressed the clinical response of nonchlamydial and nongonococcal cervicitis to antibiotic therapy, and there are no data on the benefit of sex partner treatment for such women. New research into the etiology, immunology, and natural history of this common condition is needed, especially in view of the well-established links between cervicitis and an increased risk of upper genital tract infection and human immunodeficiency virus type 1 acquisition.
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Affiliation(s)
- Jeanne M Marrazzo
- Department of Medicine, University of Washington, Seattle, WA 98104, USA.
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Abstract
Colonization of human lungs by various Trichomonas species is a frequent occurrence, but is unknown to most physicians. At this site of infection, the parasite develops into an amoeboid form that renders it unrecognizable. For this reason it has been overlooked until recently. Morphological identification is not feasible under these conditions and molecular tools provide the only means of identification. The species involved are not restricted to Trichomonas tenax, a saprophyte of the mouth that is usually cited in the rare cases of pleuropulmonary trichomoniasis reported in the literature. The recent discovery of species previously unknown in humans raises further questions, including the zoonotic potential of these microorganisms and the existence of species of animal origin that have adapted to humans. Anaerobiosis in poorly ventilated alveolar lumen, rather than immunodepression, seems to be the factor that promotes proliferation of this parasite. The diagnosis of trichomoniasis and its treatment by specific drugs will make it possible to evaluate the pathogenicity of these parasites.
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Affiliation(s)
- Christophe Duboucher
- CHI de Poissy/Saint-Germain, Laboratoire d'anatomie pathologique, Saint-Germain-en-Laye, France.
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Abstract
AIM Trichomonas vaginalis may cause symptomatic or asymptomatic urethritis in men. There are few recent studies on the prevalence of T. vaginalis infection in Japanese men, and quantification of the number of cases of urethritis attributable to this pathogen has not been performed in Japan. The aim of this study was to determine the prevalence and morbidity of T. vaginalis infection in Japanese men. METHODS One hundred subjects with or without urethritis were examined for the presence of urethral T. vaginalis using culture swabs. RESULTS Urethral swabs from all subjects were negative for T. vaginalis. CONCLUSION These results indicate Japanese men, including those with urethritis, have a low incidence of urethral T. vaginalis infection or colonization. T. vaginalis appears to be an uncommon pathogen for male urethritis in Japan.
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Affiliation(s)
- Shin-Ichi Maeda
- Department of Urology, Toyota Memorial Hospital, Toyota, Japan
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26
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Sutcliffe S, Giovannucci E, Alderete JF, Chang TH, Gaydos CA, Zenilman JM, De Marzo AM, Willett WC, Platz EA. Plasma antibodies against Trichomonas vaginalis and subsequent risk of prostate cancer. Cancer Epidemiol Biomarkers Prev 2006; 15:939-45. [PMID: 16702374 DOI: 10.1158/1055-9965.epi-05-0781] [Citation(s) in RCA: 136] [Impact Index Per Article: 7.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/13/2023] Open
Abstract
BACKGROUND Although several previous case-control studies have investigated associations between sexually transmitted infections (STI) and prostate cancer, most have focused on gonorrhea and syphilis, two well-recognized, symptomatic STIs. Another STI of interest for prostate carcinogenesis is trichomonosis, a less well recognized and frequently asymptomatic STI with known prostate involvement. We investigated this infection in relation to incident prostate cancer in a nested case-control study within the Health Professionals Follow-up Study. METHODS Prostate cancer cases were men diagnosed with prostate cancer between the date of blood draw (1993-1995) and 2000 (n = 691). Controls were men who had had at least one prostate-specific antigen test and who were free of prostate cancer and alive at the time of case diagnosis. One control was individually matched to each case by age (n = 691). Serologic evidence of a history of trichomonosis was assessed by a recombinant Trichomonas vaginalis alpha-actinin IgG ELISA. RESULTS Thirteen percent of cases and 9% of controls were seropositive for trichomonosis (adjusted odds ratio, 1.43; 95% confidence interval, 1.00-2.03). This association persisted after additional adjustment for such factors as a history of other STIs, and was strongest among men who used aspirin infrequently over the course of their lives (odds ratio, 2.05; 95% confidence interval, 1.05-4.02, P(interaction) = 0.11). CONCLUSIONS Serologic evidence of a history of trichomonosis was positively associated with incident prostate cancer in this large, nested case-control study of male health professionals. As this study is the first, to our knowledge, to investigate associations between T. vaginalis serology and prostate cancer, additional studies are necessary before conclusions can be made.
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Affiliation(s)
- Siobhan Sutcliffe
- Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Room E6138, 615 North Wolfe Street, Baltimore, MD 21205, USA
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Zhao FH, Forman MR, Belinson J, Shen YH, Graubard BI, Patel AC, Rong SD, Pretorius RG, Qiao YL. Risk factors for HPV infection and cervical cancer among unscreened women in a high-risk rural area of China. Int J Cancer 2006; 118:442-8. [PMID: 16080192 DOI: 10.1002/ijc.21327] [Citation(s) in RCA: 27] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
We report a prevalence rate of 23.6% human papillomavirus (HPV) infection with oncogenic subtypes and 2.4% cervical intraepithelial neoplasia (CIN) III and cervical cancer (CC) in rural middle-aged women in 2 counties with the highest CC mortality in Shanxi Province, China. We examined the association of risk factors to HPV infection and to CIN III and CC in 8,798 unscreened women aged 35-50 years. Multivariate odds ratios (OR) and 95% confidence intervals (CI) for each endpoint were obtained for risk factors after adjustment for covariates. The OR of oncogenic HPV were: 1.41 (95% CI = 1.25-1.60) and 1.42 (95% CI = 1.24-1.61) for the participant and her husband having multiple sexual partners, respectively; 1.67 (95% CI = 1.37-2.04), 1.15 (95% CI = 1.04-1.26), and 0.82 (95% CI = 0.72-0.94) for ever (vs. never) diagnosed with tuberculosis, cervical inflammation and vaginal trichomoniasis, respectively; while bathing in a public (v. private) facility had an OR of 1.23 (95% CI =1.11-1.35). Seasonal fluctuations in HPV infection, but not CC, appeared in Xiangyuan County, with OR of 1.23 (95% CI = 1.14-1.33) and 1.51 (95% CI = 1.35-1.67) in Spring and Winter compared to Summer, respectively. The OR of CIN III and CC in the HPV positives were: 2.03 (95% CI = 1.63-2.53) for ages > or =45 years (vs. <40); and 4.01 (95% CI = 1.46-11.0) for > or =3 (vs. no) home births. Public health interventions and control strategies for improving the reproductive health of women in these rural populations need to be developed to reduce risk of HPV and subsequent CC.
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Affiliation(s)
- Fang-Hui Zhao
- Department of Epidemiology, Cancer Institute/Hospital, Chinese Academy of Medical Sciences, Beijing, China
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28
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Grueva E, Borisov I. [The role of chlamydia trachomatis and some other associated microorganisms in endocervicitis]. Akush Ginekol (Sofiia) 2006; 45:32-5. [PMID: 17168494] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 05/13/2023]
Abstract
The objective of the study was to examine the prevalence of Chlamydia trachomatis as a causative agent in women with clinically manifested endocervicitis and to find the age group where Chlamydia trachomatis was most prevalent. 553 women sexually active women in reproductive ag with clinically manifested endocervicitis e were examined. Chlamydial infection by direct immmunofluorescence was found in 239 (43, 2%) About 75% of the patients with chlamydial infection were in the age group 20-29 years. The predominant part of these women had no other associated infection except Chlamydia trachomatis. Association of Chlamydia trachomatis with candida albicans-25, 10%, bacteria vaginosis 23, 53%, Trichomonas vaginalis in 7.53% in the women with cervicitis.
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Demirezen S, Korkmaz E, Beksaç MS. Association between trichomoniasis and bacterial vaginosis: examination of 600 cervicovaginal smears. Cent Eur J Public Health 2005; 13:96-8. [PMID: 15969458] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/03/2023]
Abstract
To determine whether there is a relationship between trichomoniasis and bacterial vaginosis (BV), cervicovaginal smears obtained from 600 women were stained with the Papanicolaou technique and examined cytologically. Thirty-six (6%) of 600 women were diagnosed as having Trichomonas vaginalis [TV(+)]. Sixteen (44.4%) of 36 TV(+) cases were observed as having BV [BV(+)]. Thirty-one of 564 TV(-) vaginal smears were also positive for BV (5.5%). There was a statistically significant correlation between trichomoniasis and bacterial vaginosis (p < 0.05). It is possible that TV might create an anaerobic environment, thereby changing the vaginal flora. This flora becomes a more suitable milieu for growing of anaerobic microorganisms. It can be postulated that TV might be the most important protozoan that contributes to the overgrowth of BV-related microorganisms.
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Affiliation(s)
- S Demirezen
- Hacettepe University, Faculty of Science, Department of Biology, Ankara, Turkey.
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Price MA, Cohen MS, Hoffman IF, Chilongozi D, Martinson FEA, Tembo T. Collecting the essence of man: semen collection for HIV transmission studies in sub-Saharan Africa. Sex Transm Infect 2005; 81:185-6. [PMID: 15800108 PMCID: PMC1764654 DOI: 10.1136/sti.2004.012104] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
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31
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Gottlieb SL, Douglas JM, Foster M, Schmid DS, Newman DR, Baron AE, Bolan G, Iatesta M, Malotte CK, Zenilman J, Fishbein M, Peterman TA, Kamb ML. Incidence of herpes simplex virus type 2 infection in 5 sexually transmitted disease (STD) clinics and the effect of HIV/STD risk-reduction counseling. J Infect Dis 2004; 190:1059-67. [PMID: 15319854 DOI: 10.1086/423323] [Citation(s) in RCA: 79] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/11/2003] [Accepted: 03/30/2004] [Indexed: 11/03/2022] Open
Abstract
The seroincidence of herpes simplex virus type 2 (HSV-2) infection was determined among 1766 patients attending sexually transmitted disease (STD) clinics and enrolled in a randomized, controlled trial of human immunodeficiency virus (HIV)/STD risk-reduction counseling (RRC). Arm 1 received enhanced RRC (4 sessions); arm 2, brief RRC (2 sessions); and arm 3, the control arm, brief informational messages. The overall incidence rate was 11.7 cases/100 person-years (py). Independent predictors of incidence of HSV-2 infection included female sex; black race; residence in Newark, New Jersey; <50% condom use with an occasional partner; and, in females, incident trichomoniasis and bacterial vaginosis. Only 10.8% of new HSV-2 infections were diagnosed clinically. Incidence rates were 12.9 cases/100 py in the control arm, 11.8 cases/100 py in arm 2, and 10.3 cases/100 py in arm 1 (hazard ratio, 0.8 [95% confidence interval, 0.6-1.1], vs. controls). The possible benefit of RRC in preventing acquisition of HSV-2 infection offers encouragement that interventions more specifically tailored to genital herpes may be useful and should be an important focus of future studies.
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Affiliation(s)
- Sami L Gottlieb
- Department of Medicine, University of Colorado Health Sciences Center, Denver, Colorado, USA.
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Monteiro CA, Bachmann LH, Desmond RA, Squires KE, Vermund SH, Hook EW, Schwebke JR, Hoesley CJ. Incidence and risk factors for sexually transmitted infections among women in an Alabama HIV clinic. AIDS Res Hum Retroviruses 2004; 20:577-83. [PMID: 15242532 DOI: 10.1089/0889222041217437] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
The objectives of this study were to assess the prevalence and incidence of curable sexually transmitted infections (STI), i.e., gonorrhea, chlamydial infection, or trichomoniasis, in a cohort of HIV-infected women. The study population was derived from women seeking primary care at an outpatient university HIV clinic who were participants in a women's natural history study. Enrollees (n = 225) were predominantly African-American, heterosexually infected, with mean age 35 years. Mean entry CD4+ T cell count was 405 cells/mm3. Over 6% were STI positive at initial screening. Subsequently, the combined curable STI incidence was 4.82/1000 woman-months over a median of 33 months of observation. Of 36 incident STIs, trichomoniasis was most common (n = 32). Predictors for acquisition of a curable STI included absenteeism at scheduled clinic appointments, RR = 1.99 (1.28, 3.08), and a higher CD4+ T cell count, RR = 1.15 (1.0028, 1.3115) for 100 cells. Interventions to prevent curable STI in HIV-infected women are warranted in primary care settings.
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Affiliation(s)
- Cheryl-Ann Monteiro
- Department of Medicine, the University of Alabama at Birmingham, Alabama 35294, USA
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Affiliation(s)
- Granville L Lloyd
- Department of Urology, Feinberg School of Medicine, Northwestern University, Chicago, IL, USA
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Price MA, Zimba D, Hoffman IF, Kaydos-Daniels SC, Miller WC, Martinson F, Chilongozi D, Kip E, Msowoya E, Hobbs MM, Kazembe PN, Cohen MS. Addition of treatment for trichomoniasis to syndromic management of urethritis in Malawi: a randomized clinical trial. Sex Transm Dis 2003; 30:516-22. [PMID: 12782954 DOI: 10.1097/00007435-200306000-00009] [Citation(s) in RCA: 67] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
BACKGROUND Male urethritis is generally treated syndromically, but failure of empirical treatment is common. GOAL The study goal was to evaluate the addition of metronidazole to the syndromic management of urethritis in Malawi in a randomized clinical trial. STUDY DESIGN Men with urethritis were randomized to receive either 2 g of metronidazole by mouth or placebo, in addition to standard care for urethritis (i.e., a single intramuscular dose of 240 mg gentamicin and 100 mg doxycycline twice daily for 7 days). The primary endpoints of the study included measurement of the effects of treatment on Trichomonas vaginalis, signs and symptoms of urethritis, and the concentration of HIV RNA in semen in dually infected subjects. RESULTS The overall prevalence of T vaginalis was 17.3% (71/411), and treatment with metronidazole cleared 95% of culture-positive infections, compared with 54% clearance among men receiving placebo (P = 0.006). Prevalence of persistent urethritis was observed in approximately 16% of both groups at the end of 1 week (29/179 of those receiving metronidazole versus 29/187 in the placebo group; P = 0.86). For a subset of HIV-infected men with trichomoniasis, the seminal plasma HIV RNA concentration was higher than in a group of HIV-positive control subjects (median copies/mL:35,000 vs. 1800 P = 0.06) [correction]. CONCLUSION In areas with a high prevalence of trichomoniasis, the addition of metronidazole to the syndromic management of male urethritis can eliminate infection with T vaginalis and may help to reduce the transmission of HIV. Such treatment should be strongly considered as part of empirical therapy for urethritis in men in Malawi and places where T vaginalis infection in men is common.
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Affiliation(s)
- Matthew A Price
- Department of Epidemiology, University of North Carolina at Chapel Hill, Chapel Hill, NC 27599, USA
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35
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Abstract
Empyema is one of the potential complications of lower respiratory tract infections. Very rarely, in predisposed individuals, empyema can be caused by Trichomonas species, of which Trichomonas tenax appears to be the most common cause. Here, we present a case of trichomonal empyema in a 56-year-old man and review the available literature of this rare occurrence.
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Affiliation(s)
- Kevin L Lewis
- Division of Pulmonary and Critical Care Medicine, The University of Kentucky Chandler Medical Center, Lexington, KY 40536, USA
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36
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Hoffman DJ, Brown GD, Wirth FH, Gebert BS, Bailey CL, Anday EK. Urinary tract infection with Trichomonas vaginalis in a premature newborn infant and the development of chronic lung disease. J Perinatol 2003; 23:59-61. [PMID: 12556929 DOI: 10.1038/sj.jp.7210819] [Citation(s) in RCA: 13] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
We report a case of a low-birth-weight infant with an infection of the urinary tract with Trichomonas vaginalis, who later developed cystic chronic lung disease suggestive of Wilson-Mikity syndrome. Although she had mild respiratory distress syndrome at birth, the extent of the chronic lung disease was out of proportion to the initial illness. We speculate that maternal infection with this organism may have resulted in an inflammatory response that led to its development.
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Affiliation(s)
- David J Hoffman
- Section of Neonatology, The Reading Hospital and Medical Center, West Reading, PA 19611, USA
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37
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Collett TF. Irregular uterine bleeding in adolescents. J Pediatr Health Care 2002; 16:313, 321-2. [PMID: 12436102 DOI: 10.1067/mph.2002.114889] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
Affiliation(s)
- Therese F Collett
- SUNY at StonyBrook School of Nursing, Adolescent Clinic, Jacobi Medical Center, Bronx, NY, USA
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38
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Berghella V, Klebanoff M, McPherson C, Carey JC, Hauth JC, Ernest JM, Heine RP, Wapner RJ, Trout W, Moawad A, Leveno KJ, Miodovnik M, Sibai BM, Van Dorsten JP, Dombrowski MP, O'Sullivan MJ, Varner M, Langer O. Sexual intercourse association with asymptomatic bacterial vaginosis and Trichomonas vaginalis treatment in relationship to preterm birth. Am J Obstet Gynecol 2002; 187:1277-82. [PMID: 12439520 DOI: 10.1067/mob.2002.127134] [Citation(s) in RCA: 17] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
Abstract
OBJECTIVE The purpose of this study was to determine whether sexual intercourse was associated with the treatment efficacy or the incidence of preterm birth in two large randomized trials in which metronidazole treatment of bacterial vaginosis or Trichomonas vaginalis did not reduce preterm birth. STUDY DESIGN Secondary analysis of two multicenter, double-blind, placebo-controlled trials in which women with asymptomatic bacterial vaginosis on Gram stain or asymptomatic T vaginalis on culture were randomized at 16 to 23 weeks of gestation to metronidazole or placebo. In both studies, women took 2 g of metronidazole or placebo in the presence of a nurse (first dose) and were given a second dose to take 48 hours later. This regimen was repeated (third and fourth doses) at 24 to 29 weeks. At the time of the third dose, bacterial vaginosis and T vaginalis specimens were collected again. Patients who were randomly selected to receive metronidazole were analyzed for bacterial vaginosis and T vaginalis at 24 to 29 weeks and for preterm birth of <37 weeks of gestation, according to intercourse between first and second doses and between the second and third doses. Continuous variables were compared with the use of the Wilcoxon rank-sum test; categoric variables were compared with the use of the chi(2 ) test, Fisher exact test, or the Mantel-Haenzel test of trend. RESULTS Sexual intercourse between the first and second doses or between the second and third doses did not influence the incidence of bacterial vaginosis (18% vs 24%; relative risk, 0.7; 95% CI, 0.5-1.1; and 23% vs 20%; relative risk, 1.2; 95% CI, 0.9-1.6, respectively) or T vaginalis (4% vs 8%; relative risk, 0.5; 95% CI, 0.1-3.6; and 5% vs 10%; relative risk, 0.5; 95% CI, 0.2-1.1; respectively) at 24 to 29 weeks of gestation compared with no intercourse. In the T vaginalis trial, sexual intercourse between the first and second doses or between the second and third doses did not influence the incidence of preterm birth (13% vs 17%; relative risk, 0.8; 95% CI, 0.3-2.1; and 16% vs 17%; relative risk, 1.0; 95% CI, 0.6-1.6; respectively) compared with no intercourse. In the bacterial vaginosis trial, although sexual intercourse between the first and second doses did not influence the incidence of preterm birth (11% vs 12%; relative risk, 0.9; 95 % CI, 0.6-1.5), sexual intercourse between the second and third doses was associated with a reduction in the incidence of preterm birth (10% vs 16%; relative risk, 0.6; 95% CI, 0.4-0.9) compared with no intercourse. CONCLUSION Sexual intercourse was associated with neither the efficacy of metronidazole treatment of bacterial vaginosis or T vaginalis nor with the incidence of preterm birth. In the bacterial vaginosis study, intercourse between the second and third doses had a negative association with preterm birth.
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Affiliation(s)
- Vincenzo Berghella
- Jefferson Medical College of Thomas Jefferson University, Philadelphia, PA, USA
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39
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Goldblum H, Munoz C. [Sexual transmissible diseases and "returning leukorrhea"]. Rev Med Suisse Romande 2002; 122:553-5. [PMID: 12522941] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 02/28/2023]
Abstract
White discharges and sexual transmissive diseases are now increasing. Confronted to this symptom, the general practician can easily diagnose and treat his patient. Therefore he must keep in his mind that behind this common symptom, a much more serious disease can be hidden.
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Affiliation(s)
- Henri Goldblum
- Service de Gynécologie Hôpital régional, 2900 Porrentruy.
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40
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Skerk V, Schönwald S, Granić J, Krhen I, Barsić B, Mareković I, Roglić S, Desnica B, Zeljko Z. Chronic prostatitis caused by Trichomonas vaginalis--diagnosis and treatment. J Chemother 2002; 14:537-8. [PMID: 12462437 DOI: 10.1179/joc.2002.14.5.537] [Citation(s) in RCA: 13] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/31/2022]
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Abstract
Trichomoniasis remains an extremely common infection despite the fact that rates of other treatable sexually transmitted diseases are declining. Newer diagnostic techniques such as polymerase chain reaction (PCR) are documenting higher rates of infection in heterosexual men than have been previously found with culture. Although data on the association of vaginal trichomoniasis with preterm birth are controversial, the association of trichomoniasis with HIV acquisition seems clear. Despite being a readily diagnosed and treated STD, trichomoniasis is not a reportable infection and control of the infection has received relatively little emphasis from public health STD control programmes. More recently, however, appreciation of high rates of disease and of associations of trichomoniasis in women with adverse outcomes of pregnancy and increased risk for HIV infection suggest a need for increased control efforts.
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Affiliation(s)
- J R Schwebke
- University of Alabama at Birmingham, 35294-0007, USA.
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42
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Rivero LR, Peña MR, Pérez CS, Monroy SP, Sariego Ramos I, Nodarse JF. [Frequency of Trichomonas vaginalis infection in couples with fertility problems]. Rev Cubana Med Trop 2002; 54:85-90. [PMID: 15849932] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 05/02/2023]
Abstract
One-hundred and seventy two couples which went for the first time to the Infertility Service of the National Institute of Endocrinology from June 1999 to June 2000, were studied to find out the frequency of Trichomonas vaginalis infection in this group, and determine its interaction with a number of clinical and risk variables. The results yielded that 10.5% were positive to the parasite, the prevailing symptom was leukorrea in women and 96.6% of men showed no symptoms. It was highly significant the fact of having a previous pathological history that might be related to infertility and current T. vaginalis infection. This protozoon was frequently associated with Candida sp. and causative agents of bacterial vaginosis in women and Haemophilus influenzae in men. This parasite seems to play an important role as a likely causative agent to be considered in fertility problems.
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Moodley P, Wilkinson D, Connolly C, Moodley J, Sturm AW. Trichomonas vaginalis is associated with pelvic inflammatory disease in women infected with human immunodeficiency virus. Clin Infect Dis 2002; 34:519-22. [PMID: 11797180 DOI: 10.1086/338399] [Citation(s) in RCA: 171] [Impact Index Per Article: 7.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/25/2001] [Revised: 08/30/2001] [Indexed: 11/03/2022] Open
Abstract
We assessed the association between the causative agents of vaginal discharge and pelvic inflammatory disease (PID) among women attending a rural sexually transmitted disease clinic in South Africa; the role played by coinfection with human immunodeficiency virus type 1 (HIV-1) was studied. Vaginal and cervical specimens were obtained to detect Neisseria gonorrhoeae, Chlamydia trachomatis, Trichomonas vaginalis, and bacterial vaginosis. HIV-1 infection was established by use of serum antibody tests. A total of 696 women with vaginal discharge were recruited, 119 of whom had clinical PID. Patients with trichomoniasis had a significantly higher risk of PID than did women without trichomoniasis (P=.03). PID was not associated with any of the other pathogens. When the patients were stratified according to HIV-1 status, the risk of PID in HIV-1-infected patients with T. vaginalis increased significantly (P=.002); no association was found in patients without HIV-1. T. vaginalis infection of the lower genital tract is associated with a clinical diagnosis of PID in HIV-1-infected women.
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Affiliation(s)
- Prashini Moodley
- Africa Centre for Population Studies and Reproductive Health and Departments of Medical Microbiology, Durban, South Africa
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Gasanova TA. [Parasitic diseases are a risk factor of inflammations of the small pelvis organs. Trichomoniasis]. Med Parazitol (Mosk) 2002:3-8. [PMID: 12224263] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 02/26/2023]
Abstract
Clinical and laboratory studies were made in 2259 persons by using serological assays, including cultural and bacterioscopic assays in 1824 and 363 persons, respectively, in order to indicate Trichomonas infection among men, women, and 2-15-year-old children who had chronic inflammation of the urogenital system, as well as among children aged 2 months to 16 years who had a severe somatic disease. Parasitic cenoses of the urogenital tract were studied in women with trichomoniasis and reproductive dysfunction. Trichomonas invasion is an etiological factor of inflammatory small pelvic diseases, chronic prostatitis, reproductive dysfunction in males and females. Furthermore, trichomoniasis is an essential factor, that predisposes to recurrent viral infections: genital herpes and pointed condyloma, and substantially increases the risk of birth of babies with clinical manifestations of intrauterine infection. According to the studies, a laboratory diagnosis of trichomoniasis should be made by cultural assay due to the low sensitivity of bacterioscopy by sampling a biological material from females in the periovulatory period that corresponds to the hyperestrogenicity, which substantially increases the number of isolated cultures and characterizes the depth of integration of metabolic processes of a parasite and its host.
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MESH Headings
- Adolescent
- Adult
- Animals
- Antibodies, Protozoan/blood
- Child
- Child, Preschool
- Condylomata Acuminata/etiology
- Female
- Genital Diseases, Female/complications
- Genital Diseases, Female/epidemiology
- Genital Diseases, Female/parasitology
- Genital Diseases, Male/complications
- Genital Diseases, Male/epidemiology
- Genital Diseases, Male/parasitology
- Herpes Genitalis/etiology
- Humans
- Infant
- Infant, Newborn
- Male
- Parasitology/methods
- Pelvic Inflammatory Disease/parasitology
- Pregnancy
- Pregnancy Complications, Parasitic/epidemiology
- Pregnancy Complications, Parasitic/parasitology
- Prostatitis/parasitology
- Risk Factors
- Russia/epidemiology
- Serologic Tests
- Trichomonas Infections/complications
- Trichomonas Infections/epidemiology
- Trichomonas Infections/parasitology
- Trichomonas vaginalis/immunology
- Trichomonas vaginalis/isolation & purification
- Virology/methods
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Bardov PV, Lebediuk MM, Stepanenko VI. [Complex diagnosis of chronic prostatitis complicated by disorders in sexual and reproductive functions]. Lik Sprava 2001:77-81. [PMID: 11560035] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 02/21/2023]
Abstract
A comprehensive clinical-and-laboratory evaluation was carried out in 132 patients with chronic prostatitis, the major proportion of these presenting with concomitant urethritis. It has been ascertained that infectious agents (chlamidia, gonococci, myco- and ureaplasms, trichomonads) play an important part in the origination and development of chronic prostatitis. In the examined patients spermograms were studied, with normospermia having been recorded in 45 (34%) patients, grade I oligospermia in 41 (31%), grade II oligospermia in 29 (22%), grade III oligospermia in 13 (10%), azospermia in 4 (3%) patients. There was no relatedness of changes revealed in qualitative characteristics of the ejaculate to etiology of chronic prostatitis. A comparative study was done on those parameters characterizing local (cell-mediated, humoral) immunity of the reproductive tract in patients with chronic prostatitis of different etiological (infectious) origin. Disturbances in local immunologic vigor in varying etiology chronic prostatitis have been shown to be of unidirectional character with no statistically significant difference in place.
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Iaremchuk AI, Vakulenko GA, Khadi D. [Etiotropic treatment of patients with early uterine carcinoma as a basis for prevention of relapses and complications]. Lik Sprava 2001:90-3. [PMID: 11519444] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 02/21/2023]
Abstract
In this paper, consideration is given to the role that etiological and pathogenetic factors have in the development of malignant tumours. Prevention of possible recurrencies and complications in patients with incipient forms of hysterocarcinoma warrant etiotropic treatment which has been shown to be effective and essential for the object to succeed in.
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Duboucher C, Farto-Bensasson F, Chéron M, Peltier JY, Beaufils F, Périé G. Lymph node infection by Trichomonas tenax: report of a case with co-infection by Mycobacterium tuberculosis. Hum Pathol 2000; 31:1317-21. [PMID: 11070125 DOI: 10.1053/hupa.2000.18502] [Citation(s) in RCA: 20] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
In an 82-year-old woman, presenting with fever and asthenia, cervical adenopathy was noted. Clinical and radiological investigations were fruitless. Laboratory examinations detected a refractory anemia. The lymph node was excised and showed numerous trichomonads on touch preparations. Histologically, the node showed caseous necrosis and macrophagic reaction. Diagnosis of lymph node infection by Trichomonas tenax was made. Three weeks later, culture of the node showed Mycobacterium tuberculosis and let us conclude co-infection. T tenax is usually regarded as a harmless saprophyte of the oral cavity. This exceptional observation shows for the first time an invasive potential of T tenax. It raises questions about links with tuberculosis and refractory anemia.
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Affiliation(s)
- C Duboucher
- Department of Pathology, Saint-Germain-en-Laye Hospital, France
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McNair RD, MacDonald SR, Dooley SL, Peterson LR. Evaluation of the centrifuged and Gram-stained smear, urinalysis, and reagent strip testing to detect asymptomatic bacteriuria in obstetric patients. Am J Obstet Gynecol 2000; 182:1076-9. [PMID: 10819832 DOI: 10.1067/mob.2000.105440] [Citation(s) in RCA: 62] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
Abstract
OBJECTIVE Our purpose was to compare the efficacy of the centrifuged and Gram-stained smear with the efficacy of both urinalysis and reagent strip testing for nitrites and leukocyte esterase in detecting asymptomatic bacteriuria in obstetric patients. STUDY DESIGN A midstream urine specimen was evaluated in 528 patients either at the initial prenatal visit or at a visit because of possible preterm labor. Separate aliquots were tested by centrifugation (with a Cytospin Cytocentrifuge; Shandon, Inc, Pittsburgh, Pa) with Gram stain, by microscopic urinalysis for the presence of moderate to large numbers of bacteria or >10 leukocytes per high-power field, and by reagent strips for the presence of nitrites or leukocyte esterase activity. Results were compared with those of a quantitative urine culture obtained with blood and MacConkey agar plates. RESULTS Thirty-six women (6.8%) had urine cultures showing 100,000 colony-forming units of a uropathogen per milliliter. The sensitivity and specificity of testing by centrifugation and Gram stain were 100% and 7.7%, respectively. Urinalysis and dipstick testing offered a sensitivity of 80.6% and 47.2%, respectively, with a specificity of 71.5% and 80.3%. No combination of tests, in series or in parallel, offered improved specificity over urinalysis alone. CONCLUSIONS Centrifugation with Gram stain of a urine specimen offers excellent sensitivity but very poor specificity compared with microscopic urinalysis for the detection of asymptomatic bacteriuria and is not an acceptable screening test in an obstetric population. The false-negative rates of urinalysis (19.4%) and reagent strip testing (52.8%) preclude these from being excellent screening tests for asymptomatic bacteriuria. Given the potential sequelae of undiagnosed asymptomatic bacteriuria in an obstetric population, we conclude that urine cultures should be used for all pregnant patients to detect asymptomatic bacteriuria.
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Affiliation(s)
- R D McNair
- Departments of Obstetrics and Gynecology and Microbiology, Northwestern University Medical School and Northwestern Memorial Hospital, Chicago, IL, USA
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Affiliation(s)
- S Jongwutiwes
- Department of Parasitology, Faculty of Medicine, Chulalongkorn University, Bangkok, Thailand.
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