Drug resistance in the sexually transmitted protozoan Trichomonas vaginalis

Trichomoniasis is the most common, sexually transmitted infection. It is caused by the flagellated protozoan parasite Trichomonas vaginalis. Symptoms include vaginitis and infections have been associated with preterm delivery, low birth weight and increased infant mortality, as well as predisposing to HIV/AIDS and cervical cancer. Trichomoniasis has the highest prevalence and incidence of any sexually transmitted infection. The 5-nitroimidazole drugs, of which metronidazole is the most prescribed, are the only approved,effective drugs to treat trichomoniasis. Resistance against metronidazole is frequently reported and crossresistance among the family of 5-nitroimidazole drugs is common, leaving no alternative for treatment, with some cases remaining unresolved. The mechanism of metronidazole resistance in T. vaginalis from treatment failures is not well understood, unlike resistance which is developed in the laboratory under increasing metronidazole pressure. In the latter situation, hydrogenosomal function which is involved in activation of the prodrug, metronidazole, is down-regulated. Reversion to sensitivity is incomplete after removal of drug pressure in the highly resistant parasites while clinically resistant strains, so far analysed, maintain their resistance levels in the absence of drug pressure. Although anaerobic resistance has been regarded as a laboratory induced phenomenon, it clearly has been demonstrated in clinical isolates. Pursuit of both approaches will allow dissection of the underlying mechanisms. Many alternative drugs and treatments have been tested in vivo in cases of refractory trichomoniasis, as well as in vitro with some successes including the broad spectrum anti-parasitic drug nitazoxanide. Drug resistance incidence in T. vaginalis appears to be on the increase and improved surveillance of treatment failures is urged.

OBSERVATION OF THE EFFECT OF S－（－）USNIC ACID SODIUM ON TRICHOMONAS VAGINALIS BY TRANSMISSION ELECTRON MICROSCOPE

This paper reports the ultrastructural changes of trichomonas vaginaiis (T. vag. ) under the action of s-(-)usnic acid sodium in vitro. These changes can be shown by the following results:At first, the degranulation of the rough endoplasmic reticulum (RER) took place, the polyribosomes disaggregated. And then, the Golgi complex and the endoplasmic reticulum dilated. The cytoplasmic matrix presented and inhomogeneous apperance. Finally, the biomembrane loosed and fractured.The cell nuclei presented the karyorrhexis.

Trichomonas vaginalis and Chlamydia trachomatis Prevalence,Incidence and Associated Factors in Pregnant Adolescents from Belém City,in the Brazilian Amazon

Background: Adolescents are disproportionally affected by sexually transmitted infections (STI). Chlamydia trachomatis (CT) and Trichomonas vaginalis (TV) are the most frequent curable STI in adolescents, causing serious consequences for their reproductive health. Therefore, we aimed to determine the prevalence and incidence of CT and TV, as well as their risk factors in pregnant adolescents from Belém, northern Brazilian Amazon. Methods: This prospective study enrolled 199 adolescents up to 20 weeks of pregnancy. They were scheduled for follow-up visit between 28 and 29 weeks of pregnancy. Sociodemographic and behavioral data were obtained by interview. Cervicovaginal samples were taken to test for TV, CT, Neisseria gonorrhoeae and bacterial vaginosis. Univariate and multivariate analyses were performed to test the association of prevalent/incident CT and TV with the variables. Results: Prevalence of cervical CT infection was 33.7% (n = 67/ 199), and for trichomoniasis it was 4.0% (n = 8/199). Cervical ectopy increased the risk for prevalent CT (OR, 1.93;95% CI, 1.01 - 3.70), while having treated vaginal discharge in the past (OR, 0.51;95% CI, 0.26 - 0.98) and being married (OR, 0.10;95% CI, 0.01 - 0.83) were protective against current CT and TV, respectively. Among the 95 (47.7%) adolescents who completed follow-up, 15 cases of incident CT were identified. Incident CT was associated with having a formal or informal job (OR, 28.4;95% CI, 2.1 - 391.6) and bacterial vaginosis treatment at the baseline (OR, 0.08;95% CI, 0.01 - 0.69). Conclusion: Prevalence and incidence rates of TV and CT are high in this population devoid of STI routine screening. Treatment of bacterial vaginosis may benefit this population by reducing risk for CT acquisition.

Comparative drug susceptibility study of five clonal strains of Trichomonas vaginalis in vitro

Objective:To produce comparative data on a group of Trichomonas vaginalis clonal strains with varied drug responses using identical methods and materials.Methods:Five clonal strains of Trichomonas vaginalis were isolated from reference strain using agar plate technique.The variability of growth kinetic and susceptibility of clonal strain to metronidazole,tinidazole, satranidazole and nitazoxanide were observed in 96 well microlilre plate.Results:Among these clonal strains there was a good correlation between rates of growth with the relative susceptibility of the strains to drugs in vitro.Regarding metronidazole,tinidazole and satranidazole susceptibility,different degrees of susceptibility were determined.However,no difference in nitazoxanide susceptibility was found between the clonal strain tested and a reference strain. Conclusions:This is the first description of biological variability in clonal stock of Trichomonas vaginalis.Different degrees of drug susceptibility were determined among clonal strains tested. Further studies will be necessary to ascertain the importance of this variability in clinical infection.

<i>Toxoplasma gondii</i>But Not <i>Leishmania major</i>or <i>Trichomonas vaginalis</i>Decreases Cell Proliferation and Increases Cell Death on Fibrosarcoma Cancer Cells in Culture Medium

It has been shown that some parasites interfere with malignant tumor cells growth in vivo or in vitro. In this work anticancer activity of three live protozoan parasites;Toxoplasma gondii, Trichomonas vaginalis and Leishmania major on fibrosarcoma cells growth has been investigated in cell culture medium. In this experimental study, WEHI-164 fibrosarcoma cells treated with alive Toxoplasma gondii tachyzoite, Trichomonas vaginalis trophozoite or Leishmania major promastigote as case groups or left intact as control groups. Following 24 hours incubation the number of cells, lactate dehydrogenase (LDH) and apoptosis were determined in case and control groups. Toxoplasma gondii tachyzoite decreased cell proliferation and increased cell lyses’ but it did not induce apoptosis. Trichomonas vaginalis or Leishmania major didn’t show any effects on cell proliferation, cell lyses or apoptosis. Therefore Toxoplasma gondii may have anticancer activity and further works is recommended to understand the mechanisms of action.

Incidence of Trichomonas vaginalis among Internally Displaced Women in Ibaka, Akwa Ibom State, Nigeria

A total of 282 outpatient pregnant antenatal and non-pregnant women from internally displaced camps attending the Poly Health Clinic (PHC) and the Enwang Health Centre (EHC) were examined for Trichomonas vaginalis infection. Direct wet mount microscopy and Giemsa staining techniques were used on High Vaginal Swab (HVS) specimens collected on sterile swab sticks. A prevalence of 20 (57.1%) was recorded using both methods;12 (7.2%) in PHC and 08 (6.2%) in EHC Mbo local government area, Akwa Ibom State respectively. Differences among pregnant and non-pregnant women used were statistically significant (P < 0.05). Women in the age group 15 - 19 years had the highest prevalence of infection 03 (10.5%), closely followed by those of age group 20 - 24 years 6 (6.8%). A total number of 14 (6.7%) infections were recorded among married women followed by single women with 06 (10%). A higher prevalence rate of 01 (24%) was recorded among women who attended Quranic level of education and 04 (16.7%) with uneducated women, this may be due to small sample size within this group of women. 12 (6.5%) in women with primary school education and 03 (4.7%) in women with secondary school level of education. The need for improved personal hygiene in IDP camps and other effective intervention programmes among these vulnerable groups of women is advocated.

Trichomonas vaginalis perturbs the junctional complex in epithelial cells

Trichomonas vaginalis,a protist parasite of the urogenital tract in humans,is the causative agent of trichomonosis,which in recent years have been associated with the cervical cancer development.In the present study we analyzed the modifications at the junctional complex level of Caco-2 cells after interaction with two isolates of T.vaginalis and the influence of the iron concentration present in the parasite’s culture medium on the interaction effects.Our results show that T.vaginalis adheres to the epithelial cell causing alterations in the junctional complex,such as:(a)a decrease in transepithelial electrical resistance;(b)alteration in the pattern of junctional complex proteins distribution as observed for E-cadherin,occludin and ZO-1;and(c)enlargement of the spaces between epithelial cells.These effects were dependent on(a)the degree of the parasite virulence isolate,(b)the iron concentration in the culture medium,and(c)the expression of adhesin proteins on the parasite surface.

Rationale of Longitudinal Cohort Study on Obstetrical Outcomes of Trichomonas vaginalis Infection in Kinshasa, DR Congo

Background: Trichomoniasis is the most common non-viral sexually transmitted infection (STI) in the world, and the occurrence of this infection during pregnancy is responsible for adverse obstetrical outcomes like premature labor, premature rupture of membranes (PROM) and low birth weight (birth weight < 2500 g). The association with a number of factors (maternal age, low level of education, low socio-economic status and multiple sexual partners, etc.) that can be found in our environment suggest its probably high prevalence amongst vaginal infections that are responsible for adverse obstetrical outcomes, but up-to-date estimates are lacking. Objective: To assess the obstetrical risk associated with Trichomonas vaginalis (T. vaginalis) infection in our environment. Methods: We designed a protocol for a prospective cohort study which will take place in four medical facilities in the city of Kinshasa, where all pregnant women with a pregnancy of at least 20 weeks and who will give written consent will be included. Vaginal swab specimens will be collected for T. vaginalis research by direct microscopy wet mount. Follow-up will consist of recording the process of the pregnancy and obstetrical outcomes. Conclusion: Results from this study will allow to enhance management and also bring updated estimates on T. vaginalis prevalence and its obstetrical outcomes for infected pregnant woman in our environment.

Detection of Trichomonas Vaginalis Infection in Male Non-gonococcal Urethritis Patients by InPouch TV Culture and Polymerase Chain Reaction

Objective: To study the prevalence of Trichomonas vaginalis (TV) infection in Chinese male patients with nongonococcalurethritis (NGU), to evaluate the sensitivity and specificity ofurine-based and urethral swab polymerase chain reaction(PCR) detection, to set up a method for non-invasive detectionof male TV infection. Method: One hundred and five male NGU patients wereselected from a Beijing STD clinic. Two urethral swabs wereobtained from each patient, one for the InPouch TV culturesystem and the other for PCR. In addition, one first void urinespecimen was collected for PCR detection. Culture wasconsidered the 'gold standard'. The sensitivity, specificity,positive predictive value (PPV) and negative predictive value(NPV) of the two PCR detections were compared to cultureresults. Results: The prevalence of urine-based PCR and urethralswab PCR detection was 3.81% (4/105) and 4.76% (5/105)respectively. Compared to culture, the sensitivity, specificity,PPV and NPV were 80%, 100%, 100% and 99% for urinbased PCR and 80%, 99%, 80% and 99% for urethral swab PCR. Conclusion: TV is one of the etiological agents in male NGU,with a 4.76% prevalence of infection in our study. The urine-based PCR detection has higher sensitivity and specificity andprovides a noninvasive method more feasible in practice.

Pleomorphic rhabdomyosarcoma of the vagina: A case report

BACKGROUND Rhabdomyosarcoma(RMS)of the vagina in postmenopausal women is an extre-mely rare malignant tumor that was originally described as a unique group of soft tissue sarcomas originating from primitive mesenchymal cells.It was first re-ported in postmenopausal women in 1970,and fewer than 50 postmenopausal patients have been reported to date.CASE SUMMARY A 68-year-old multiparous female was admitted to the hospital on October 11,2023,with the chief complaint of a mass causing vaginal prolapse with incomplete urination that had persisted for 4 months.The vaginal mass was approximately the size of a pigeon egg;after lying down,the vaginal mass retracted.Complete resection was performed,and vaginal pleomorphic RMS was diagnosed based on pathology and immunohistochemical staining features.The patient is currently undergoing chemotherapy.The present study also reviewed the clinical,histolo-gical,and immunohistochemical features and latest treatment recommendations for vaginal RMS.Any abnormal vaginal mass should be promptly investigated through pelvic examination and appropriate imaging.The current initial treat-ment for vaginal RMS is biopsy and primary chemotherapy.CONCLUSION When surgery is planned for vaginal RMS,an organ-preserving approach should be considered.

Trichomonas vaginalis and human papillomavirus:Association with the microbiota and burden on the cervix

Trichomoniasis and HPV infection are common non-viral and viral sexually transmitted diseases worldwide.Emerging evidence shows that the female genital tract and its microbiota are greatly affected by these pathogens.However,the relationship between Trichomonas vaginalis,the vaginal microbiome,and High-risk(HR)-HPV infection is complex and multifaceted.Studies have proven that concurrent infections of HIV and HPV increase the risk of cervical cancer.With this basis,a question arises:How does the concurrent infection of trichomonas vaginalis and HPV affect genital tract health?Does this concurrent infection enhance or inhibit the development of cervical lesions?This review aims to bring light to these questions.This review also covers the association of trichomonas vaginalis and HPV with the microbiota of the genital tract.

Atopobium vaginae与细菌性阴道病关系的研究

目的:应用非培养方法研究Atopobium vaginae与细菌性阴道病的关系。方法:根据Nugent评分标准从15例健康妇女及17例BV患者的其阴道分泌物中提取细菌总DNA。分别选择健康妇女及BV患者样本各3例,构建16S rRNA基因克隆文库并进行测序分析。应用Atopobium vaginae16S rRNA基因的特异性引物对32例样本进行PCR扩增。结果:Atopobium vaginae是BV患者阴道菌群中的优势菌种,它存在于大部分(14/17)BV患者阴道中,健康妇女阴道中(1/15)则很罕见。结论:Atopobium vaginae与细菌性阴道病的发生有一定的相关性。

The secretory products of Trichomonas vaginalis decrease fertilizing capacity of mice sperm in vitro

Trichomonas vaginalis infection is one of the most prevalent sexually transmitted infections in humans and is now recognized as an important cause of infertility in men. There is little information about the effect of extracellular polymeric substances （EPS） from T. vaginalis on sperm, but previous reports do not provide a conclusive description of the functional integrity of the sperm. To investigate the impact of EPS on the fertilizing capacity of sperm, we assessed sperm motility, acrosomal status, hypo-osmotic swelling, and in vitro fertilization rate after incubating the sperm with EPS in vitro using mice. The incubation of sperm with EPS significantly decreased sperm motility, viability, and functional integrity in a concentration and time-dependent manner. These effects on sperm quality also resulted in a decreased fertilization rate in vitro. This is the first report that demonstrates the direct negative impact of the EPS of T. vaginalis on the fertilization rate of sperm in vitro. However, further study should be performed using human sperm to determine if EPS has similar negative impact on human sperm fertilizing capacity in vitro.

A systematic identification of Kolobok superfamily transposons in Trichomonas vaginalis and sequence analysis on related transposases

Transposons are sequence elements widely distributed among genomes of all three kingdoms of life, providing genomic changes and playing significant roles in genome evolution. Trichomonas vaginalis is an excellent model system for transposon study since its genome （- 160 Mb） has been sequenced and is composed of - 65% transposons and other repetitive elements. In this study, we primarily report the identification of Kolobok-type transposons （termed tvBac） in T. vaginalis and the results of transposase sequence analysis. We categorized 24 novel subfamilies of the Kolobok element, including one autonomous subfamily and 23 non-autonomous subfamilies. We also identified a novel H2CH motif in tvBac transposases based on multiple sequence alignment. In addition, we supposed that tvBac and Mutator transposons may have evolved independently from a common ancestor according to our phylogenetic analysis. Our results provide basic information for the understanding of the function and evolution of tvBac transposons in particular and other related transposon families in general.

Vaginal Discharge in the Prostitutes of the Group Yèrêlon of Bobo-Dioulasso: Epidemiological, Clinical and Etiological Aspects

The authors report a cross-sectional descriptive study over 6 years, from December 8th, 2003 to October 27th, 2009, involving 911 women involved in the sex trade within the Yèrêlon group in Bobo-Dioulasso. Objectives: To describe the epidemiological, clinical and etiological aspects of vaginal discharge in women in the Yèrêlon group of the city Bobo-Dioulasso. Results: Frequency of vaginal discharge was 48.89%. The mean age was 28.4 years with extremes of 16 and 54 years. Single, divorced and widowed women accounted for 78.8% of the study population. Women who never attended school and those with primary education accounted for 74.3% of the study population. HIV serology was positive in 38.4% of cases. The main symptoms were genital itching, dyspareunia and urinary signs. The main germs identified in the laboratory were Candida albicans, Trichomonas vaginalis and Gardenerella vaginalis. Conclusion: vaginal discharge was found in 48.89% of women in the Yèrêlon group of Bobo-Dioulasso. The clinical study of the discharge and the laboratory results allowed a diagnosis and a better management of the leucorrhea in the group Yèrêlon.

Primary extragastrointestinal stromal tumor arising in the vaginal wall: significant clinicopathological characteristics of a rare aggressive soft tissue neoplasm

Gastrointestinal(GI)stromal tumor is the most common mesenchymal neoplasm of the GI tract but also occurs with a lower frequency in extragastrointestinal regions and is called extragastrointestinal stromal tumor(EGIST).We report an unusual case of EGIST presenting as a vaginal mass.A 41-year-old woman presented with a gradually enlarging vaginal mass for the last2 years.Physical examination revealed an elliptical,non-tender mass about 7.5 cm×7 cm in size in the posterior vaginal wall and was resected completely.Under histological examination,the tumor showed a spindle cell type with coagulation necrosis,hemorrhage and high mitotic count.Immunohistochemical analysis revealed tumor cells were positive for DOG1,CD117,CD34 and p53 protein.Ki-67 labeling was 8%.Genetic analysis showed a deletion of exon 11 of the c-kit gene at codons 557-558.EGISTs should be kept in mind in the differential diagnosis in patients presenting with solid mass of the vaginal wall.

Vagina vasorum dissection during D2 lymphadenectomy for gastric carcinoma

AIM: To explore the relationship between metastasis and vagina vasorum in the progress of gastric carcinoma and to find some facts and references for gastric surgeons. METHODS: One hundred and seven specimens of left or right gastric arteries (55 left and 52 right) were gathered from 59 patients undergoing radical gastrectomy for gastric carcinoma. All the frozen specimens were cut into 3 μm-thick sections and stained with hematoxylin-eosin (HE) and immunohistochemical method separately. Cytokeratin (CK) and mesothelial cells (MC) were stained with immunohistochemical method. Cancer cells inside vagina vasorum were detected and the structure of artery wall was observed under microscope. RESULTS: Metastatic cancer cells or tubercles were found inside vagina vasorum in some stage Ⅲ or Ⅳ specimens, but not in stageⅠor Ⅱ specimens. Tumor cells in vagina vasorum were CK positive in 26 specimens of 14 tumors. Among them, stage Ⅲ was found in 4 specimens of 2 tumors, and stage Ⅳ in 22 specimens of 12 tumors. None of these specimens was positive for MC. The positive rate of CK increased with TNM staging. Compared with the lower part, tumors in the upper and middle parts of stomach were more likely to metastasize into vagina vasorum. CONCLUSION: Vagina vasorum dissection should be performed during D2 lymphadenectomy for TNM stage Ⅲ or Ⅳ gastric carcinoma.

Comparison of Electro Ejaculator and Artificial Vagina on Semen Collection from South African Indigenous Goat Following Assessment by Computer Aided Sperm Analysis

South African indigenous bucks are raised under extensive conditions and are more likely to reject artificial vagina (AV) due to their limited contact with human beings, as they are less handled. The purpose of the study was to compare goat semen collection techniques used for goats based on semen traits of South African indigenous bucks during the natural breeding season. A total of eight South African indigenous bucks were used, four bucks per semen collection technique due to their scarcity. Before semen collection with AV group, ten bucks were trained and exposed to AV. Semen was then collected from both groups over a period of six weeks per individual buck. Semen volume, pH and sperm concentration were evaluated immediately. The Computer Aided Sperm Analysis (CASA) assessed the sperm motility rates. Sperm morphology was evaluated using a fluorescence microscope with the aid of eosin-nigrosin staining. Analysis of variance was used to test the differences among the semen collection groups following assessment by CASA. Semen collected with EE resulted in higher semen volume (1.1 mL) compared with AV (0.5 mL) technique. However, AV technique resulted in higher total sperm motility and rapid movement (91.9% and 48.7%), live sperm (72%) and sperm concentration (635.6 × 106 sperm/mL) compared with EE (86.3% and 30.4%;69% and 463.7 × 106 sperm/mL, respectively). There were no significant differences observed in pH and sperm morphology characteristics between two semen collection techniques. Moreover, EE had higher sperm moving in a progressive (53.6%) and medium rate compared with AV (41.1% and 21.9%) technique. It was concluded that the AV yielded higher total sperm motility rate, sperm concentration and rapid sperm movement compared with EE. Therefore, AV was more suitable for semen collection of South African indigenous bucks, even though training was problematic to such indigenous bucks.

Supportive tissues of the vagina with special reference to a fibrous skeleton in the perineum: A review

With the aid of immunohistochemistry, the present review attempts to demonstrate the composite fibers and nerve topographical anatomy in the vaginal supportive tissues. Along the tendinous arch of the pelvic fasciae, distal parts of the pelvic plexus extend antero-inferiorly and issue nerves to the internal anal sphincter as well as the cavernous tissues. At the attachment of the levator ani muscle to the rectum, smooth muscles in the endopelvic fascia lining the levator ani merge with the longitudinal smooth muscle layer of the rectum to provide the conjoint longitudinal muscle coat or the longitudinal anal muscle (LAM: smooth muscle). However, at the rectovaginal interface, the longitudinal smooth muscle layer of the rectum continues to the LAM without any contribution of the endopelvic fascia. The bilateral masses of the perineal smooth muscles (PSMs) are connected by the perineal body, and the PSMs receive 1) the longitudinal anal muscle, 2) the internal and external anal sphincters and, 3) the perineal membrane lining the vestibular wall. Tensile stress from the levator ani seems to be transferred to the PSMs via the LAM. Because of their irregularly arrayed muscle fibers, instead of a synchronized contraction in response to nerve impulses, the PSMs are likely to act as a barrier, septum or protector against mechanical stress because, even without innervation, such smooth muscle fibers resist (not absorb) pressure, in accordance with Bayliss’ rule. The external anal sphincter, a strong striated muscle, inserts into the PSMs and seems to play a dynamic role in supporting the rectovaginal interface to maintain the antero-posterior length of the urogenital hiatus. However, we do not think that smooth muscles play an active traction role without cooperation from striated muscle. The fibrous skeleton composed of smooth muscle in the female perineum is explained in terms of a “catamaran” model.

PRIMARY MALIGNANT MELANOMA OF THE VAGINA:CLINICAL, PATHOLOGICAL AND IMMUNOHISTOCHEMICAL STUDIES OF 9 CASES

Nine cases of vaginal primary malignant melanoma were diagnosed and treaed in Zhejiang Cancer Hospital from 1964 to 1990. The mean age of patients was 48. 6 years. Abnormal vaginal bleeding was the Incipient symptom in 6 patients. Five cases of malignant melanoma located in the lower one-third of the vagina. Five patients had the tumor in size larger than or equal to 4 cm In diameter. All of them were of the cauliflower-like, nodular configuration grossly. The surface of the mass demonstrated in a variable degree of black or grey- blackish in 7 patients. The htstological appearances were similar to those in the skin. Sections of 4 cases Indicated only few or no melanin under microscope. The covering epithelial changes of 3 vaginal primary malignant melanoma resembled that of malignant melanoma in situ. All sections of 9 cases showed positive reaction to S-100 protein and negative to CEA immunohistochemically. This article laid emphasis on the origin, diagnosis and treatment of this tumor, and make discussion in conjunction with the literature.