AJOG ReviewsTrichomoniasis: under control or undercontrolled?
Section snippets
Prevalence: What is the true state of affairs?
T vaginalis is common among women seen in gynecology clinics, family planning clinics, sexually transmitted disease (STD) clinics, and high school or college health centers4., 5., 6., 7. (Table IA, Table IB).8., 9., 10., 11., 12., 13., 14., 15., 16., 17., 18., 19., 20., 21., 22., 23., 24., 25., 26., 27., 28.
Diagnosis based on wet mount or Papanicolaou (Pap) smear will result in lower prevalence rates than a diagnosis based on culture results.29 Polymerase chain reaction (PCR) methods of
Sequelae of infection: a growing concern
Several studies demonstrate that T vaginalis is a risk factor for a variety of gynecologic and obstetric complications. Trichomoniasis in men can also lead to morbidity,7., 7., 30. thus providing a rationale for more diligent diagnosis and treatment in both women and men. The complications associated with trichomoniasis in women include (1) increased HIV transmission and infectivity; (2) greater risk of tubal infertility and atypical pelvic inflammatory disease (PID), (3) increased risk of
Transmission
The evidence for sexual transmission of trichomoniasis is unequivocal. Prevalence is highest among women with multiple sexual partners and in women with other STIs.7., 61., 62. Transmission rates seem to be high from men to women: a rate of 70% was seen among men having sexual contact with infected women in the previous 48 hours. This compares with a prevalence of 80% to 100% in female partners of infected men.7., 61. Because trichomoniasis is not a reportable disease, this represents a major
Diagnosis: a need for improvement
Clinical signs and symptoms of trichomoniasis are neither sensitive nor specific enough to be used alone for diagnosis.69 Positive demonstration of the organism is required. Several diagnostic methods are traditionally used to detect T vaginalis in women and men23., 26., 28., 70., 71., 72., 73., 74., 75., 76. (Table IIIA, Table IIIB).
Culture in Diamond's medium will successfully identify up to 95% of infections, achieving both a high degree of sensitivity (85%-95%) and specificity (>95%).70 The
Treatment: What are the options?
The introduction of the 5-nitroimidazoles in 1960 dramatically changed the management of trichomoniasis. Systemic metronidazole and other 5-nitroimidazoles (tinidazole, ornidazole, and secnidazole) have been the standard therapies for the treatment of trichomoniasis for more than 30 years.70 Metronidazole is the only 5-nitroimidazole available in the United States and the only effective therapy for treating T vaginalis available here. Metronidazole cure rates are >90% as either a 7-day regimen
Future directions
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Screening for and diagnosing trichomoniasis among reproductive-aged men and women needs improvement, and currently available tools exist to achieve this goal.
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Trichomoniasis is a source of morbidity for women and has important health consequences in men as well.
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Among men, trichomoniasis represents an important consideration in the differential diagnosis of urethritis and prostatitis.
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Infection with T vaginalis can reduce the chances of conception from both female and male factors and should be
References (89)
- et al.
Vaginitis in sexually active women: relationship to nine sexually transmitted organisms
Am J Obstet Gynecol
(1982) - et al.
Prevalence of six sexually transmitted disease agents among pregnant inner-city adolescents and pregnancy outcome
Lancet
(1984) - et al.
Risk factors for prematurity and premature rupture of membranes: a prospective study of the vaginal flora in pregnancy
Am J Obstet Gynecol
(1984) - et al.
Bacterial vaginosis and trichomonas vaginalis are risk factors for cuff cellulitis after abdominal hysterectomy
Am J Obstet Gynecol
(1990) - et al.
Trichomonas vaginalis and amplification of HIV-I transmission
Lancet
(1998) - et al.
Protozoan infections in the male genital tract
J Urol
(1996) - et al.
Interference of human spermatozoal motility by Trichomonas vaginalis
J Urol
(1977) - et al.
Aetiology of chronic prostatitis
Int J Antimicrob Agents
(2002) Sexually transmitted parasitic diseases
Prim Care
(1991)- et al.
A single dose of two grams of metronidazole for Trichomonas vaginalis vaginitis
Am J Obstet Gynecol
(1977)
Trichomoniasis: trends in diagnosis and management
Am J Obstet Gynecol
Diagnosis of Trichomonas vaginalis in adolescent females: InPouch TV culture versus wet-mount microscopy
J Adolesc Health
Natural history of urogenital trichomoniasis in men
J Urol
Global prevalence and incidence estimates of curable STD's
Sex Transm InfectSuppl
Estimates of the incidence and prevalence of sexually transmitted diseases in the United States
Sex Transm DisSuppl
Trichomonas vaginalis polymerase chain reaction compared with standard diagnostic and therapeutic protocols for the detection and treatment of vaginal trichomoniasis
Clin Infect Dis
Trichomonas vaginalis infection
Trichomonas vaginalis
Clinical and microbiological aspects of Trichomonas vaginalis
Clin Microbiol Rev
Trichomonas vaginalis and trichomiasis
Clinical manifestations of vaginal trichomoniasis
JAMA
Development and validation of PCR based enzyme-linked immunosorbent assay with urine for use in clinical research settings to detect Trichomonas vaginalis in women
J Clin Microbiol
The clinical and laboratory diagnosis of Trichomonas vaginalis infection
Sex Transm Dis
Trichomonas vaginalis: a reevaluation of its clinical presentation and laboratory diagnosis
J Infect Dis
Self-collection of vaginal swabs for the detection of Chlamydia, gonorrhea, and trichomoniasis
Sex Transm Dis
Self obtained vaginal swabs for diagnosis of treatable sexually transmitted diseases in adolescent girls
Arch Pediatr Adolesc Med
Trichomonas vaginalis associated with low birth weight and preterm delivery: the Vaginal Infections and Prematurity Study Group
Sex Transm Dis
Risk and prevalence of treatable sexually transmitted diseases at Birmingham substance abuse treatment facility
Am J Public Health
Rates of risk factors for trichomoniasis among pregnant inmates in New York City
Sex Transm Dis
Prevalence of lower genital tract infections among human immunodeficiency virus (HIV)–seropositive and high-risk HIV–seronegative women
Clin Infect Dis
The relationship of cocaine use and human immunodeficiency virus serostatus to incident sexually transmitted diseases among women
Sex Transm Dis
Trichomoniasis in a non-gonococcic urethitis among male patients
J Egypt Soc Parasitol
Trichomoniasis in men: old issues and new data
Sex Transm Dis
Comparative prevalence of infection with Trichomonas vaginalis among men attending a sexually transmitted disease clinic
Sex Transm Dis
Prevalence of Trichomonas vaginalis in a male sexually transmitted disease clinic population by interview, wet mount microscopy, and the InPouch TV test
Genitourin Med
Detection of Trichomonas vaginalis in males: traditional vs molecular methods
Proceedings of the 41st annual Interscience Conference on Antimicrobials Agents and Chemotherapy; 2001 December 16-19; Chicago, Ill
Prevalence of Trichomonas vaginalis in men at high risk for sexually transmitted diseases
Sex Transm Dis
Natural history of trichomonal infection in males
Br J Venereal Dis
Trichomonas vaginalis epidemiology: parameterising and analyzing a model of treatment interventions
Sex Transm Infect
Consider diagnosis and treatment of trichomoniasis in men
Sex Transm Dis
Is Trichomonas vaginalis a cause of cervical neoplasia? Results from a combined analysis of 24 studies
Int J Epidemiol
Gynecological infections as risk determinants of subsequent cervical neoplasia
Acta Oncol
Sexually transmitted disease and tubal infertility
Sex Transm Dis
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2018, Colloids and Surfaces A: Physicochemical and Engineering AspectsCitation Excerpt :Moreover, methyl jasmonate was used in Trichomonas Vaginalis therapy. Anti-parasitic activity of MeJA is related to dose-dependent reduction in the number of living organisms [7]. Jasmonic acid and its derivatives were used to stimulate the growth of human keratin fibers, to inhibit hair loss and increase hair density, therefore these compounds may be used in the therapy of different types of alopecia [8].
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2018, Journal of Nutritional BiochemistryCitation Excerpt :Intriguingly, the gut microbiota and their metabolites can regulate several other pathogens infecting distantly from the gut. Pathogenesis of Trichomonas vaginalis, a major vaginal pathogen, and its endosymbiont Mycoplasma hominis has been reported to be regulated by the gut microbial composition [197,198]. Interestingly, recent studies conducted on mouse models suggested that the composition of the gut microbiota modulates the host’s susceptibility to several enteropathogens [134,190].