Co-infection by Tritrichomonas foetus and Pentatrichomonas hominis in asymptomatic cats

Abstract: Tritrichomonas foetus, a parasite well known for its significance as a venereally transmitted pathogen in cattle, has been identified as a cause of chronic large bowel diarrhea in domestic cats in many countries of the world. In Brazil, several studies on the diagnosis of bovine trichomoniasis have been performed, but until now, no study was made regarding feline trichomoniasis. Thus, this is the first study to report the occurrence of T. foetus and Pentatrichomonas hominis in cats using morphological and molecular analysis. Feces from 77 cats were examined, four of which (5.2%) were positive for the presence of parabasalids. Morphological analysis of stained smears revealed piriform trophozoites showing the three anterior flagella, elongated nucleus and axostyle ending abruptly in fillet, characteristic of T. foetus. In scanning and transmission electron microscopy, identification characters similar to those previously reported for T. foetus were observed. The cultures containing trophozoites were submitted for molecular analysis, which resulted positive for T. foetus DNA using specific primers (TFR3 and TFR4), and all samples were positive and subjected to sequencing in which they showed 99.7-100% similarity with another isolate sequencing of T. foetus (JX960422). Although no trophozoite with consistent morphology of P. hominis has been visualized in the samples, differential diagnosis was performed using specific primers for P. hominis (TH3 and TH5) amplicon. In three of the four samples (3.89%) sequencing revealed 100% similarity when compared with another sequence of P. hominis deposited in Genbank (KC623939). Therefore, the present study revealed through the diagnostic techniques employed the simultaneous infection by T. foetus and P. hominis in the feces of cats. However, it was necessary to use more than one technique for the diagnosis of the co-infection. These results demonstrate the importance of a correct diagnosis to allow an appropriate treatment by the veterinarian.

Prevalência de doenças sexualmente transmissíveis em mulheres profissionais do sexo, em um município do interior paulista, Brasil

Fundação de Amparo à Pesquisa do Estado de São Paulo (FAPESP)

ANALISE ANTIGENICA DE PROTEASES DE DIFERENTES CEPAS DE TRICHOMONAS VAGINALIS ISOLADAS DE PACIENTES DA REGIAO DE ARARAQUARA, SP, BRASIL

Trichomonas vaginalis is the flagellate that causes trichomonadiasis, a sexually transmitted disease. Immunological methods have been proposed for the study of antigenic characterization using strains isolated from different patients. This work compares protease profiles from the different strains using gelatin containing polyacrylamide gels to analyse the protease activity. High molecular weight proteases (20 to 100 kDa) were found on gels showing quantitative differences. Human IgG antiproteases were detected by immunoblotting using the same extracts. These proteases could be related with T. vaginalis pathogenesis.

Adesão de protozoários ̀a superfície de dispositivos intra-uterinos

Intrauterine devices (IUD) have been used by approximately hundred million of women in the world. IUD are unprescribed to women who have pelvic inflammation disease predisposition which is caused in general by non-treated sexually transmitted diseases (STD). Trichomoniasis, one of the most important vaginal infections, is caused by a flagellated protozoan, Trichomonas vaginalis, transmitted by sexual contact and also asyntomatic women are able to transmit it. The objective of this work was verify by scanning microscopy the adhesion of this protozoan on plastic and metalic IUD surfaces. IUD fragments were added in Diamond medium containing T. vaginalis and after 3 days at 37°C incubation, they were taken out and treated as necessary for scanning microscopy. The analysis showed showed the adhesion of the protozoans on plastic and metalic IUD surfaces. Even though the IUD were not yet directly associated with high incidence of the inflammation pelvic disease, it would become an infection reservoir of potencial pathogenic organisms.

Prevalência das doenças sexualmente transmissíveis em mulheres profissionais do sexo do Município de Botucatu/SP

Fundação de Amparo à Pesquisa do Estado de São Paulo (FAPESP)

Estudo da interação in vitro entre Tritrichomonas foetus e espermatozoides bovinos

Coordenação de Aperfeiçoamento de Pessoal de Nível Superior (CAPES)

Total bacterial counting and the response to treatment of bacterial vaginosis with metronidazole

Objective: To evaluate if the total bacterial count of vaginal samples with bacterial vaginosis assessed by flow cytometry influences the response to treatment with metronidazol. Methods: In this cross-sectional study, 273 low-risk reproductive aged women were enrolled. Vaginal samples were taken to evaluate the pattern of vaginal flora according to Nugent’s criteria, as well as the presence of trichomoniasis and candidosis. Cases identified of bacterial vaginosis were treated with metronidazole and controlled after 45 days. Cervical infection by Chlamydia trachomatis and Neisseria gonorrhoeae were also assessed. Flow cytometry for total bacterial counting was performed in propidium iodide stained cervicovaginal samples, using fluorescent beads at a known concentration. Non-parametric Mann-Whitney test was used to compare total bacterial count between groups of interest, at p<0.05. Results: From the total of 273 women enrolled, 50 were excluded as they presented at least one of the infections investigated. Bacterial vaginosis was detected in 79 women (35.4%), of which 33 (41.8%) returned for re-evaluation after treatment, being 21 cases successfully treated and 12 with persistent abnormal vaginal flora. Flow cytometric data showed that total bacterial counting does not differ between normal flora and bacterial vaginosis samples (p=0.14). Also, no difference was found between the cases of treated and persistent bacterial vaginosis (p=0.48). Conclusion: Total bacterial counting does not influence the response to metronidazole treatment of bacterial vaginosis

Prevalence of and risk factors for bacterial vaginosis among women of reproductive age attending cervical screening in southeastern Brazil

To determine the prevalence of and risk factors for bacterial vaginosis. A cross-sectional study of women aged 14-54 years attending 18 primary healthcare units in Botucatu, Brazil, for cervical screening was undertaken between September 1, 2012, and January 31, 2013. Data on sociodemographics, sexual behavior, and medical history were obtained by interview. Vaginal swabs were taken to classify the vaginal flora according to the Nugent scoring system. Candida sp. hyphae and infection by Trichomonas vaginalis were also evaluated by microscopy and culture, respectively. Stepwise logistic regression analysis was performed to identify risk factors independently associated with bacterial vaginosis. Among 1519 women included in analyses, 457 (30.1%) had bacterial vaginosis. Variables independently associated with bacterial vaginosis were a single marital status (OR 1.4; 95%CI 1.1-1.8), partner infidelity (OR 1.5; 95%CI 1.2-1.9), abnormal discharge in the previous year (OR 1.5; 95%CI 1.2-2.0), and concurrent trichomoniasis (OR 4.1; 95%CI 1.5-11.5). Current use of hormonal contraception (OR 0.7; 95%CI 0.5-0.9), luteal phase of menstrual cycle (OR 0.8; 95%CI 0.6-0.9), higher income (OR 0.8; 95%CI 0.6-0.9), and vaginal candidiasis (OR 0.5; 95%CI 0.3-0.9) all had protective effects. The prevalence of bacterial vaginosis in the study population is high. The epidemiological data provide evidence of the sexual transmissibility of bacterial vaginosis.

Genital infections of HIV-infected women assisted by a specialized service

The present study aimed at analyzing the persistence/recurrence of genital infections and its associated factors in HIV-infected women. Fifty-eight women treated for chlamydial infection, trichomoniasis, vulvovaginal candidiasis, and/or bacterial vaginosis (BV) and who had specimens collected for cure control up to one year after treatment were studied. Diagnoses were performed by the Gram staining method for cases of BV and candidiasis and by T. vaginalis culture and qualitative PCR for C. trachomatis. Antiretroviral therapy was used by 79.3% of patients, and 62.1% showed an undetectable HIV plasma load. The most frequent infection was BV with persistence/recurrence of 52.4%, which was associated with a longer time period between treatment and cure control (P = 0.0455), postmenopausal period (P = 0.0451), and having a steady partner (P = 0.007). Persistence/recurrence of vulvovaginal candidiasis was observed in 25%, trichomoniasis in 23.1%, and chlamydial infection in 10.5%. The letter was associated with inadequate treatment of the partner (P = 0.073) among patients with low T CD4 lymphocyte counts. The majority of women in the present study showed good HIV-infection control and a vulnerable sexual behavior, which stress the importance of maintaining gynecological followup.

Improved effectiveness of partner notification for patients with sexually transmitted infections: systematic review

OBJECTIVE: To examine the effectiveness of methods to improve partner notification by patient referral (index patient has responsibility for informing sex partners of their exposure to a sexually transmitted infection). DESIGN: Systematic review of randomised trials of any intervention to supplement simple patient referral. DATA SOURCES: Seven electronic databases searched (January 1990 to December 2005) without language restriction, and reference lists of retrieved articles. REVIEW METHODS: Selection of trials, data extraction, and quality assessment were done by two independent reviewers. The primary outcome was a reduction of incidence or prevalence of sexually transmitted infections in index patients. If this was not reported data were extracted according to a hierarchy of secondary outcomes: number of partners treated; number of partners tested or testing positive; and number of partners notified, located, or elicited. Random effects meta-analysis was carried out when appropriate. RESULTS: 14 trials were included with 12 389 women and men diagnosed as having gonorrhoea, chlamydia, non-gonococcal urethritis, trichomoniasis, or a sexually transmitted infection syndrome. All studies had methodological weaknesses that could have biased their results. Three strategies were used. Six trials examined patient delivered partner therapy. Meta-analysis of five of these showed a reduced risk of persistent or recurrent infection in patients with chlamydia or gonorrhoea (summary risk ratio 0.73, 95% confidence interval 0.57 to 0.93). Supplementing patient referral with information for partners was as effective as patient delivered partner therapy. Neither strategy was effective in women with trichomoniasis. Two trials found that providing index patients with chlamydia with sampling kits for their partners increased the number of partners who got treated. CONCLUSIONS: Involving index patients in shared responsibility for the management of sexual partners improves outcomes. Health professionals should consider the following strategies for the management of individual patients: patient delivered partner therapy, home sampling for partners, and providing additional information for partners.

Toward global prevention of sexually transmitted infections (STIs): The need for STI vaccines.

An estimated 499 million curable sexually transmitted infections (STIs; gonorrhea, chlamydia, syphilis, and trichomoniasis) occurred globally in 2008. In addition, well over 500 million people are estimated to have a viral STI such as herpes simplex virus type 2 (HSV-2) or human papillomavirus (HPV) at any point in time. STIs result in a large global burden of sexual, reproductive, and maternal-child health consequences, including genital symptoms, pregnancy complications, cancer, infertility, and enhanced HIV transmission, as well as important psychosocial consequences and financial costs. STI control strategies based primarily on behavioral primary prevention and STI case management have had clear successes, but gains have not been universal. Current STI control is hampered or threatened by several behavioral, biological, and implementation challenges, including a large proportion of asymptomatic infections, lack of feasible diagnostic tests globally, antimicrobial resistance, repeat infections, and barriers to intervention access, availability, and scale-up. Vaccines against HPV and hepatitis B virus offer a new paradigm for STI control. Challenges to existing STI prevention efforts provide important reasons for working toward additional STI vaccines. We summarize the global epidemiology of STIs and STI-associated complications, examine challenges to existing STI prevention efforts, and discuss the need for new STI vaccines for future prevention efforts.

Global Estimates of the Prevalence and Incidence of Four Curable Sexually Transmitted Infections in 2012 Based on Systematic Review and Global Reporting.

BACKGROUND Quantifying sexually transmitted infection (STI) prevalence and incidence is important for planning interventions and advocating for resources. The World Health Organization (WHO) periodically estimates global and regional prevalence and incidence of four curable STIs: chlamydia, gonorrhoea, trichomoniasis and syphilis. METHODS AND FINDINGS WHO's 2012 estimates were based upon literature reviews of prevalence data from 2005 through 2012 among general populations for genitourinary infection with chlamydia, gonorrhoea, and trichomoniasis, and nationally reported data on syphilis seroprevalence among antenatal care attendees. Data were standardized for laboratory test type, geography, age, and high risk subpopulations, and combined using a Bayesian meta-analytic approach. Regional incidence estimates were generated from prevalence estimates by adjusting for average duration of infection. In 2012, among women aged 15-49 years, the estimated global prevalence of chlamydia was 4.2% (95% uncertainty interval (UI): 3.7-4.7%), gonorrhoea 0.8% (0.6-1.0%), trichomoniasis 5.0% (4.0-6.4%), and syphilis 0.5% (0.4-0.6%); among men, estimated chlamydia prevalence was 2.7% (2.0-3.6%), gonorrhoea 0.6% (0.4-0.9%), trichomoniasis 0.6% (0.4-0.8%), and syphilis 0.48% (0.3-0.7%). These figures correspond to an estimated 131 million new cases of chlamydia (100-166 million), 78 million of gonorrhoea (53-110 million), 143 million of trichomoniasis (98-202 million), and 6 million of syphilis (4-8 million). Prevalence and incidence estimates varied by region and sex. CONCLUSIONS Estimates of the global prevalence and incidence of chlamydia, gonorrhoea, trichomoniasis, and syphilis in adult women and men remain high, with nearly one million new infections with curable STI each day. The estimates highlight the urgent need for the public health community to ensure that well-recognized effective interventions for STI prevention, screening, diagnosis, and treatment are made more widely available. Improved estimation methods are needed to allow use of more varied data and generation of estimates at the national level.

Avaliação comparativa da eficácia dos meios de diagnóstico das vulvovaginites: implantação de tecnologia no ensino prático da ginecologia

Inaccurate diagnosis of vulvovaginitis generates inadequate treatments that cause damages women's health. Objective: evaluate the effectiveness of methods when diagnosing vulvovaginitis. Method: a cross-sectional study was performed with 200 women who complained about vaginal discharge. Vaginal smear was collected for microbiological tests, considering the gram stain method as gold standard. The efficacy of the available methods for diagnosis of vaginal discharge was assessed (sensitivity, specificity, positive predictive value and negative predictive value). Data were inserted to Graphpad Prism 6, for statistical analysis. Results: the following results were obtained: wet mount for vaginal candidiasis: sensitivity = 31%; specificity = 97%; positive predictive value (PPV) = 54%; negative predictive value (NPV) =93%; accuracy = 91%. Wet mount for bacterial vaginosis: sensitivity = 80%; specificity =95%; positive predictive value (PPV) = 80%; negative predictive value (NPV) = 95%; accuracy = 92%. Syndromic approach for bacterial vaginosis: sensitivity = 95%; specificity=43%; positive predictive value (PPV) =30%; negative predictive value (NPV) = 97%; accuracy = 54%. Syndromic approach for vaginal candidiasis: sensitivity = 75%; specificity =91%; positive predictive value (PPV) = 26%; negative predictive value (NPV) = 98%; accuracy = 90%. Pap smear for vaginal candidiasis: sensitivity = 68%, specificity = 98%; positive predictive value (PPV) = 86%; negative predictive value (NPV) =96%; accuracy = 96%. Pap smear for bacterial vaginosis: sensitivity = 75%; specificity = 100%; positive predictive value (PPV) = 100%; negative predictive value (NPV) =94%; accuracy = 95%. There was only one case of vaginal trichomoniasis reported – diagnosed by oncological cytology and wet mount – confirmed by Gram. The syndromic approach diagnosed it as bacterial vaginosis. From the data generated and with support on world literature, the Maternidade Escola Januário Cicco’s vulvovaginitis protocol was constructed. Conclusion: Pap smear and wet mount showed respectively low and very low sensitivity for vaginal candidiasis. Syndromic approach presented very low specificity and accuracy for bacterial vaginosis, which implies a large number of patients who are diagnosed or treated incorrectly.

Rastreio de Infeções Sexualmente Transmissíveis não víricas nos adolescentes: qual o estado da arte

As infeções sexualmente transmissíveis (IST) constituem um problema persistente de saúde pública, sendo os adolescentes e adultos jovens os que apresentam as taxas de prevalência mais elevadas para algumas IST. As IST não víricas nos países desenvolvidos incluem a Chlamydia Trachomatis, a Neisseria gonorrhoeae, o Treponema pallidume a Trichomonas vaginalis. A deteção precoce das IST não víricas tem impacto positivo a nível individual e na saúde pública: permite instituição atem- pada de tratamento adequado, a redução de transmissão entre parceiros, bem como reduzir as complicações a longo prazo, nomeadamente doença inflamatória pélvica, dor pélvica crónica, gravidez ectópica e infertilidade. Várias sociedades médicas internacionais publicaram recomendações para o rastreio de algumas IST não víricas em de- terminados grupos. Em Portugal, a Direção Geral de Saúde (DGS) atualizou em 2014 a norma sobre a notificação obrigatória de doenças transmissíveis, que inclui a gonorreia, a sífilis e a infeção por Chlamydia Trachomatis. Não obstante, os estudos sobre a epidemiologia de IST são parcos em Portugal e apenas recentemente foi contemplado o rastreio oportunístico de infeção genital por Chlamydia Trachomatis no Plano Nacional de Saúde 2011-2016. O médico de família através da sua abordagem holística centrada na pessoa, no seu contexto familiar e social (focando antecedentes pessoais / comportamentos de risco) tem necessariamente um papel determinante na prevenção primária e no rastreio das IST.

Características de las enfermedades de transmisión sexual en pacientes atendidos en el Hospital José Carrasco Arteaga, durante el periodo de enero del 2013 - abril del 2015

OBJETIVO: Determinar las características de las enfermedades de transmisión sexual en pacientes que acudieron al Hospital José Carrasco Arteaga, durante el período de enero del 2013 al mes de abril del 2015. MATERIALES Y MÉTODOS: Fue un tipo de estudio descriptivo, el método utilizado fue la revisión de historias clínicas, el instrumento utilizado fue un formulario el cual permitió registrar la información para su posterior análisis y organización en tablas estadísticas. Se utilizó el programa SPSS V 15.0, en el que se creó una base de datos con la información obtenida, se utilizaron tablas que permitió realizar el análisis a través de las medidas estadísticas: distribución de frecuencias y porcentaje. RESULTADOS: De los 145 pacientes, en cuanto a edad y sexo; en el sexo masculino los adultos joven presentaron con mayor frecuencia 52.08% y en los de sexo femenino fue la categoría adulto 52.00%. En el sexo masculino y femenino el estado civil más frecuente fueron los casados representando el 65% y 60.82% La ETS más prevalente en el sexo masculino es el molusco contagioso 33.33 % y en el sexo femenino la Tricomoniasis 52.58%. Dentro del adulto joven y adulto la ETS más frecuente es la Tricomoniasis con el 39.71% y 35.82%; se relaciona con el tratamiento recibido, fueron los antiparasitarios con el 27.50% y 29%. CONCLUSIONES: De las enfermedades de trasmisión sexual la más frecuente fue la tricomoniasis con predominio del sexo femenino