Amoebicidal and trichomonicidal capacity of polymeric nanoparticles loaded with extracts of the plants Curcuma longa (Zingiberaceae) and Berberis vulgaris (Berberidaceae) / Capacidad amebicida y tricomonicida de nanopartículas poliméricas cargadas con extractos de las plantas Curcuma longa (Zingiberaceae) y Berberis vulgaris (Berberidaceae)

Abstract Introduction: Pathogenic protozoans, like Entamoeba histolytica and Trichomonas vaginalis, represent a major health problem in tropical countries; and polymeric nanoparticles could be used to apply plant extracts against those parasites. Objective: To test Curcuma longa ethanolic extract and Berberis vulgaris methanolic extracts, and their main constituents, against two species of protozoans. Methods: We tested the extracts, as well as their main constituents, curcumin (Cur) and berberine (Ber), both non-encapsulated and encapsulated in polymeric nanoparticles (NPs), in vitro. We also determined nanoparticle characteristics by photon correlation spectroscopy and scanning electron microscopy, and hemolytic capacity by hemolysis in healthy erythrocytes. Results: C. longa consisted mainly of tannins, phenols, and flavonoids; and B. vulgaris in alkaloids. Encapsulated particles were more effective (P < 0.001); however, curcumin and berberine nanoparticles were the most effective treatments. CurNPs had IC50 values (µg/mL) of 9.48 and 4.25, against E. histolytica and T. vaginalis, respectively, and BerNPs 0.24 and 0.71. The particle size and encapsulation percentage for CurNPs and BerNPs were 66.5 and 73.4 nm, and 83.59 and 76.48 %, respectively. The NPs were spherical and significantly reduced hemolysis when compared to non-encapsulated extracts. Conclusions: NPs represent a useful and novel bioactive compound delivery system for therapy in diseases caused by protozoans.

Resumen Introducción: Los protozoos patógenos, como Entamoeba histolytica y Trichomonas vaginalis, representan un importante problema de salud en los países tropicales; y se podrían usar nanopartículas poliméricas para aplicar extractos de plantas contra esos parásitos. Objetivo: Probar los extractos etanólicos de Curcuma longa y Berberis vulgaris, y sus principales constituyentes, contra dos especies de protozoos. Métodos: Probamos los extractos, así como sus principales constituyentes, curcumina (Cur) y berberina (Ber), tanto no encapsulados como encapsulados en nanopartículas poliméricas (NPs), in vitro. También determinamos las características de las nanopartículas por espectroscopía de correlación de fotones y microscopía electrónica de barrido, y la capacidad hemolítica por hemólisis en eritrocitos sanos. Resultados: C. longa tenía principalmente: taninos, fenoles y flavonoides; y B. vulgaris, alcaloides. Las partículas encapsuladas fueron más efectivas (P < 0.001); sin embargo, las nanopartículas de curcumina y berberina fueron los tratamientos más efectivos. CurNPs tenía valores IC50 (µg/mL) de 9.48 y 4.25, contra E. histolytica y T. vaginalis, respectivamente, y BerNPs 0.24 y 0.71. El tamaño de partícula y el porcentaje de encapsulación para CurNPs y BerNPs fueron: 66.5 y 73.4 nm, y 83.59 y 76.48 %, respectivamente. Los NP son esféricos y redujeron significativamente la hemólisis en comparación con los extractos no encapsulados. Conclusiones: Las NP representan un sistema de administración de compuestos bioactivos útil y novedoso para la terapia enfermedades causadas por protozoos.

Agents causing genital infections in routine cytological tests: frequency and characteristics of Papanicolaou smears / Agentes causadores de infecções genitais em exames citológicos de rotina: frequência e características dos esfregaços de papanicolaou

Urinary tract infections are responsible for most human infections, these are caused by bacteria, fungi, protozoa and associated microorganisms. The goal of this study was to determine the rate of vaginal infection-causing agents in routine cytological exams and also to evaluate the characteristics of positive tested Pap smears. A retrospective documental with descriptive aspect research was performed in a Clinical Pathology laboratory from Maceió-AL. The results of the Pap smears exams for Trichomonas vaginalis, Gardnerella vaginalis, Candida spp and HPV were arranged in a database as well as other data such as bacterial, protozoan, fungal and viral coinfections. The sample was composed by 18.645 women who have undergone Pap smear exams from 2013 to 2017. Of these analyzed exams, 27.4% in 2013, 10.9% in 2014, 10.6% in 2015, 15.2% in 2016 and 13.67% in 2017 were within normal range, however more than half of these exams presented some infections caused by unspecific or microbiological agents. By analyzing all the reports, 4.073 (21.84%) presented inflammations caused by some species of infectious agent with the following rate order: G. vaginalis and T. vaginalis. Furthermore, it was possible to confirm high rates of coinfection by and Candida spp. The rate of genital infections in this study highlights that there is a public health matter that must be controlled, which points a greater need for monitoring, guidance and actions towards greater awareness in order to prevent these problems.

Infecções do trato urinário são responsáveis pela maior parte das infecções humanas, sendo causadas por bactérias, fungos, protozoários, e por microrganismos associados. O objetivo deste trabalho foi determinar a frequência de agentes causadores de infecções vaginais nos exames citológicos de rotina, bem como avaliar as características dos esfregaços positivos. Foi realizada uma pesquisa do tipo documental retrospectiva de aspecto descritivo, com abordagem quantitativa, em um Laboratório de Patologia Clínica de Maceió-AL. Nesse sentido, os resultados dos exames colpocitológicos para Trichomonas vaginalis, Gardnerella vaginalis, Candida spp e HPV foram organizados em um banco de dados, contendo os resultados para estes agentes, bem como a coinfecção bacteriana, protozoária, fúngica e viral. A amostra foi composta por 18.645 mulheres que realizaram exame colpocitológico, no período de 2013 a 2017. Destes exames analisados 27,4% em 2013, 10,9% em 2014, 10,6% em 2015, 15,2% em 2016 e 13,67% em 2017, estavam dentro do limite da normalidade, porém mais que a metade desses exames analisados apresentou algumas infecções causadas por agentes inespecíficos ou microbiológicos. Do total de laudos analisados, 4.073 (21,84%), apresentaram inflamações causadas por algum tipo de agente infeccioso, com a seguinte ordem de frequência: G. vaginalis, e T. vaginalis. Além disto, foi possível confirmar a elevada frequência de coinfecção entre G. vaginalis e Candida spp. Os índices de infecções genitais nesse trabalho mostram que há um problema de saúde pública que deve ser controlado, apontando uma necessidade maior de acompanhamento, orientações e de ações para uma maior conscientização para prevenir esses problemas.

Prevalence of Trichomonas vaginalis in women attended at a private laboratory / Prevalência de Trichomonas vaginalis em mulheres atendidas em um laboratório privado

Introduction: Sexually Transmitted Infections (STIs) are caused by viruses, fungi, bacteria, or other microorganisms, thus being a serious public health issue. Trichomonas vaginalis is the disease causative agent of trichomoniasis, a worldwide protozoan. The prevalence of trichomoniasis depends on some factors, including age, sexual activity, number of sexual partners, hygiene habits, among others. Objective: To evaluate the prevalence of Trichomonas vaginalis in gynecological cytology in a private laboratory in the city of Fortaleza, state of Ceará, Brazil. Methods: This is a retrospective, quantitative, and descriptive study carried out in a private laboratory in Fortaleza, state of Ceará. Data for the research, such as age, marital status, and symptoms, were collected from the patients' medical records as well as the prevalence of cases in liquid-based cytology (LBC) and conventional cytology (CC). Results: In 2019, 83 women were positive for trichomoniasis. The most prevalent age group was between 36 and 51 years old (41%), with an average of 39.9 years old. Regarding symptoms, 14 (16.8%) were asymptomatic and 41 (49.3%) had some symptom. Conclusion: The data obtained in this study describe the profile of women affected by Trichomonas vaginalis.

As infecções sexualmente transmissíveis são causadas por vírus, fungos, bactérias ou outros microrganismos, sendo assim um grave problema de saúde pública. O Trichomonas vaginalis, um protozoário presente em todo o mundo, é o agente etiológico causador da tricomoníase. A prevalência dessa doença depende de alguns fatores, incluindo idade, atividade sexual, números de parceiros sexuais, hábitos de higiene, entre outros. Objetivo: Avaliar a prevalência de Trichomonas vaginalis, em citologia ginecológica em um laboratório privado em Fortaleza, Ceará, Brasil. Métodos: Trata-se de estudo retrospectivo, quantitativo e descritivo realizado em laboratório privado em Fortaleza. Os dados para a pesquisa, como idade, estado civil, sintomas, foram retirados de prontuários das pacientes, assim como a prevalência de casos em citologia em meio líquido e CO. Resultados: No ano de 2019, 83 mulheres apresentaram positividade para tricomoníase. A faixa etária mais prevalente foi a de 36 a 51 anos (41%), ficando com a média de 39,9 anos. Em relação aos sintomas, 14 (16,8%), apresentaram-se assintomáticas e 41 (49,3%) apresentaram algum sintoma. Conclusão: Os dados obtidos neste estudo descrevem o perfil das mulheres acometidas pelo Trichomonas vaginalis.

El diagnóstico de Infecciones de Transmisión Sexual por la técnica de biología molecular es la mejor estrategia para su diagnóstico oportuno y específico. Un caso clínico / The diagnosis of Sexually Transmitted Infections by the molecular biology technique is the best strategy for its timely and specific diagnosis. A clinical case

Resumen Se presenta el caso de un paciente a quien se le diagnosticó una Infección de Transmisión Sexual (ITS) por la técnica de PCR múltiple y en quién se logró por esta técnica, detectar cuatro agentes diferentes simultáneamente: Neisseria gonorreae, Mycoplasma hominis, Ureaplasma urealyticum/parvum y Trichomonas vaginalis, situación esta, que no hubiera sido posible utilizando el procedimiento estándar.

Summary Here we report the case of a patient with a Sexually Transmitted Disease (STI) in whom four different agents were detected by a multiple PCR technique: Neisseria gonorreae, Mycoplasma hominis, Ureaplasma urealyticum / parvum and Trichomonas vaginalis. This detection of multiple agents would not have been possible using conventional procedures.

Concordancia entre autotoma y colección estándar de muestras endocervicales para identificar infecciones de trasmisión sexual en un área urbano-rural del Perú / Concordance between self-sampling and standar endocervical sample collection to identify sexual transmission infections in an urban-rural area of Peru

RESUMEN Con el objetivo de evaluar la concordancia entre la autotoma de muestras vaginales y la toma estándar de muestras endocervicales para la identificación de Chlamydia trachomatis, Neisseria gonorrhoeae, Trichomonas vaginalis y Candida spp. realizadas por el personal de salud en mujeres de un área urbano-rural del Perú, se realizó un estudio prospectivo y transversal en 206 mujeres en edad fértil, identificamos algunas infecciones de transmisión sexual como Chlamydia trachomatis o Trichomonas vaginalis en 9 mujeres (4,4%). Obtuvimos una concordancia casi perfecta en la identificación de Candida spp. (k=0,97), Chlamydia trachomatis (k=0,92) y Trichomonas vaginalis por microscopía (k=1,00), y considerable para la identificación de Trichomonas vaginalis por cultivo (k=0,66). La técnica de la autotoma de muestras vaginales podría ser usada para la identificación de algunas infecciones de transmisión sexual en población urbano-rural.

ABSTRACT With the objective of evaluating the concordance between the self-sampling of vaginal samples and the standard collection of endocervical samples for the identification of Chlamydia trachomatis, Neisseria gonorrhoeae, Trichomonas vaginalis and Candida spp. carried out by health personnel in women from an urban-rural area of Peru, a prospective and cross-sectional study was carried out in 206 women of childbearing age, we identified some sexually transmitted infections such as Chlamydia trachomatis or Trichomonas vaginalis in 9/206 (4.4%). We obtained a high degree of agreement in the identification of Candida spp. (k = 0.97), Chlamydia trachomatis (k=0.92) and Trichomonas vaginalis by microscopy (k=1.00), and a considerable agreement for the identification of Trichomonas vaginalis by culture (k=0.66). The self-sampling technique can be used to identify some sexually transmitted infections in urban-rural populations.

Concordancia entre autotoma y colección estándar de muestras endocervicales para identificar infecciones de trasmisión sexual en un área urbano-rural del Perú / Concordance between self-sampling and standar endocervical sample collection to identify sexual transmission infections in an urban-rural area of Peru

RESUMEN Con el objetivo de evaluar la concordancia entre la autotoma de muestras vaginales y la toma estándar de muestras endocervicales para la identificación de Chlamydia trachomatis, Neisseria gonorrhoeae, Trichomonas vaginalis y Candida spp. realizadas por el personal de salud en mujeres de un área urbano-rural del Perú, se realizó un estudio prospectivo y transversal en 206 mujeres en edad fértil, identificamos algunas infecciones de transmisión sexual como Chlamydia trachomatis o Trichomonas vaginalis en 9 mujeres (4,4%). Obtuvimos una concordancia casi perfecta en la identificación de Candida spp. (k=0,97), Chlamydia trachomatis (k=0,92) y Trichomonas vaginalis por microscopía (k=1,00), y considerable para la identificación de Trichomonas vaginalis por cultivo (k=0,66). La técnica de la autotoma de muestras vaginales podría ser usada para la identificación de algunas infecciones de transmisión sexual en población urbano-rural.

ABSTRACT With the objective of evaluating the concordance between the self-sampling of vaginal samples and the standard collection of endocervical samples for the identification of Chlamydia trachomatis, Neisseria gonorrhoeae, Trichomonas vaginalis and Candida spp. carried out by health personnel in women from an urban-rural area of Peru, a prospective and cross-sectional study was carried out in 206 women of childbearing age, we identified some sexually transmitted infections such as Chlamydia trachomatis or Trichomonas vaginalis in 9/206 (4.4%). We obtained a high degree of agreement in the identification of Candida spp. (k = 0.97), Chlamydia trachomatis (k=0.92) and Trichomonas vaginalis by microscopy (k=1.00), and a considerable agreement for the identification of Trichomonas vaginalis by culture (k=0.66). The self-sampling technique can be used to identify some sexually transmitted infections in urban-rural populations.

Diagnóstico de la Tricomonas vaginalis en la mujer / Diagnosis of Trichomonas vaginalis in women

OBJETIVO: revisar los diferentes métodos de diagnóstico de la tricomoniasis vaginal disponibles hasta el presente. MATERIALES Y MÉTODOS: se revisó la bibliografía latinoamericano e internacional a través de los sitios electrónicos de Pub-Med y Scielo. RESULTADOS: la Tricomonas vaginalis es considera como la enfermedad de transmisión sexual no viral, curable más frecuente y prevalente en el mundo. Se revisan los diferentes de métodos para diagnosticar la presencia de la tricomonas vaginalis en pacientes femeninos con síntomas y signos de la infección producida por el protozoario flagelado. CONCLUSIONES: se revisaron los diferentes métodos de diagnostico de la infección producida por la Tricomonas vaginalis en pacientes femeninas, desde los clásicos hasta los más actuales que emplean alta tecnología.

OBJECTIVE: to review the different diagnostic methods of Trichomonas vaginal available at the present time. MATERIAL AND METHOD: it was reviewed the Latin-American and international bibliography using the Pub-Med and Scielo web sites. RESULTS: Trichomonas vaginalis is considered the most common and prevalent sexual transmitted disease curable and non-viral worldwide. It was reviewed the different methods to diagnose the presence of Trichomonas vaginalis in female patients with symptoms and signs of infection produces by the flagellate protozoa. CONCLUSION: Different methods of diagnosis of the infection produced by Trichomonas vaginalis, since the classics to the most current methods that use high technology, were reviewed.

TRICHOMONAS VAGINALIS in female prison inmates from Uberlândia, Minas Gerais, Brazil: prevalence, diagnosis and epidemiological aspects

Trichomonas vaginalis is the etiological agent of trichomoniasis one of the most prevalent sexually transmitted infections worldwide. This paper aimed to determine the prevalence and the risk factors associated to the dissemination of the parasite in the prison environment, as well as comparing the diagnostic methods used for its detection. The present study included 56 female inmates at Professor Jacy de Assis Penitentiary, in Uberlandia, Minas Gerais, Brazil, regardless of ethnicity, socioeconomic status, age and sexual orientation. To diagnose T. vaginalis, wet mount and culture in TYM medium were utilized. The results were compared to the Papanicolaou test, the routine diagnostic method used in prisons. To outline the socioepidemiological profile of the participants an investigative survey was applied during an interview preceding the medical consultation. Of the 56 women included in the present study, six were diagnosed positive for T. vaginalis, by the three methods resulting in a prevalence of 10.7%. Culture and wet mount presented 100% specificity and sensitivity. On the other hand, sensitivity and specificity of the Papanicolaou test were 75% and 96%, respectively. None of the variables analysed, herein, could be associated with the infection. Despite the presence of the parasite, it was not possible to set an epidemiological pattern for positive patients, highlighting the particularities of this population. Regarding the diagnostic methods, wet mount and culture were equally efficient and superior to Papanicolaou in detecting T. vaginalis.

Bacteroides Fragilis induces conformational alterations in Trichomonas Vaginalis ultrastructure in an in vitro interaction

Bacteroides genus are commonly found on mucous membranes, including the female genital tract, acting as agents for several site infections. Anaerobic infections are usually polymicrobial and endogenous. Trichomonas vaginalis, the trichomoniasis etiologic agent, is a facultative anaerobic flagellated parasite spread worldwide. The purpose of this study was to explore the association between vaginal bacteria and T. vaginalis, as well as to understand factors that may favour the infection of T. vaginalis. We have, therefore, used T. vaginalis trophozoites and the species Bacteroides fragilis, which is considered the most important in its genus, once it is the most commonly isolated bacteria from endogenous infections. The parasite-bacteria interaction was performed in different proportions in periods varying from 1 to 12 hours applying viability tests. The data were analyzed to compare the parasite viability in vitro in the presence and absence of B. fragilis. The results indicate that in the 1:100 proportion postinteraction analysis, ultrastructural alterations were noticeable after 6 hours. After 8 hours, T. vaginalis viability decreased, and after 12 hours of interaction no viable trophozoites were found. These data suggest that the parasite can deal with B. fragilis in short interaction periods. However, in longer interaction periods the trophozoites collapse, indicating that B. fragilis may produce toxic metabolites against T. vaginalis activity.

Prevalência de casos de tricomoníase em laudos citopatológicos de um laboratório particular da cidade do Crato ­ Ceará / Prevalence of tricomoníase cases in citopatological reports of a particular laboratory of the city of Crato-Ceará

Objetivo: o presente artigo tem como objetivo avaliar a prevalência de mulheres infectadas pelo protozoário Trichomonas vaginalis (T. vaginalis) em um laboratório particular da cidade do Crato, Ceará. Metodologia: tratou-se de um estudo do tipo descritivo, retrospectivo com abordagem quantitativa. A coleta de dados foi realizada em um Laboratório particular de Análises Clínicas, localizado na cidade de Crato-CE, cujo grupo de estudo foi todas as mulheres, com idade entre 17 e 87 anos, que realizaram o exame de Papanicolau no período de 2014 a 2016. Resultados: foram quantificados os percentuais de amostras positivas para a tricomoníase e outras patologias correlatas obtendo-se como resultado que entre os anos de 2014 a 2016 foram realizados 28.910 exames citopatológicos, dos quais 2,22 % foram positivos para tricomoníase. Dentre os casos positivos 22,15% apresentaram co-infecção com outros microrganismos, sendo a Gardnerella vaginalis a principal bactéria encontrada, obtendo um total de 80,99% dos casos, Cândida sp com 11,97% dos casos, Leptothrix com 5,63% e Papilomavírus humano (HPV) com 1,41% dos casos. Observou-se que a faixa etária com maior incidência de tricomoníase é entre 26 a 45 anos, com um percentual de 65,21%, sendo possível notar a alta prevalência de tricomoníase na população feminina. Conclusão: os resultados foram apresentados a Secretaria de Saúde da cidade de Crato ­ Ceará com o intuito de alertar os profissionais de saúde com relação ao número de casos, incentivando a periodicidade do exame de Papanicolau e outros exames voltados ao diagnóstico dessa patologia, além de uma atenção especial ao tratamento das mulheres já infectadas .

Objective: the present article aims to evaluate the prevalence of women infected by the protozoan Trichomonas vaginalis (T. vaginalis) in a private laboratory in the city of Crato, Ceará. Methodology: this was a descriptive, retrospective study with a quantitative approach. The data collection was performed in a Private Laboratory of Clinical Analyzes, located in the city of Crato-CE, whose study group were all women aged between 17 and 87 years who underwent the papanicolau in the period from 2014 to 2016. Results: the percentages of positive samples for trichomoniasis and other related pathologies were quantified, resulting in 28.910 cytopathological exams between 2014 and 2016, of which 2.22% were positive for trichomoniasis. Among the positive cases, 22.15% presented co-infection with other microorganisms, Gardnerella vaginalis being the main bacterium found, obtaining a total of 80.99% of the cases, Candida sp. With 11.97% of the cases, Leptothrix with 5, 63% and human papillomavirus (HPV) with 1.41% of the cases. It was observed that the age group with the highest incidence of trichomoniasis is between 26 and 45 years old, with a percentage of 65.21%, being possible to note the high prevalence of trichomoniasis in the female population. In view of these results it is possible to note the high prevalence of trichomoniasis in the female population. Conclusion: the results were presented to the Health Department of the city of Crato-Ceará with the aim of alerting health professionals about the number of cases, encouraging the periodicity of the papanicolau and other tests aimed at the diagnosis of this pathology, besides paying special attention to the treatment of women already infected.

The frequency of in Pap smear and liquid-based cytology (SurePath ) between 2013 and 2018 in a reference laboratory in Fortaleza, Brazil / Frequência de Trichomonas vaginalis no exame de Papanicolaou e citologia em base líquida (SurePathTM) entre 2013 e 2018 em um laboratório de referência em Fortaleza, Brasil

Introduction: Trichomonas vaginalis (Tv) is a parasite responsible for the most frequent non-viral sexually transmitted infection and causes more than 250 million new cases around the world each year. Frequently, Tv is identified in cervical cancer screening. Objective: To assess the frequency of Tv identified on cytology between 2013 and 2018 in a private Laboratory at Fortaleza, Brazil. Methods: Cases from the files of a laboratory in Fortaleza, Brazil, were searched for diagnoses of Tv on cytology (Pap smear and SurePathTM [SP]) between 2013 and 2018, and the frequency of infection in each year, as well as differences between the years, were calculated. A linear regression test was performed to analyze the relationship between time and infection with a 95% confidence interval. The research was approved by an ethics committee. Results: The mean age of the patients was 35.9 (+12.5) years in the Pap smear group and 33.4(+11.9) years in the liquid-based cytology group. Tv was diagnosed in 281 of 207,863 patients (0.14%) (113 [0.12%] in the Pap smear group and 168 [0.15%] in SP cytology). Assessing year by year differences, it was observed that Tv was identified on cytology in 36 of 33,193 in 2013 (0.1%) (Pap smear=19/ 19,734 [0.1%]; SP=17/ 13,459 [0.13%], 50 of 34,661 in 2014 (0.14%) (Pap smear=22/ 16,358 [0.13%]; SP=28/ 18,303 [0.15%]), 34 of 33,623 in 2015 (0.1%) (Pap smear=10/ 14,501 [0.07%]; SP=24/ 19,122 [0.13%]), 29 of 34,492 in 2016 (0.1%) (Pap smear=9/ 15,629 [0.06%]; SP=20/ 18,863 [0.1%]), 52 of 35,446 in 2017 (0.15%) (Pap smear=22/ 15,948 [0.14%]; SP=30/ 19,498 [0.15%], and 80 of 36,448 in 2018 (0.22%) (Pap smear=31/ 15,408 [0.2%]; SP=49/ 21,040 [0.23%]). Conclusion: There was a tendency towards increased frequency of Tv diagnosis in the gynecologic cytology group (Pap smear or SP), mainly in the last year, reflecting what is observed using more sensitive methods.

Introdução: Trichomonas vaginalis (Tv) é um parasita responsável pela infecção sexualmente transmissível não viral mais frequente e incidindo em mais de 250 milhões de novos casos a cada ano no mundo. Frequentemente, o Tv é identificado no rastreamento citológico do câncer de colo do útero. Objetivo: Avaliar a frequência de Tv identificada por citologia entre 2013 e 2018 em um laboratório privado em Fortaleza, Brasil. Métodos: Foram pesquisados casos dos prontuários de um laboratório em Fortaleza, Brasil, para dianóstico de Tv por citologia (exame de Papanicolaou ou SurePathTM [SP]) entre 2013 e 2018, e foram calculados a frequência da infecção a cada ano bem como as diferenças entre eles. Um teste de regressão linear foi aplicado para analizar a relação entre o tempo e a infecção com intervalo de confiança de 95%. A pesquisa foi aprovada pelo comitê de ética. Resultados: A idade média das pacientes foi 35.9 (+12.5) anos na citologia convencional (CC) e 33.4 (+11.9) anos no grupo de citologia em meio líquido. Tv foi diagnosticada em 281 de 207.863 pacientes (0,14%) (113 [0,12%] no grupo de CC e 168 [0,15%] no grupo de SP). Avaliando ano a ano, foi observado que o Tv foi identificado em 36 de 33.193 em 2013 (0,1%) (CC=19/ 19.734 [0,1%]; SP=17/ 13.459 [0,13%], 50 de 34.661 em 2014 (0,14%) (CC=22/ 16.358 [0,13%]; SP=28/ 18.303 [0,15%]), 34 de 33.623 em 2015 (0,1%) (CC=10/ 14.501 [0,07%]; SP=24/ 19.122 [0,13%]), 29 de 34.492 em 2016 (0,1%) (CC=9/ 15.629 [0,06%]; SP=20/ 18.863 [0,1%]), 52 de 35.446 em 2017 (0,15%) (CC=22/ 15.948 [0,14%]; SP=30/ 19.498 [0,15%], e 80 de 36.448 em 2018 (0,22%) (CC=31/ 15.408 [0,2%]; SP=49/ 21.040 [0,23%]). Conclusão: Há a tendência de aumento na frequência de diagnóstico de Tv na citologia (Papanicolaou ou SP), principalmente no último ano, refletindo o que já tem sido observado por métodos mais sensíveis.

Cribado de infecciones cervicales de transmisión sexual en mujeres embarazadas y su relación con la microbiota vaginal / Screening of cervical sexually transmitted infections in pregnant women and the relation with the vaginal microbiota

Resumen Introducción: La mujer embarazada está expuesta anumerosas infecciones de transmisión sexual (ITS), las que pueden producir aborto, enfermedad en el feto y/o en el recién nacido, además de alteraciones en el curso normal del embarazo. Objetivo: Realizar tamizaje de infección cervical asintomática en mujeres embarazadas y su relación con la microbiota. Pacientes y Métodos: Se enrolaron 85 mujeres embarazadas sin cervicitis clínica que consultaron en control de rutina de embarazo (47 pacientes) o que fueron derivadas a una unidad de ITS (38 pacientes). Se tomaron muestras de fondo de saco vaginal, que fueron analizadas por técnicas clásicas de microscopía y cultivo corriente y reacción de polimerasa en cadena para Neisseria gonorrhoeae, Trichomonas vaginalis y Chlamydia trachomatis. Resultados: Se encontró 12,9% de infección por C. trachomatis, 2,4% de T. vaginalis. En este estudio no se encontró N. gonorrhoeae. El 23,3% de pacientes con microbiota alterada (vaginosis bacteriana y microbiota intermedia) fue positiva para C. trachomatis. Conclusión: En este trabajo, encontramos una alta frecuencia de infección por C. trachomatis, que se relaciona en forma significativa con la presencia de microbiota alterada. Esta alta frecuencia debería promover estrategias preventivas en los controles de salud de la mujer embarazada.

Background: Pregnant woman is exposed to many sexual transmitted infections (STI). Many of these infections may produce diseases in the fetus and newborn, and also alteration in the normal course of the pregnancy. Aim: Screening of asymptomatic cervical infection in pregnant woman and its relationship with the vaginal microbiota. Patients and Methods: 85 pregnant women without clinical cervicitis who consult in the routine pregnant control (47 patients) and women derived from STI service (38 patients). The samples were obtained from the vaginal fund sac and were analyzed with optic microscopy, cultures and PCR of Neisseria gonorrhoeae, Trichomonas vaginalis and Chlamydia trachomatis. Results: 12,9% of the enrolled women were positive for C. trachomatis, 2,4% for T. vaginalis. In this study, we did not found N. gonorrhoeae. We observed 23,3% of patients with altered microbiota (bacterial vaginosis and intermediate microbiota) was positive for C. trachomatis. Conclusions: In this study, we found a high frequency of C. trachomatis infection, that correlates with the presence of altered microbiota. This high frequency would promote preventive strategies in the pregnant women routine controls.

The Association of Glutaminase (glut) P3 Different Alleles of Trichomonas vaginalis with Infertility in a sample of Iraqi women

Trichomonas vaginalis (T. vaginalis), the etiologic agent of human trichomoniasis, is a flagellated protozoan parasite, has been associated sith advese pregnancy outcomes, HIV transmission, and infertilityh. A total of one hundred and fifty-seven (157) women at childbearing age (14-49 years), were included in the presnt study, eighty six (86) symptomatic fertile while the other seventy-one (71) were infertile with or without sumptoms attending the Gynecology outpatient Department in Al-Emamayn Al-Kadhimayn Medical City, the High Institute of Infertility Diagnosis and Assisted Reproductive Technoligies at Al-Nahrain University in Baghdad, the maternity Teaching hospital, and Dr. Khawer center for infertility and IVF in Erbil province in Iraq. Two vaginal swab specimens were obtained from each of them:; one swab was immediately examined by wet mount microscopy, the other swab for molecular study (DNA extraction and p3 nested PCR). One hundred (100) samples positive in one or more test were identified: 20 (12.7%) infecions were detected by wet mount microscopy, while nested PCR was positive in 100 (63.7%) samples. These positive samples were seguenced and phylogenetic tree were done and, there was no association between the variations in glut (p3) gene of T. vaginalis isolated from infected women (fertile and infertile)

Trichomonas vaginalis and HIV infection: relation and prevalence among women in southern Brazil

Trichomoniasis is a curable sexually transmitted infection (STI) that has been reported to be linked to exposure to human immunodeficiency virus (HIV), although few studies have described this association. The purpose of this study was to focus on the incidence of trichomoniasis in low-income women, its relation to HIV status, viral load levels and TCD4+cell counts, among other risk factors, using an in vitro culture as a diagnostic test. A cross-sectional study among 267 women (103 HIV-positive and 164 HIV-negative) was conducted in 2015. The overall prevalence of Trichomonas vaginalis (TV) infection was 6.4%. Among HIV-positive and HIV-negative women, the prevalence was 3.9% and 7.9%, respectively, yet these results were not statistically different (p=0.1878). The factors associated with TV infection were cigarette smoking (OR= 3.52), vaginal itching (OR=4.43) and bacterial vaginosis (BV) (OR= 5.29). HIV status, TCD4+ cell count and viral load were not associated with TV infection in this group. The prevalence rates found, lower than those observed in other studies, may be due to the fact that the women evaluated in the present study are part of a low-risk population as well as the limited sample size of HIV positive women

Prevalence of Trichomonas vaginalis and Human papillomavirus in female sex workers in Central Veracruz, Mexico / Prevalencia de Trichomonas vaginalis y virus del papiloma humano en mujeres trabajadoras sexuales en el centro de Veracruz, México

Female sex workers (FSWs) have been considered a key population for sexually transTrichomonas mitted infections (STIs); therefore, they are periodically screened as a requirement to obtain a work card. However, there is insufficient epidemiological data on STIs among FSWs in Mexico. The detection of Trichomonas vaginalis is limited to microscopic studies and the molecular screening of Human papillomavirus (HPV) is only done to women 35 years of age and older. The objective of this study was to determine the prevalence of T. vaginalis and HPV infections in FSWs in the city of Orizaba, Veracruz, Mexico. Samples from 105 FSWs were obtained by cervical swab and analyzed. The identification of T. vaginalis and HPV was performed by molecular methods. HPV DNA was identified in 5.71% of the samples with the presence of HPV16, HPV18, and HPV58. A percentage of 25.7% samples were positive for T. vaginalis for optical microscopy and 23.8% for PCR. The results of the study indicate the need to incorporate more sensitive methods for the timely diagnosis of STIs as well as comprehensive health promotion programs directed to the most vulnerable groups among FSWs.

Las mujeres trabajadoras sexuales (MTS) han sido consideradas una población clave para las infecciones de transmisión sexual (ITS), por ello son examinadas periódicamente como requisito para obtener una tarjeta de trabajo. Sin embargo, no existen datos epidemiológicos suficientes sobre las ITS en las MTS en México. La detección de Trichomonas vaginalis se limita a los estudios microscópicos, y el cribado molecular del virus del papiloma humano (Human papillomavirus: HPV) solo se realiza en las mujeres de 35 años o mayores. El objetivo de este estudio fue determinar la prevalencia de T. vaginalis e infecciones por HPV en las MTS de la ciudad de Orizaba, Veracruz, México. Se analizaron 105 muestras de las MTS, obtenidas mediante frotis cervical. La identificación de T. vaginalis y HPV se realizó por métodos moleculares. El ADN del HPV se identificó en el 5,71% de las muestras, con la presencia de HPV16, HPV18 y HPV58. El 25,7% de las MTS fueron positivas para T. vaginalis por microscopia óptica el 23,8% por PCR. Los resultados del estudio indican la necesidad de incorporar métodos más sensibles para el diagnóstico oportuno de ITS y programas integrales de promoción de la salud en los grupos más vulnerables, entre las MTS.

Systematic review: The potency of Zataria multiflora Boiss in treatment of vaginal infections / Revisión sistemática: Potencia de la calendula Zataria multiflora para el tratamiento de infecciones vaginales

Vaginitis as female infectious disease is accompanied with some clinical symptoms such as vaginal abnormal discharges, itching, burning and many other unpleasant signs in patients. The responsible microorganisms in vaginitis are belonged to different kind of microorganisms including bacteria (Gardenella vaginitis), yeast (Candida albicans) and protozoa (Trichomonas vaginalis). The current treatments of these infections are chemical oral and vaginal drugs with many adverse effects for patients. Furthermore, appearance of resistant microorganisms to these drugs has intensified the treatment's problem. The aim of this review article was to evaluate the potency of "Zataria multiflora" essential oil in treatment of women's vaginitis. For preparing this manuscript, the information was extracted from different electronic and published resources. Investigation in different resources showed there were 6 clinical trials that evaluate it as suitable treatment for vaginitis. 5 clinical studies have been focused on 0.1% Z. multiflora essential oils in treatment of bacterial vaginosis (n=1), candidiasis (n=1) and trichomoniasis (n=1). Two clinical studies were related to treatments of bacterial vaginosis, trichomoniasis and mixed infection. There is one clinical study for treatment of candidiasis by 1% Z. multiflora methanol extract. Z. multiflora was formulated in cream form and applied for 5-7 continuous days. The results of clinical trials showed that Z. multiflora essential oil (0.1%) can be used as safe and efficient alternative treatment for treatment of bacterial vaginosis, candidiasis and to a lesser extent for trichomoniasis.

La vaginitis es una enfermedad infecciosa femenina acompañada de algunos síntomas como flujo vaginal, prurito, sensación de ardor y otros síntomas de incomodidad para las pacientes. Los microorganismos responsables de vaginitis son variados e incluyen bacterias (Gardenella vaginitis), hongos (Candida albicans) y protozoos (Trichomonas vaginalis). Los tratamientos utilizados actualmente son medicamentos de uso oral o vaginal con potenciales efectos adversos. Adicionalmente se encuentran organismos resistentes a estos tratamientos, lo que ha llevado a la búsqueda de nuevas alternativas. El propósito de esta revisión sistemática fue evaluar la potencia del aceite esencia de "Zataria multiflora" para el tratamientos de la vaginitis. Se realizó una búsqueda en recursos bibliográficos y bases de datos electrónicos. Se encontraron seis ensayos clínicos que evaluaron este aceite para el tratamiento de la vaginitis. En 5 estudios clínicos se utilizó aceite esencial al 0.1% de Z. multiflora para el tratamiento de vaginosis bacteriana (n=1), candidiasis (n=1) y tricomoniasis (n=1) y en tres estudios se usó para tratamiento tanto de infecciones bacterianas, tricomoniasisi o mixtas. Se encontró un estudio para tratamiento de la candidiasis con extracto en metanol 1% de Z. multiflora. Se hizo formulación de Z. multiflora en crema tópica y aplicada por 5-7 días continuos. Los resultados mostraron que el aceite esencial de Z. multiflora (0.1%) puede ser usado de manera segura y eficiente como alternativa en vaginosis bacteriana, candidiasis y en menor grado para tricomoniasis.

Morphologic study of the effect of iron on pseudocyst formation in Trichomonas vaginalis and its interaction with human epithelial cells

BACKGROUND Trichomonas vaginalis is the aetiological agent of human trichomoniasis, which is one of the most prevalent sexually transmitted diseases in humans. Iron is an important element for the survival of this parasite and the colonisation of the host urogenital tract. OBJECTIVES In this study, we investigated the effects of iron on parasite proliferation in the dynamics of pseudocyst formation and morphologically characterised iron depletion-induced pseudocysts. METHODS We performed structural and ultrastructural analyses using light microscopy, scanning electron microscopy and transmission electron microscopy. FINDINGS It was observed that iron depletion (i) interrupts the proliferation of T. vaginalis, (ii) induces morphological changes in typical multiplicative trophozoites to spherical non-proliferative, non-motile pseudocysts, and (iii) induces the arrest of cell division at different stages of the cell cycle; (iv) iron is the fundamental element for the maintenance of typical trophozoite morphology; (v) pseudocysts induced by iron depletion are viable and reversible forms; and, finally, (vi) we demonstrated that pseudocysts induced by iron depletion are able to interact with human epithelial cells maintaining their spherical forms. MAIN CONCLUSIONS Together, these data suggest that pseudocysts could be induced as a response to iron nutritional stress and could have a potential role in the transmission and infection of T. vaginalis.

Utilidad de la reacción de polimerasa en cadena convencional para la detección de Mycoplasma hominis, Ureaplasma spp. y Trichomonas vaginalis en muestras genitales de mujeres en consulta ambulatoria / Usefulness of conventional polymerase chain reaction for the detection of Mycoplasma hominis, Ureaplasma spp. and Trichomonas vaginalis in female outpatient's genital samples

Introduction: Trichomonas vaginalis, Mycoplasma hominis and Ureaplasma spp. are microorganisms responsible for genitourinary and pregnancy pathologies. Nucleic acid amplification methods have shown several advantages, but have not been widely studied for the detection of these microorganisms. Aim: To implement a conventional polymerase chain reaction (PCR) for the detection of the microorganisms and to compare its results versus the methods currently used at our laboratory. Material and Methods: 91 available samples were processed by PCR, culture (M. hominis y Ureaplasma spp.) and wet mount (T vaginalis). Results were compared and statistically analyzed by kappa agreement test. Results: 85, 80 and 87 samples resulted in agreement for the detection of M. hominis, Ureaplasma spp. y T. vaginalis, respectively. For M. hominis and Ureaplasma spp., agreement was substantial, whereas for T. vaginalis it was moderate, however, for the latter, PCR detected more cases than wet mount. Conclusion: We recommend the implementation of PCR for detection of T. vaginalis whereas culture kit is still a useful method for the other microorganisms.

Introducción: Trichomonas vaginalis, Mycoplasma hominis y Ureaplasma spp. son microorganismos causantes de patología genito-urinaria y durante el embarazo. Los métodos de amplificación de ácidos nucleicos han demostrado numerosas ventajas, pero no han sido ampliamente estudiados para la detección de estos microorganismos. Objetivo: Implementar una reacción de polimerasa en cadena convencional (RPC) para su detección y comparar sus resultados con los métodos actuales de nuestro laboratorio. Material y Métodos: Se procesaron 91 muestras mediante RPC, cultivo (M. hominis y Ureaplasma spp.) y observación microscópica al fresco (T. vaginalis). Los resultados fueron comparados y analizados estadísticamente mediante el test de concordancia kappa. Resultados: 85, 80 y 87 muestras tuvieron resultados concordantes para la detección de M. hominis, Ureaplasma spp. y T. vaginalis, respectivamente. Para M. hominis y Ureaplasma spp. el nivel de concordancia fue considerable mientras que para T. vaginalis fue moderado; sin embargo, para esta última, la RPC detectó más casos que la microscopia al fresco. Conclusión: Se recomienda la implementación de la RPC para la detección de T. vaginalis. Para M. hominis y Ureaplasma spp. el kit de cultivo continúa siendo un buen método.

Association of human papillomavirus and Chlamydia trachomatis with intraepithelial alterations in cervix samples

The influence of different infectious agents and their association with human papillomavirus (HPV) in cervical carcinogenesis have not been completely elucidated. This study describes the association between cytological changes in cervical epithelium and the detection of the most relevant aetiological agents of sexually transmitted diseases. Samples collected from 169 patients were evaluated by conventional cytology followed by molecular analysis to detect HPV DNA, Chlamydia trachomatis, herpes simplex virus 1 and 2,Neisseria gonorrhoeae, Mycoplasma genitalium, Trichomonas vaginalis, andTreponema pallidum, besides genotyping for most common high-risk HPV. An association between cytological lesions and different behavioural habits such as smoking and sedentariness was observed. Intraepithelial lesions were also associated with HPV and C. trachomatis detection. An association was also found between both simple and multiple genotype infection and cytological changes. The investigation of HPV and C. trachomatisproved its importance and may be considered in the future for including in screening programs, since these factors are linked to the early diagnosis of patients with precursor lesions of cervical cancer.

COMPARISON OF PERMANENT STAINING METHODS FOR THE LABORATORY DIAGNOSIS OF TRICHOMONIASIS

Trichomonas vaginalis is the etiologic agent of trichomoniasis, the most common non-viral sexually transmitted disease (STD) in the world. The diagnosis is based on wet mount preparation and direct microscopy on fixed and stained clinical specimens. The aim of this study was to compare the performance of different fixing and staining techniques used in the detection of T. vaginalis in urine. The smears were fixed and submitted to different methods of permanent staining and then, the morphological aspects of the parasites were analyzed and compared. The Papanicolaou staining with ethanol as the fixative solution showed to be the best method of permanent staining. Our data suggest that staining techniques in association with wet mount examination of fresh specimens contribute to increase the sensitivity in the diagnosis of trichomoniasis.