Clinical importance of detection of bacterial vaginosis, trichomonas vaginalis, candida albicans and actinomyces in Papanicolaou smears.

OBJECTIVE: The aim of this study was to determine the role of Papanicolaou (pap) smears in the diagnosis of lower genital tract infections. MATERIALS AND METHODS: A retrospective study was planned by reviewing charts of patients for trichomonas vaginalis, bacterial vaginosis, actinomyces, candida and nonspecific vaginitis. RESULTS: Charts of 9,080 patients were reviewed and 1,733 women had a diagnosis of lower genital tract infection in the pap smear or had had a clinically treated lower genital tract infection. Only 33.5%, 30.4%, 43.3%, and 0% of patients with bacterial vaginosis, trichomonas vaginalis, candida and actinomyces, respectively on pap smear were diagnosed and treated clinically. Postmenopausal patients had a higher rate of trichomonas vaginalis infection and a lower rate of candida infection when compared to women of the reproductive age group. Patients using an intrauterine device for contraception had a statistically significantly increased rate of trichomonas vaginalis and candida infection when compared to women using other contraceptive methods or those who were not using any contraception. CONCLUSIONS: Finding trichomonas vaginalis, bacterial vaginosis and actinomyces infections in pap smears might be considered an indication for treatment without performing other diagnostic tests. Treatment of asymptomatic infections can prevent complications in selected patients. Candida can be a commensal bacteria in the vagina, therefore asymptomatic patients may not require treatment. Detection of a higher rate of trichomonas vaginalis and candida infection in IUD users shows that IUDs can increase the risk of vaginal infections and associated complications.

Il4ra-independent vaginal eosinophil accumulation following helminth infection exacerbates epithelial ulcerative pathology of HSV-2 infection.

How helminths influence the pathogenesis of sexually transmitted viral infections is not comprehensively understood. Here, we show that an acute helminth infection (Nippostrongylus brasiliensis [Nb]) induced a type 2 immune profile in the female genital tract (FGT). This leads to heightened epithelial ulceration and pathology in subsequent herpes simplex virus (HSV)-2 infection. This was IL-5-dependent but IL-4 receptor alpha (Il4ra) independent, associated with increased FGT eosinophils, raised vaginal IL-33, and enhanced epithelial necrosis. Vaginal eosinophil accumulation was promoted by IL-33 induction following targeted vaginal epithelium damage from a papain challenge. Inhibition of IL-33 protected against Nb-exacerbated HSV-2 pathology. Eosinophil depletion reduced IL-33 release and HSV-2 ulceration in Nb-infected mice. These findings demonstrate that Nb-initiated FGT eosinophil recruitment promotes an eosinophil, IL-33, and IL-5 inflammatory circuit that enhances vaginal epithelial necrosis and pathology following HSV-2 infection. These findings identify a mechanistic framework as to how helminth infections can exacerbate viral-induced vaginal pathology.

Exploring the feasibility and possible efficacy of mass treatment and education of young females as schistosomiasis influences the HIV epidemic.

PURPOSE: Genital schistosomiasis may be a risk factor for HIV, but chronic lesions in adults may be refractory to standard treatment. We aimed to investigate young girls' risk factors for gynaecological schistosomiasis, possible protective factors and possibilities for behavioural change and mass treatment in rural Tanzania. METHODS: A standardised questionnaire was used to interview females between 5 and 20 years of age in a small cross-sectional study. RESULTS: One third of the girls were found to be at risk of acquiring schistosomal infection. Younger and older girls were engaged in more risk behaviour than the 10-14-year-olds. Knowledge of the parasite was associated with less risky water contact, and most of the girls had acquired this knowledge through primary school education. CONCLUSION: Mass treatment for gynaecological schistosomiasis should be done in collaboration with the school system as a joint venture with the health system in order to reach non-enrolled girls who may be at particular risk. Research is still needed to assess the preventive effect of treatment on genital lesions and on HIV incidence.

[Enterobiasis vaginal. Report of one case]. / Enterobiasis vaginal. Comunicación de un caso.

The nematode Enterobius vermicularis is normally found within the human gastrointestinal tract. Pregnant females migrate towards the anus to lay their eggs. During this nocturnal migration some worms find another adjacent orifices, most commonly the female genitourinary tract. The presented case is a 34-year-old woman referred to the Colposcopy Unit of the Antiguo Hospital Civil of Guadalajara Fray Antonio Alcalde by cervical erosion. With the colposcopy a live worm in the vagina was visualized; it was identified as a gravid female of Enterobius vermicularis by microscopy. The diagnosis of ectopic enterobiasis was an incidental finding during the colposcopic examination of the patient with diagnosis of ectopy.

Is vaginal microscopy an essential tool for the management of women presenting with vaginal discharge?

SUMMARY: Point-of-care microscopy is the gold standard for the diagnosis of vaginal discharge in genitourinary (GU) medicine clinics but not used in primary care settings and reproductive health clinics to which many patients present. In our GU medicine clinic setting, we conducted an audit to assess the utility of microscopy of vaginal secretions versus clinical diagnosis alone for the differential diagnosis of uncomplicated lower vaginal infections. Clinical diagnosis (including pH) of bacterial vaginosis had a sensitivity between 85% and 88% at two clinic sites. Our results suggest that it may be safe and more cost-effective to restrict vaginal microscopy to a subgroup of women presenting with vaginal discharge.

Prevalence and genetic diversity of Trichomonas vaginalis in the general population of Granada and co-infections with Gardnerella vaginalis and Candida species.

PURPOSE: Purulent or exudative genitourinary infections are a frequent cause of consultation in primary and specialized healthcare. The objectives of this study were: to determine the prevalence of Trichomonas vaginalis and co-infections with Candida spp. and Gardnerella vaginalis in vaginal secretion; and to use multilocus sequence typing (MLST) to analyse the genetic diversity of T. vaginalis strains. METHODOLOGY: The samples were submitted for analysis (n=5230) to a third-level hospital in Granada (Southern Spain) between 2011 and 2014; eight T. vaginalis strains isolated during 2015 were randomly selected for MLST analysis. Culture and nucleic acid hybridization techniques were used to detect microorganisms in the samples. RESULTS: The prevalence of T. vaginalis was 2.4 % between 2011 and 2014, being higher during the first few months of both 2011 and 2012. Among samples positive for T. vaginalis, co-infection with G. vaginalis was detected in 29 samples and co-infection with Candida spp. in 6, while co-infection with all three pathogens was observed in 3 samples. The only statistically significant between-year difference in co-infection rates was observed for T. vaginalis with G. vaginalis due to an elevated rate in 2011. MLST analysis results demonstrated a high genetic variability among strains circulating in our setting. CONCLUSION: These findings emphasize the need for the routine application of diagnostic procedures to avoid the spread of this sexually transmitted infection.

Unusual cases of human myiasis due to Old World screwworm fly acquired indoors in Hong Kong.

Myiasis is the infestation of tissue by the larvae of flies. We report eight cases of human myiasis in Hong Kong. All patients were nursing home residents with an average age of 81.8 years. Seven patients were bedridden with advanced dementia. Four patients had pre-existing wounds. Five had poor oral hygiene and four of those were on tube feeding. All of the five patients with poor oral hygiene suffered from oral myiasis. Two patients had vaginal infestations and one had wound myiasis in his diabetic foot ulcer. Seven cases were infested by Chrysomya bezziana, an obligatory parasite that requires living mammalian tissue for its larval development. Larvae of the Calliphoridae family were responsible for the remaining case. Patients were managed with manual removal of larvae and irrigation of the site of infestation with saline. All infestations were nosocomial, being acquired in nursing homes. Carers of the old and debilitated should be made aware of the need for better oral care, especially for those on tube feeding. The use of window screens in nursing homes should be encouraged to reduce the chance of flies entering the vicinity of these patients. Electrocuters could also be mounted indoors to kill flies that do enter.

Unusual protozoal infestation of the cervical mucus.

The transient colonization of the female genital tract with an unusual multiflagellated protozoan is reported. The presence of active organisms in large numbers in the mucus of the endocervical canal and their absence from the gastrointestinal tract and other areas indicates true colonization rather than contamination. The colonization resolved spontaneously. The organism has been classified as a Polymastigidan.

Host and pathogen interaction during vaginal infection by Trichomonas vaginalis and Mycoplasma hominis or Ureaplasma urealyticum.

Vaginal infections by Trichomonas vaginalis and Mycoplasma hominis have been shown to be associated. Since M. hominis and Ureaplasma urealyticum are similar pathogens, both belonging to the class of the mycoplasmata, we describe here a molecular study into the interdependence of U. urealyticum and T. vaginalis during infection. Susceptibility towards infection by U. urealyticum depends on genetic polymorphism in the interleukin-1 receptor antagonist (IL-1RA) gene. Now, we defined the relation between IL-1RA genotypes and infection by M. hominis and T. vaginalis. Finally, we also developed a restriction fragment length polymorphism (RFLP) tool for mapping variation in the T. vaginalis AP33 adhesin in order to define putative associations between parasite subtype and mycoplasmata or host. Studies using crudepellets from T. vaginalis culture broth clearly confirm the association between T. vaginalis and M. hominis infection. The association between IL-1RA genotype 2,2 and lack of U. urealyticum infection is corroborated as well. U. urealyticum infection and infection by T. vaginalis are independent. Furthermore, T. vaginalis and M. hominis infection are not depending on IL-1RA genotypes. Interestingly, one of the three AP33 RFLP types identified appeared to be associated with the absence of U. urealyticum infection. In conclusion, the complex interaction between bacterial and parasitic pathogens and the infected host is determined by genetic characteristics of host and microorganisms involved.

Quantification of Candida albicans morphology in vaginal smears.

The morphology index (Mi) of Candida albicans cells was determined by microscopic image analysis in vaginal smears from 26 patients. The morphology of the cells typically showed a broad distribution of forms, but the mean Mi was greater than 2.0 in 23/26 instances, indicating a preponderance of pseudohyphal and hyphal forms. No association could be found between Mi and the clinical assessment of signs or symptoms of Candida infection. Comparison of these 26 patients with 43 others who had Candida-positive vaginal smears but with fewer than 15 fungal cells in the smear revealed significantly lower scores for vulvovaginal symptoms among the latter.

Development of a topical vaginal microbicide: lessons learned from human milk.

Vaccines are not presently available to prevent adherence and transmission of many common pathogens at mucosal surfaces. As a result, sexually transmitted diseases were one of the most commonly reported infections in the US in 1999. New methods are needed to reduce the spread of mucosal infections. Providing nonspecific protective factors, such as lipids and retinoids found in human milk to mucosal surfaces could reduce mucosal infection caused by viruses, e.g., herpes simplex virus-1 (HSV-1) and bacteria, e.g., Pseudomonas aeruginosa. Human milk lipids enzymatically modified to produce monoglycerides were antimicrobial and inactivated enveloped viruses, as well as gram-positive and gram-negative bacteria. Enveloped viruses were inactivated in seconds following contact with antimicrobial lipids, and P. aeruginosa infectivity was reduced by 99.9% after 2 hours. Transmission of pathogens at mucosal surfaces can also be prevented using retinoids that inhibit viral replication. In a human embryonic intestinal cell line the retinoic acid (RA) derivatives all-trans-RA and 9-cis-RA (10 microg/mL) decreased the production of HSV-1 and Echo-6 viruses by 1-2 log10 over a 48-hour period. In addition, all-trans-RA inhibited HSV-1 replication in Vero cells as effectively as interferon beta, reducing viral production by 2.5log10. These studies indicate that lipids and retinoids could be part of a topical microbicide to prevent mucosal infections.

Induced Tritrichomonas foetus infection in beef heifers.

Four virgin beef heifers were inoculated intravaginally with 7 x 10(6) Tritrichomonas foetus organisms. Protozoal colonization of the vagina, cervix, and uterus developed within the first week after inoculation. Protozoa were no longer detected in secretions from these regions at approximately the same time in each heifer. Trichomonads were detected in reproductive tract secretions for 13 to 28 weeks. Eight weeks after clearance of trichomonads from the reproductive tract, a second infection was established in 2 of the 4 heifers by intravaginal inoculation of T foetus. The second infections were maintained for up to 4 weeks. The diagnostic sensitivity of wet-mount examination of the reproductive tract secretions was 30%, compared with 78% for culture of trichomonads in secretions. Collection and culturing of specimens of cervical and vaginal mucus provided the most reliable method for diagnosis of trichomoniasis during induced infection of heifers.

[The microbial etiology of genital discharges in Nouakchott, Mauritania]. / Etiologie microbienne des écoulements génitaux à Nouakchott, Mauritanie.

The survey carried on 579 patients of both sexes, consulting for genital discharges (spontaneous or referred), showed that in 61.1% men cases, STD agents were isolated (Neisseria gonorrhoeae 51.5%) and 64.4% in women cases (Gardnerella vaginalis 24%, Candida albicans 20%. Trichomonas vaginalis 14%). 17% of Neisseria gonorrhoeae strains were penicillinase-producing (PPNG).