Bacterial vaginosis, vulvovaginal candidiasis and trichomonal vaginitis among reproductive-aged women seeking primary healthcare in Sana'a city, Yemen.

BACKGROUND: In Yemen, the underlying causes of infectious vaginitis have been neglected. Therefore, this study aimed to determine the prevalence and risk factors associated with bacterial vaginosis (BV), vulvovaginal candidiasis (VVC) and trichomonal vaginitis (TV) among non-pregnant reproductive-aged women. METHODS: A cross-sectional study was conducted among 347 non-pregnant reproductive-aged women seeking primary healthcare in Sana'a city, Yemen. Data about sociodemographic characteristics, lifestyle-related behaviors, routine hygienic practices, menstrual care and history and type of contraceptive intake were collected using a structured questionnaire. Vaginal discharge samples were collected and examined for discharge characteristics and pH by a gynecologist. Then, samples were examined for BV, VVC and TV. Data were analyzed using suitable statistical tests. RESULTS: Vaginal infections were prevalent among 37.6% of reproductive-aged women, where BV was the most prevalent (27.2%). VVC was significantly higher among symptomatic women and significantly associated with itching (P = 0.005). Using bivariate analysis, the age of < 25 years (odds ratio [OR] = 1.9, 95% confidence interval [CI]: 1.16-3.10; P = 0.010) and using intrauterine contraceptive devices (IUCDs) (OR = 1.8, 95% CI: 1.09-2.89; P = 0.020) were significantly associated with BV, while history of miscarriage was significantly associated with a lower risk of BV (OR = 0.5, 95% CI: 0.31-0.85, P = 0.009). However, polygyny was significantly associated with VVC (OR = 3.4, 95% CI: 1.33-8.66; P = 0.007). Multivariable analysis confirmed that age of < 25 years and using IUCD were the independent predictors of BV, while history of miscarriage was an independent protective factor against BV. On the other hand, marriage to a polygamous husband was the independent predictor of VVC. CONCLUSIONS: More than a third of non-pregnant reproductive-aged women seeking PHC in Sana'a have single or mixed infections with BV, VVC or TV. BV is the most frequent cause of vaginitis and is significantly associated with the age of < 25 years and using IUCDs, while VVC is significantly higher among women with polygamous husbands. Health education of polygamous husbands and their wives, regular monitoring of BV among IUCD users and screening women for vaginitis before treatment are recommended.

Risk of bacterial vaginosis, Trichomonas vaginalis and Candida albicans infection among new users of combined hormonal contraception vs LNG-IUS.

OBJECTIVE: The study assessed the risk of bacterial vaginosis, Trichomonas vaginalis and Candida albicans infection among new users of either a combined oral contraceptive pill (COC) or the levonorgestrel-releasing intrauterine system (LNG-IUS). METHODS: This prospective observational study included 430 women, without active vaginitis at inclusion, who were divided into two groups according to their chosen method of contraception: COC group (n = 236) and LNG-IUS group (n = 194). Participants were examined for bacterial vaginosis, T. vaginalis and C. albicans infection initially and then at 6 weeks, 6 months and 12 months after the start of contraceptive use. Data were collected and statistically analysed. RESULTS: The rates of acquisition of bacterial vaginosis, T. vaginalis and C. albicans infection during follow-up were significantly increased and comparable between the groups (p < .001) and decreased in frequency over time (p < .05). The rates of acquisition of bacterial vaginosis among COC users (Nugent score) were 24.6, 18.6 and 15.2% and among LNG-IUS users 20.6, 13.5 and 9.3% at 6 weeks, 6 months and 12 months, respectively (p < .001). Body mass index >25 kg/m2, history of bacterial vaginosis, history of sexually transmitted infection, vaginal douching more than five times per week and coital frequency more than five times per week were strong risk factors for acquisition of bacterial vaginosis during the follow-up period (p < .001). CONCLUSIONS: The use of COCs and LNG-IUS is associated with an increased, comparable risk of acquisition of bacterial vaginosis, T. vaginalis and C. albicans infections, which is greatest during initial use of the method but which improves over time.

Prevalence and Risk Factors for Infections in a Pregnant Adolescent Population.

STUDY OBJECTIVE: Our objective was to identify risk factors associated with maternal infections and placental inflammation in pregnant adolescents attending an urban adolescent maternity clinic. DESIGN: This cross-sectional, descriptive study used survey and medical chart data collected at entry and prospectively across gestation. The prevalence of maternal infections and placental inflammation was determined and potential risk factors were identified. SETTING: Rochester Adolescent Maternal Program (RAMP) in Rochester, NY. PARTICIPANTS: Racially and ethnically diverse pregnant adolescents (n = 158 ≤ 18 y at entry) were recruited. INTERVENTIONS AND MAIN OUTCOME MEASURES: Main outcome measures were diagnosis of an infection or inflammatory condition in relation to demographic, anthropometric, dietary, socioeconomic, and health data. RESULTS: The three most prevalent infections diagnosed in this study population were recto-vaginal colonization of group B Streptococcus (GBS) (38%), bacterial vaginosis (BV) (40%) and candida (42%). African-American teens (AOR = 4.6; 95% CI: 1.74-13.02) and those with higher pre-pregnancy BMI (ppBMI; AOR = 1.2; 95% CI: 1.04-1.31) were more likely to test positive for BV across gestation. Older maternal age decreased the likelihood of positive tests for trichomoniasis (OR = 0.51; 95% CI: 0.26-0.92) and gonorrhea (OR = 0.38; 95% CI: 0.16-0.82). Higher mean dietary vitamin D intake (mcg/d) was associated with a lower likelihood of testing positive for recto-vaginal GBS (OR = 0.87; 95% CI: 0.77-0.98). CONCLUSION: Addressing modifiable risk factors associated with dietary intake and pre-pregnancy weight may help reduce health disparities among pregnant minority adolescents. Additionally, targeted sexual health education may greatly benefit younger female adolescents.

STI tests and proportion of positive tests in female sex workers attending local public health departments in Germany in 2010/11.

BACKGROUND: In Germany, local public health departments (LPHD) are required to offer low-threshold access to confidential counselling and testing for sexually transmitted infections (STI) for sex workers. We collected data from LPHD in Germany to estimate the number of performed STI tests and the proportion of positive STI tests among attending female sex workers (FSW) in order to formulate recommendations for improving STI testing and care for FSW in Germany. METHODS: We recruited LPHD across Germany to collect aggregated data on attending FSW between January 2010 and March 2011. Baseline characteristics, the number of attending FSW, STI tests (HIV, Chlamydia trachomatis, Neisseria gonorrhoea, syphilis and Trichomonas vaginalis) and the number of positive results were provided by participating LPHD. We described the number of STI tests per FSW visit and the proportion of positive test results, including interquartile range (IQR). We tested whether baseline characteristics of LPHD were associated with the proportion of positive test results. RESULTS: Overall, 28 LPHD from 14 of the 16 federal states reported 9284 FSW visits over the study period, with a median of 188 FSW visits (IQR 45-440) per LPHD. Overall, a median of 77.1% (IQR 60.7-88.0) of visiting FSW received a test for Neisseria gonorrhoea, followed by HIV (66.0%, IQR 47.9-86.8), Chlamydia trachomatis (65.4%, IQR 50.7-83.6) and syphilis (61.6, IQR 48.6-78.6). In total, 22,914 STI tests were performed. The proportion of positive tests was 3.1% (IQR 1.3-4.8), with the highest proportion of positive tests for Chlamydia trachomatis (6.8%, IQR 2.5-10.4), followed by Neisseria gonorrhoea (3.2%, IQR 0.0-5.3), Trichomonas vaginalis (3.0%, IQR 0.0-15.4), syphilis (1.1%, IQR 0.0-1.3) and HIV (0.2%, IQR 0.0-0.4). The proportion of positive tests varied between 0 and 13.9% between LPHD, with a higher variation of proportion of positive tests in LPHD with a smaller number of reported STI tests. CONCLUSIONS: Participating LPHD varied in terms of performed STI tests and FSW visits. The proportion of positive STI tests was low, but varied between LPHD. This variation likely reflects different testing strategies. Existing testing guidelines should be used by all LPHD to ensure high quality care for FSW.

Recurrent vulvovaginitis.

Vulvovaginitis (VV) is one of the most commonly encountered problems by a gynecologist. Many women frequently self-treat with over-the-counter medications, and may present to their health-care provider after a treatment failure. Vulvovaginal candidiasis, bacterial vaginosis, and trichomoniasis may occur as discreet or recurrent episodes, and have been associated with significant treatment cost and morbidity. We present an update on diagnostic capabilities and treatment modalities that address recurrent and refractory episodes of VV.

The role of physical examination in diagnosing common causes of vaginitis: a prospective study.

OBJECTIVE: We evaluated agreement in diagnoses for bacterial vaginosis (BV), Trichomonas vaginalis (TV) and vulvovaginal candidiasis (VVC) between clinicians examining the patient and performing diagnostic tests versus a clinician with access only to the patient's history and diagnostic findings from self-obtained vaginal swabs (SOVS). DESIGN: Women presenting with vaginal discharge to a sexually transmitted infections clinic provided SOVS for evaluation and completed the study and qualitative questionnaires. A clinician then obtained a history and performed speculum and bimanual examinations. Participants' history and diagnostic test results from SOVS were provided to a masked non-examining clinician who rendered independent diagnoses. Overall agreement in diagnoses and κ statistics was calculated. RESULTS: The prevalence of infections among the 197 participants was 63.4% (BV), 19% (TV) and 14% (VVC). The per cent agreement between the examining and non-examining clinician for the diagnoses of BV was 68.5%, 90.9% for TV and 91.9% for VVC. Of the 105 women diagnosed with BV by the examining clinician, 34 (32%) were missed by the non-examining clinician. The non-examining clinician missed 13 (48%) of 27 women and 12 (34%) of 35 women treated for VVC and TV, respectively. Four women who all presented with abdominal pain were diagnosed with pelvic inflammatory disease. CONCLUSIONS: Tests from SOVS and history alone cannot be used to adequately diagnose BV, TV and VVC in women presenting with symptomatic vaginal discharge. Cost benefits from eliminating the speculum examination and using only tests from SOVS may be negated by long-term costs of mistreatment.

Vaginal infections update.

Vaginal symptoms are one of the leading reasons that women visit their health care providers. Women often self-diagnose and may treat themselves inappropriately. This article describes the etiology, risk factors, symptoms, diagnosis, and treatment of the 3 most common vaginal infections: bacterial vaginosis, trichomoniasis, and vulvovaginal candidiasis.

Risk factors for reproductive tract infections among married women in rural areas of Anhui Province, China.

OBJECTIVES: The goal of this study is to identify factors that contribute to reproductive tract infections (RTIs) among women in rural China, including prevalence, influence of sociodemographic characteristics, knowledge, hygienic behaviors and the history of childbearing, menstruation and abortion. STUDY DESIGN: A stratified cluster sample of 53,652 married women in rural Anhui Province of China completed an interviewer-administered standardized questionnaire, and underwent gynecological examination and laboratory investigation. RESULTS: RTIs were relatively common (30,939/58.1%) among our sample of 53,652 married women. The three most frequent RTIs in our samples were endocervicitis, bacterial vaginosis (BV) and trichomoniasis, with prevalences of 41.7%, 12.0% and 4.5%, respectively. Multiple infections were prevalent among our sample. 20.4% (10,854) of our sample had two RTIs and 8.8% (4713) had at least three RTIs. Multivariate analysis showed that women's age, education, occupation, dysmenorrhea, number of deliveries, personal hygiene habit, menstrual cycle, menstruation, abortion, the interval between abortion and sexual intercourse afterwards, RTI knowledge and the frequency of sexual intercourse per month were all related to RTIs in our sample. CONCLUSIONS: Among married women in rural China, the prevalence of RTIs was high, indicating the need for health education.

Beyond douching: use of feminine hygiene products and STI risk among young women.

INTRODUCTION: Use of feminine hygiene products (feminine wipes, sprays, douches, and yeast creams) by adolescent women is common, yet understudied. AIM: We examine the association among these genital hygiene behaviors, condom use, and sexually transmitted infection (STI). MAIN OUTCOME MEASURES: Using the interview as our unit of analysis, we examined associations between genital hygiene behaviors (use of feminine wipes, feminine sprays, douches, or yeast creams), STI risk factors, and infection with Chlamydia trachomatis, Neisseria gonorrhoeae, and Trichomonas vaginalis. METHODS: We recruited 295 adolescent women from primary care clinics as part of a larger longitudinal study of STI among high-risk adolescents. Participants completed face-to-face interviews every 3 months, and provided vaginal swabs for STI testing. Data were analyzed with repeated measures logistic models to control for multiple observations contributed by each participant. RESULTS: Participants reported douching in 25% of interviews, feminine sprays in 29%, feminine wipes in 27%, and yeast creams in 19% of interviews. We observed a co-occurrence of douching, spraying, and wiping. A past STI (6 months or more prior) was associated with increased likelihood of yeast cream use, and a recent STI (3 months prior) was associated with increased likelihood of feminine wipe use. Condom use was modestly associated with increased likelihood of douching. CONCLUSIONS: Young women frequently use feminine hygiene products, and it is important for clinicians to inquire about use as these products may mimic or mask STI. We found no associations between douching and STI, but instead modest associations between hygiene and STI prevention, suggesting motivation for self-care.

[The relation between trichomoniasis and contraceptive methods]. / Dogum kontrol yöntemleri ile trichomonasis arasindaki iliski.

Trichomoniasis is a sexually transmitted disease caused by Trichomonas vaginalis (T. vaginalis) infecting the urogenital system. In this study, the relation between different contraceptive methods used and T. vaginalis infection was investigated. A total of 253 women (aged from 20-48 years) with abnormal vaginal discharges who applied to the Obstetrics and Gynecology outpatient clinic were enrolled in the study. T. vaginalis was diagnosed by microscopic examination of direct and Giemsa stained preparations. In addition, contraceptive methods, such as an intrauterine device (IUD), coitus interruptus (CI), oral contraceptive (OC), condoms, and injection that had been used, were recorded in the patients' questionnaire forms. Of the 253 women, 207 were using one of the contraceptive methods and a total of 22 (8.69%) trichomoniasis cases were observed. T. vaginalis was detected in 13 of 114 IUD users (14.70%), 5 of 34 CI (11.40%) cases, 3 of 31 (9.67%) condom users, 1 of 46 (2.17%) nonusers. There was no relation between women using the method of OC and T. vaginalis infection. T. vaginalis is the cause of vulvovaginitis and women with abnormal vaginal discharges should be investigated for possible trichomoniasis. In this study, detection of a higher rate of T. vaginalis infection in IUD users means that IUD usage might increase the risk of Trichomonas infection.

Risk factors for prevalent and incident Trichomonas vaginalis among women attending three sexually transmitted disease clinics.

GOAL: Trichomonas vaginalis is the most common nonviral sexually transmitted infection in the United States and may be associated with adverse birth outcomes and may also increase susceptibility to or transmissibility of human immunodeficiency virus. The purpose of this analysis is to describe the epidemiology of T. vaginalis in Sexually Transmitted Disease clinics and characterize the risk factors associated with prevalent and incident T. vaginalis within the same population. METHODS: We analyzed data from visits occurring during February 1999-December 2001 from 3 sexually transmitted disease clinics in Newark, NJ; Long Beach, CA; and Denver, CO. Data were analyzed from 1462 women aged 15 to 39 years who were tested by culture at their initial visit for T. vaginalis, and for 1269 women with at least 1 follow-up visit. Risk factors for prevalent infections at baseline and incident infections among treated or previously uninfected women were assessed. RESULTS: At baseline, 13.0% of the women had a prevalent infection; risk factors included the following: older age (> or =20 years), black race, having less than 12 years of education, and having a concurrent chlamydial infection. At follow-up, 4.6% of women had an incident infection; risk factors included the following: older age (35-39 years), black race, having a concurrent chlamydial infection, having had multiple sexual partners in the 3 months before incident infection, and having had T. vaginalis at the visit before their incident infection. CONCLUSIONS: T. vaginalis incidence is high in women. Risk factors for prevalent and incident infection are similar. T. vaginalis was associated with older age in women, unlike other sexually transmitted infections.

Dealing with trichomoniasis.

Trichomoniasis is a common but less well known sexually transmitted infection affecting men and women. In men it is often asymptomatic and goes undetected. In women it can produce a profuse, frothy, unpleasant-smelling vaginal discharge with pruritus and soreness which is sometimes confused with vulvo-vaginal candidiasis (thrush) and bacterial vaginosis. Women often mistakenly treat themselves for thrush with no result. Diagnosis is by laboratory culture and treatment is with metronidazole. Partner notification and treatment should be undertaken. Trichomoniasis often coexists with chlamydia and gonorrhoea. It can have consequences for reproduction, including low birth weight and preterm labour, and has been found to be a co-factor in the transmission of HIV. It is therefore mandatory to ensure prompt and appropriate treatment for all patients diagnosed with trichomoniasis.

A Community-based study of risk factors for Trichomonas vaginalis infection among women and their male partners in Moshi urban district, northern Tanzania.

OBJECTIVE: The objective of this study was to determine predictors of Trichomonas vaginalis among women and their partners in Moshi, Tanzania. STUDY DESIGN: Women (N = 1440) and their partners (N = 588) were interviewed and specimens for detection of T. vaginalis and sexually transmitted infections (STIs) were collected. RESULTS: Prevalence of T. vaginalis was 10.7% in women and 6.3% in men. Having a partner with T. vaginalis was the strongest risk factor in women (adjusted odds ratio [OR], 19.44; 95% confidence interval [CI], 7.84-48.25) and men (adjusted OR, 19.01; 95% CI, 6.8-52.40). Risk of T. vaginalis infection was increased in subjects with less education. Other risk factors in women were daily alcohol consumption, being separated, reporting infertility problems, having a partner who had children with other women, and other STIs; and in men, the risk factor was having no income. T. vaginalis was not associated with HIV-1 in women and men. CONCLUSIONS: Prevention of T. vaginalis and other STIs among couples is a major priority. Reduction of alcohol consumption in women is an important intervention.

Sexually transmitted infections among pregnant women attending an antenatal clinic in Fuzhou, China.

OBJECTIVE: To determine the prevalence of sexually transmitted infections (STIs) among women attending an antenatal clinic in urban China and to show whether reported symptoms and findings on clinical examination predicted STIs in this population. STUDY DESIGN: Cross-sectional descriptive study was conducted among 504 pregnant women attending an antenatal clinic in Fuzhou, China. Structured questionnaires were used to collect demographic and behavioral information, and clinical and gynecologic examinations were performed to detect clinical signs of STIs. Blood samples, vaginal swabs, and cervical swabs were collected, respectively, to test for antibodies to syphilis, culture Trichomonas vaginalis (T. vaginalis), and perform PCR to detect Chlamydia trachomatis (C. trachomatis) and Neisseria gonorrhoeae (N. gonorrhoeae). RESULTS: C trachomatis was detected in 51 (10.1%), N gonorrhoeae in 4 (0.8%), T vaginalis in 16 (3.2%), and syphilis in 1 (0.2%) of the 504 pregnant women. Fifty-two (73%) of 71 women with any STI were asymptomatic. Multiple logistic regression analysis indicated that age RMB 2000 yuan (OR=3.57) were significant independent risk factors for chlamydial infection (P<0.05). The reported symptom of vaginal discharge or the clinical sign of either vaginal or cervical discharge poorly predicted infection with C trachomatis, N gonorrhoeae, or T vaginalis, with a positive predictive value <25% for each STI. CONCLUSION: A substantial prevalence of STIs, including a large proportion of asymptomatic infections, was found among pregnant women in the study area. These results support a strategy of screening pregnant women for bacterial STIs (followed by treatment of infections), which could be integrated into routine pregnancy care in China.

The prevalence of chlamydia, gonorrhea, and trichomonas in sexual partnerships: implications for partner notification and treatment.

BACKGROUND: Treatment of sex partners by patient-delivered partner therapy (PDPT) may prove to be an effective strategy in reducing reinfection and preventing the sequelae of sexually transmitted infections (STIs). However, limited data exists regarding STIs within sexual partnerships (dyads). OBJECTIVE: The objective of this study was to determine the prevalence of Chlamydia trachomatis (CT), Neisseria gonorrhoeae (GC), and Trichomonas vaginalis (TV) in sexual dyads to estimate the potential yield and limitations of PDPT. METHODS: Male and female STI clinic attendees were invited to participate. Index subjects and partners were interviewed and tested for CT, GC, and TV. All partners were sought regardless of infection status of the index subject. RESULTS: Of 210 dyads, the prevalence in index subjects was CT, 46%; GC, 18%; and TV, 14%. Considering the partners of 72 CT-only-infected index subjects, 57% had CT, 6% had GC, and 11% had TV. Considering the partners of 35 index subjects with GC or GC-CT coinfection, 57% had GC and/or CT; however, in 20% of partners, unsuspected TV was present. Among 74 dyads with uninfected index subjects, 26% of partners had an STI. Among the partners of 19 index subjects with TV only, 11% had CT, 5% had GC, and 37% had TV. CONCLUSION: In our clinic population, a substantial number of partners had infections different from or in addition to those infections in the index. Many of these infected partners would not be diagnosed and treated using PDPT. Partners of index attendees without detected infection were at high risk (26%) for STI, mostly CT.

[Analysis on the relative factors of trichomonal vaginitis in married childbearing age women in rural impoverished area].

OBJECTIVE: To investigate the status and relative factors of trichomonal vaginitis among married childbearing age women in rural impoverished area of the northwestern part of China and hence identify the risk factors and provide a basis for the prevention and treatment of trichomonal vaginitis. METHODS: Questionnaire investigation, gynecological and laboratory examination were carried out in 480 women who had been selected by multi-stage cluster sampling in rural impoverished area of Bao Ji in ShannXi province. A case-control study was conducted to analyze the relative factors of trichomonal vaginitis and other reproductive tract infection (RTI) complications. RESULTS: The prevalence rate of trichomonal vaginitis was 12.9%, and 64.5% of the cases were complicated with chronic cervicitis, 17.7% were complicated with adnexitis. Uni-variated and multi-variated logistic regression analyses revealed that lack of reproductive health knowledge, bath with polluted water, washing vulva or penis with polluted water before sexual intercourse, having intercourse during menstrual period, having past history of trichomonal vaginitis, as well as no-income woman's and husband's negative attitude towards wife's RTIs were risk factors of trichomonal vaginitis and complicating chronic cervicitis or adnexitis. And lack of reproductive health knowledge, bath with polluted water, washing penis with polluted water before sexual intercourse, past history of trichomonal vaginitis, husband's negative attitude to wife's RTIs were relative factors of trichomonal vaginitis and complicating chronic cervicitis or adnexitis revealed by the binary logistic regression analysis. The less score of reproductive health knowledge, the more risk of suffering from trichomonal vaginitis complicating chronic cervicitis. CONCLUSION: Compositive and successive prevention and treatment scheme should be used to control trichomonal vaginitis and other RTI complications in rural impoverished area of northwestern China. The scheme should be focused on four ways, including improving sanitation behaviors in couples, insisting on normative treatment, generalizing reproductive health knowledge and mobilizing husbands to pay attention.

Targeted screening for Trichomonas vaginalis with culture using a two-step method in women presenting for STD evaluation.

OBJECTIVES: Trichomonas vaginalis is the most common nonviral sexually transmitted pathogen. Wet mount microscopy performs poorly compared with culture; however, universal screening using culture would be cost-prohibitive. GOAL: The goal of this study was to develop a predictive model for wet mount-negative women who may benefit from targeted use of culture for T. vaginalis detection. STUDY: Women presenting for sexually transmitted disease evaluation were prospectively screened for trichomoniasis using wet mount and culture. Multivariate logistic regression was used to identify predictors of culture-proven trichomoniasis among wet mount-negative women. RESULTS: A total of 2194 women were screened for trichomoniasis; overall, the prevalence of T. vaginalis was 17.5%. Three predictors (any drug use, contact to trichomoniasis, and African-American race) provided the most specific model (100%); any 1 predictor, the most sensitive model (97.8%). CONCLUSIONS: Given the public health impact of trichomoniasis, we recommend using any 1 of 3 predictors to identify women who would benefit from targeted culture for T. vaginalis.

Association of Trichomonas vaginalis with sociodemographic factors and other STDs among female inmates in Lisbon.

A study on STDs was conducted among 211 female inmates in a prison in Lisbon, Portugal, in order to establish possible associations between Trichomonas vaginalis infection, sociodemographic factors and other STDs. T. vaginalis was found in 31.2% of the women, from whom only 65.1% presented symptoms. It was more frequently isolated in the 20-40 year age group. On univariate analysis there was an association, although not statistically significant, between the existence of T. vaginalis, multiple sexual partners, drug addiction and no condom use. A statistically significant association was found between trichomoniasis, prostitution and other STDs. These were found in 87% of all women. T. vaginalis was detected alone in 23.8% (15/63) of all women with trichomoniasis, while 76.2% (48/63) of them had multiple infections with trichomonas and other STDs. A statistically significant association was present between trichomoniasis and Mycoplasma hominis and infection with Treponema pallidum. This study showed that the prevalence of T. vaginalis is as high as that of multiple infections with other STDs. Therefore, our findings seem to confirm that trichomoniasis serves as a marker for other STDs. Screening for STDs should then be offered to Portuguese inmates, or, at least, these women should be screened for T. vaginalis, as a marker for the other STDs.

Predictive value of the clinical diagnosis of lower genital tract infection in women.

OBJECTIVE: We hypothesized that diagnostic approaches to lower genital tract infections are inaccurate and proposed this study to evaluate typical approaches. STUDY DESIGN: Clinical diagnoses were made with symptoms, direct observation, wet mount, vaginal pH, and amines in 598 women with genital complaints. Laboratory testing for N gonorrhoeae, yeast, T vaginalis, C trachomatis, and bacterial vaginosis by Gram stain. RESULTS: The most frequent symptoms were vaginal discharge (64%), change in discharge (53%), malodor (48%), and pruritus (32%). The infection rates were 46% bacterial vaginosis, 29% yeast, 12% trichomoniasis, 11% chlamydia or gonorrhea; 21% of the patients had no infection. The symptoms did not predict laboratory diagnosis. Clinical signs and symptoms with office-based tests and microscopy improved the accuracy of diagnoses. Amsel's clinical diagnosis of bacterial vaginosis was the most sensitive at 92%. The sensitivity of wet mount diagnosis of trichomoniasis was 62%, of yeast by microscopy was 22%, and of mucopus for the prediction of gonorrhea and/or chlamydia was 30%. CONCLUSION: Symptoms alone should not be used to direct treatment in instances in which resources permit more complete evaluation with office-based testing that includes microscopy. Treatment failures or diagnostic uncertainty should prompt specific laboratory testing.

Production of interleukin-8 by human neutrophils stimulated with Trichomonas vaginalis.

Neutrophils are the predominant inflammatory cells found in the vaginal discharges of patients infected with Trichomonas vaginalis. Although chemoattractants, such as leukotriene B(4) and interleukin-8 (IL-8), are found in the vaginal discharges of symptomatic trichomoniasis patients, little is known about the mechanism of how neutrophils accumulate or mediate initial inflammatory response after acute T. vaginalis infection. We examined IL-8 production in neutrophils activated by T. vaginalis and evaluated the factors involved in T. vaginalis adherence that might affect IL-8 production. When human neutrophils were stimulated with live trophozoites, T. vaginalis lysate, or T. vaginalis excretory-secretory products, the live trichomonads induced higher levels of IL-8 production than the lysate or products did. When live trichomonads were pretreated with various inhibitors of proteinase, microtubule, microfilament, or adhesin (which are all known to participate in the adherence of T. vaginalis to vaginal epithelial cells), IL-8 production significantly decreased compared with the untreated controls. Furthermore, an NF-kappaB inhibitor (pyrrolidine dithiocarbamate), a mitogen-activated protein (MAP) kinase (MEK) inhibitor (PD98059), and a p38 MAP kinase inhibitor (SB203580) significantly suppressed IL-8 synthesis in neutrophils. These results suggest that live T. vaginalis, particularly adherent trophozoites, can induce IL-8 production in neutrophils and that this action may be mediated through the NF-kappaB and MAP kinase signaling pathways. In other words, T. vaginalis-induced neutrophil recruitment may be mediated via the IL-8 expressed by neutrophils in response to activation by live T. vaginalis.