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1.
Sex Transm Infect ; 96(5): 342-347, 2020 08.
Artículo en Inglés | MEDLINE | ID: mdl-32241905

RESUMEN

OBJECTIVES: In 2016, WHO estimated 376 million new cases of the four main curable STIs: gonorrhoea, chlamydia, trichomoniasis and syphilis. Further, an estimated 290 million women are infected with human papillomavirus. STIs may lead to severe reproductive health sequelae. Low-income and middle-income countries carry the highest global burden of STIs. A large proportion of urogenital and the vast majority of extragenital non-viral STI cases are asymptomatic. Screening key populations and early and accurate diagnosis are important to provide correct treatment and to control the spread of STIs. This article paints a picture of the state of technology of STI point-of-care testing (POCT) and its implications for health system integration. METHODS: The material for the STI POCT landscape was gathered from publicly available information, published and unpublished reports and prospectuses, and interviews with developers and manufacturers. RESULTS: The development of STI POCT is moving rapidly, and there are much more tests in the pipeline than in 2014, when the first STI POCT landscape analysis was published on the website of WHO. Several of the available tests need to be evaluated independently both in the laboratory and, of particular importance, in different points of care. CONCLUSION: This article reiterates the importance of accurate, rapid and affordable POCT to reach universal health coverage. While highlighting the rapid technical advances in this area, we argue that insufficient attention is being paid to health systems capacity and conditions to ensure the swift and rapid integration of current and future STI POCT. Unless the complexity of health systems, including context, institutions, adoption systems and problem perception, are recognised and mapped, simplistic approaches to policy design and programme implementation will result in poor realisation of intended outcomes and impact.


Asunto(s)
Prestación de Atención de Salud/organización & administración , Pruebas en el Punto de Atención/organización & administración , Enfermedades de Transmisión Sexual/diagnóstico , Infecciones por Chlamydia/diagnóstico , Infecciones por Chlamydia/tratamiento farmacológico , Infecciones por Chlamydia/prevención & control , Infecciones por Chlamydia/transmisión , Femenino , Gonorrea/diagnóstico , Gonorrea/tratamiento farmacológico , Gonorrea/prevención & control , Gonorrea/transmisión , Infecciones por VIH/diagnóstico , Infecciones por VIH/tratamiento farmacológico , Infecciones por VIH/prevención & control , Infecciones por VIH/transmisión , Humanos , Ciencia de la Implementación , Masculino , Infecciones por Mycoplasma/diagnóstico , Infecciones por Mycoplasma/tratamiento farmacológico , Infecciones por Mycoplasma/prevención & control , Infecciones por Mycoplasma/transmisión , Mycoplasma genitalium , Infecciones por Papillomavirus/diagnóstico , Infecciones por Papillomavirus/prevención & control , Infecciones por Papillomavirus/transmisión , Enfermedades de Transmisión Sexual/tratamiento farmacológico , Enfermedades de Transmisión Sexual/prevención & control , Enfermedades de Transmisión Sexual/transmisión , Sífilis/diagnóstico , Sífilis/tratamiento farmacológico , Sífilis/prevención & control , Sífilis/transmisión , Vaginitis por Trichomonas/diagnóstico , Vaginitis por Trichomonas/tratamiento farmacológico , Vaginitis por Trichomonas/prevención & control , Vaginitis por Trichomonas/transmisión
2.
Int J STD AIDS ; 31(3): 221-229, 2020 03.
Artículo en Inglés | MEDLINE | ID: mdl-31996095
4.
Int J Parasitol ; 49(9): 697-704, 2019 08.
Artículo en Inglés | MEDLINE | ID: mdl-31254529

RESUMEN

Trichomonas vaginalis is a primary urogenital parasite that causes trichomoniasis, a common sexually transmitted disease. As the first line of host defense, vaginal epithelial cells play critical roles in orchestrating vaginal innate immunity and modulate intracellular Cl- homeostasis via the cystic fibrosis transmembrane conductance regulator (CFTR), an anion channel that plays positive roles in regulating nuclear factor-κB (NF-κB) signalling. However, the association between T. vaginalis infection and intracellular Cl- disequilibrium remains elusive. This study showed that after T. vaginalis infection, CFTR was markedly down-regulated by cysteine proteases in vaginal epithelial cells. The intracellular Cl- concentration ([Cl-]i) was consequently elevated, leading to NF-κB signalling activation via serum- and glucocorticoid-inducible kinase-1. Moreover, heightened [Cl-]i and activated NF-κB signalling could be sustained in a positive feedback regulatory manner resulting from decreased intracellular cAMP through NF-κB-mediated up-regulation of phosphodiesterase 4. The results conclusively revealed that the intracellular Cl- of the human vaginal epithelium could be dynamically modulated by T. vaginalis, which contributed to mediation of epithelial inflammation in the human vagina.


Asunto(s)
Cloruros/metabolismo , Vaginitis por Trichomonas/prevención & control , Trichomonas vaginalis/efectos de los fármacos , Vagina/patología , Western Blotting , Línea Celular , Fosfodiesterasas de Nucleótidos Cíclicos Tipo 4/metabolismo , Proteasas de Cisteína/metabolismo , Regulador de Conductancia de Transmembrana de Fibrosis Quística/metabolismo , Regulación hacia Abajo , Ensayo de Inmunoadsorción Enzimática , Epitelio/metabolismo , Epitelio/parasitología , Epitelio/patología , Femenino , Humanos , Proteínas Inmediatas-Precoces/metabolismo , FN-kappa B/metabolismo , Proteínas Serina-Treonina Quinasas/metabolismo , Reacción en Cadena en Tiempo Real de la Polimerasa , Vaginitis por Trichomonas/parasitología , Vagina/metabolismo , Vagina/parasitología
5.
Nurs Clin North Am ; 53(2): 189-202, 2018 06.
Artículo en Inglés | MEDLINE | ID: mdl-29779513

RESUMEN

The spread of sexually transmitted infections (STIs) remains a significant public health issue in the United States. Social, economic, and behavioral implications affecting the spread of STIs have been identified. The most important social factor in the United States is the stigma associated with discussing sex and STI screening. In this article, specific recommendations for women are included regarding screening, diagnosing, and treating common vaginal and cervical infections. Screening women for infections of the vagina and cervix is essential because untreated infections may result in complications that have current and long-term health consequences and impact quality of life.


Asunto(s)
Enfermedades de Transmisión Sexual/prevención & control , Femenino , Humanos , Infecciones por Papillomavirus/enfermería , Infecciones por Papillomavirus/prevención & control , Enfermedades de Transmisión Sexual/enfermería , Vaginitis por Trichomonas/enfermería , Vaginitis por Trichomonas/prevención & control , Vaginosis Bacteriana/enfermería , Vaginosis Bacteriana/prevención & control , Servicios de Salud para Mujeres
7.
Sex Transm Infect ; 93(S4): S69-S80, 2017 12.
Artículo en Inglés | MEDLINE | ID: mdl-29223965

RESUMEN

OBJECTIVES: Advancing the field of point-of-care testing (POCT) for STIs can rapidly and substantially improve STI control and prevention by providing targeted, essential STI services (case detection and screening). POCT enables definitive diagnosis and appropriate treatment in a single visit and home and community-based testing. METHODS: Since 2014, the WHO Department of Reproductive Health and Research, in collaboration with technical partners, has completed four landscape analyses of promising diagnostics for use at or near the point of patient care to detect syphilis, Neisseria gonorrhoeae, Chlamydia trachomatis, Trichomonas vaginalis and the human papillomavirus. The analyses comprised a literature review and interviews. Two International Technical Consultations on STI POCTs (2014 and 2015) resulted in the development of target product profiles (TPP). Experts in STI microbiology, laboratory diagnostics, clinical management, public health and epidemiology participated in the consultations with representation from all WHO regions. RESULTS: The landscape analysis identified diagnostic tests that are either available on the market, to be released in the near future or in the pipeline. The TPPs specify 28 analytical and operational characteristics of POCTs for use in different populations for surveillance, screening and case management. None of the tests that were identified in the landscape analysis met all of the targets of the TPPs. CONCLUSION: More efforts of the global health community are needed to accelerate access to affordable quality-assured STI POCTs, particularly in low- and middle-income countries, by supporting the development of new diagnostic platforms as well as strengthening the validation and implementation of existing diagnostics according to internationally endorsed standards and the best available evidence.


Asunto(s)
Infecciones por Chlamydia/diagnóstico , Gonorrea/diagnóstico , Infecciones por Papillomavirus/diagnóstico , Pruebas en el Punto de Atención/tendencias , Salud Pública , Salud Reproductiva , Sífilis/diagnóstico , Vaginitis por Trichomonas/diagnóstico , Adulto , Infecciones por Chlamydia/prevención & control , Pruebas Diagnósticas de Rutina , Femenino , Gonorrea/prevención & control , Humanos , Masculino , Infecciones por Papillomavirus/prevención & control , Reproducibilidad de los Resultados , Sífilis/prevención & control , Vaginitis por Trichomonas/prevención & control
8.
Sex Transm Infect ; 93(7): 520-529, 2017 11.
Artículo en Inglés | MEDLINE | ID: mdl-28377421

RESUMEN

OBJECTIVES: Trichomonas vaginalis is the most prevalent curable STI worldwide and has been associated with adverse health outcomes and increased HIV-1 transmission risk. We conducted a cross-sectional analysis among couples to assess how characteristics of both individuals in sexual partnerships are associated with the prevalence of male and female T. vaginalis infection. METHODS: African HIV-1 serodiscordant heterosexual couples were concurrently tested for trichomoniasis at enrolment into two clinical trials. T. vaginalis testing was by nucleic acid amplification or culture methods. Using Poisson regression with robust standard errors, we identified characteristics associated with trichomoniasis. RESULTS: Among 7531 couples tested for trichomoniasis, 981 (13%) couples contained at least one infected partner. The prevalence was 11% (n=857) among women and 4% (n=319) among men, and most infected individuals did not experience signs or symptoms of T. vaginalis. Exploring concordance of T. vaginalis status within sexual partnerships, we observed that 61% (195/319) of T. vaginalis-positive men and 23% (195/857) of T. vaginalis-positive women had a concurrently infected partner. In multivariable analysis, having a T. vaginalis-positive partner was the strongest predictor of infection for women (relative risk (RR) 4.70, 95% CI 4.10 to 5.38) and men (RR 10.09, 95% CI 7.92 to 12.85). For women, having outside sex partners, gonorrhoea, and intermediate or high Nugent scores for bacterial vaginosis were associated with increased risk of trichomoniasis, whereas age 45 years and above, being married, having children and injectable contraceptive use were associated with reduced trichomoniasis risk. Additionally, women whose male partners were circumcised, had more education or earned income had lower risk of trichomoniasis. CONCLUSIONS: We found that within African HIV-1 serodiscordant heterosexual couples, the prevalence of trichomoniasis was high among partners of T. vaginalis-infected individuals, suggesting that partner services could play an important role identifying additional cases and preventing reinfection. Our results also suggest that male circumcision may reduce the risk of male-to-female T. vaginalis transmission.


Asunto(s)
Infecciones por VIH/epidemiología , Seronegatividad para VIH , Seropositividad para VIH , Heterosexualidad/estadística & datos numéricos , Vaginitis por Trichomonas/epidemiología , Trichomonas vaginalis/aislamiento & purificación , Adulto , Circuncisión Masculina , Estudios Transversales , ADN Protozoario , Femenino , Infecciones por VIH/prevención & control , VIH-1 , Humanos , Masculino , Persona de Mediana Edad , Embarazo , Complicaciones Infecciosas del Embarazo/epidemiología , Complicaciones Infecciosas del Embarazo/prevención & control , Prevalencia , Estudios Prospectivos , Factores de Riesgo , Conducta Sexual , Parejas Sexuales , Vaginitis por Trichomonas/diagnóstico , Vaginitis por Trichomonas/prevención & control , Vaginitis por Trichomonas/transmisión , Trichomonas vaginalis/genética
9.
Nurs N Z ; 23(4): 20-24, 2017 May.
Artículo en Inglés | MEDLINE | ID: mdl-30549796

Asunto(s)
Enfermedades de Transmisión Sexual/enfermería , Infecciones por Chlamydia/diagnóstico , Infecciones por Chlamydia/epidemiología , Infecciones por Chlamydia/enfermería , Infecciones por Chlamydia/prevención & control , Femenino , Gonorrea/diagnóstico , Gonorrea/epidemiología , Gonorrea/enfermería , Gonorrea/prevención & control , Infecciones por VIH/diagnóstico , Infecciones por VIH/epidemiología , Infecciones por VIH/enfermería , Infecciones por VIH/prevención & control , Herpes Genital/diagnóstico , Herpes Genital/epidemiología , Herpes Genital/enfermería , Herpes Genital/prevención & control , Humanos , Transmisión Vertical de Enfermedad Infecciosa , Masculino , Infecciones por Mycoplasma/diagnóstico , Infecciones por Mycoplasma/epidemiología , Infecciones por Mycoplasma/enfermería , Infecciones por Mycoplasma/prevención & control , Mycoplasma genitalium , Nueva Zelanda/epidemiología , Factores de Riesgo , Enfermedades de Transmisión Sexual/diagnóstico , Enfermedades de Transmisión Sexual/epidemiología , Enfermedades de Transmisión Sexual/prevención & control , Sífilis/diagnóstico , Sífilis/epidemiología , Sífilis/enfermería , Sífilis/prevención & control , Vaginitis por Trichomonas/diagnóstico , Vaginitis por Trichomonas/epidemiología , Vaginitis por Trichomonas/enfermería , Vaginitis por Trichomonas/prevención & control , Uretritis/diagnóstico , Uretritis/epidemiología , Uretritis/enfermería , Uretritis/prevención & control
10.
BMJ Open ; 6(10): e013997, 2016 10 13.
Artículo en Inglés | MEDLINE | ID: mdl-27737887

RESUMEN

OBJECTIVES: In this cross-sectional epidemiological study we aimed to identify molecular profiles for Trichomonas vaginalis and to determine how these molecular profiles were related to patient demographic and clinical characteristics. SETTING: Molecular typing methods previously identified two genetically distinct subpopulations for T. vaginalis; however, few molecular epidemiological studies have been performed. We now increased the sensitivity of a previously described multilocus sequence typing (MLST) tool for T. vaginalis by using nested PCR. This enabled the typing of direct patient samples. PARTICIPANTS: From January to December 2014, we collected all T. vaginalis positive samples as detected by routine laboratory testing. Samples from patients either came from general practitioners offices or from the sexually transmitted infections (STI) clinic in Amsterdam. Epidemiological data for the STI clinic patients were retrieved from electronic patient files. PRIMARY AND SECONDARY OUTCOME MEASURES: The primary outcome was the success rate of genotyping direct T. vaginalis positive samples. The secondary outcome was the relation between T. vaginalis genotypes and risk factors for STI. RESULTS: All 7 MLST loci were successfully typed for 71/87 clinical samples. The 71 typed samples came from 69 patients, the majority of whom were women (n=62; 90%) and half (n=34; 49%) were STI clinic patients. Samples segregated into a two population structure for T. vaginalis representing genotypes I and II. Genotype I was most common (n=40; 59.7%). STI clinic patients infected with genotype II reported more sexual partners in the preceding 6 months than patients infected with genotype I (p=0.028). No other associations for gender, age, ethnicity, urogenital discharge or co-occurring STIs with T. vaginalis genotype were found. CONCLUSIONS: MLST with nested PCR is a sensitive typing method that allows typing of direct (uncultured) patient material. Genotype II is possibly more prevalent in high-risk sexual networks.


Asunto(s)
Tipificación de Secuencias Multilocus , Vaginitis por Trichomonas/microbiología , Trichomonas vaginalis/clasificación , Trichomonas vaginalis/genética , Adulto , Estudios Transversales , Femenino , Genotipo , Humanos , Masculino , Persona de Mediana Edad , Tipificación de Secuencias Multilocus/métodos , Países Bajos/epidemiología , Filogenia , Reacción en Cadena de la Polimerasa , Prevalencia , Conducta Sexual , Parejas Sexuales , Enfermedades de Transmisión Sexual/epidemiología , Enfermedades de Transmisión Sexual/microbiología , Enfermedades de Transmisión Sexual/prevención & control , Vaginitis por Trichomonas/epidemiología , Vaginitis por Trichomonas/prevención & control , Trichomonas vaginalis/aislamiento & purificación , Adulto Joven
11.
Sex Transm Infect ; 92(4): 305-8, 2016 06.
Artículo en Inglés | MEDLINE | ID: mdl-26347544

RESUMEN

OBJECTIVE: The social context of poverty is consistently linked to Trichomonas vaginalis infection, yet few studies regarding T. vaginalis have been conducted exclusively among low-income individuals. We identified social determinants of health associated with prevalent T. vaginalis infection among homeless and unstably housed adult women. METHODS: Between April and October of 2010, we conducted cross-sectional T. vaginalis screening and behavioural interviews in an existing cohort of San Francisco homeless and unstably housed women. Data were analysed using multivariable logistical regression. RESULTS: Among 245 study participants, the median age was 47 years and 72% were of non-Caucasian race/ethnicity. T. vaginalis prevalence was 12%, compared to 3% in the general population, and 33% of infected individuals reported no gynaecological symptoms. In adjusted analysis, the odds of T. vaginalis infection were lower among persons older than 47 years, the population median (OR=0.14, 95% CI 0.04 to 0.38), and higher among those reporting recent short-term homeless shelter stays (OR=5.36, 95% CI 1.57 to 18.26). Race and income did not reach levels of significance. Sensitivity analyses indicated that testing all women who report recent unprotected sex would identify more infections than testing those who report gynaecological symptoms (20/30 vs 10/30; p=0.01). CONCLUSIONS: The prevalence of T. vaginalis is high among homeless and unstably housed adult women, over one-third of infected individuals have no gynaecological symptoms, and correlates of infection differ from those reported in the general population. Targeted screening and treatment among impoverished women reporting recent unprotected sex, particularly young impoverished women and all women experiencing short-term homelessness, may reduce complications related to this treatable infection.


Asunto(s)
Personas sin Hogar/estadística & datos numéricos , Vivienda/estadística & datos numéricos , Factores Socioeconómicos , Vaginitis por Trichomonas/epidemiología , Vaginitis por Trichomonas/microbiología , Trichomonas vaginalis/aislamiento & purificación , Salud Urbana , Salud de la Mujer/estadística & datos numéricos , Adulto , Estudios Transversales , Femenino , Humanos , Persona de Mediana Edad , Pobreza/estadística & datos numéricos , Prevalencia , Factores de Riesgo , San Francisco/epidemiología , Conducta Sexual/estadística & datos numéricos , Vaginitis por Trichomonas/diagnóstico , Vaginitis por Trichomonas/prevención & control , Frotis Vaginal , Servicios de Salud para Mujeres , Adulto Joven
12.
Sex Transm Infect ; 92(1): 58-62, 2016 Feb.
Artículo en Inglés | MEDLINE | ID: mdl-26071390

RESUMEN

OBJECTIVES: Trichomoniasis (TV) is associated with an increased risk of acquisition of sexually transmitted diseases (STDs) and HIV. The purpose of this study is to evaluate factors associated with incidence TV among female STD clinic attendees in the USA. METHODS: Data were collected from women participating in a randomised controlled trial evaluating brief risk reduction counselling at the time of HIV testing to reduce sexually transmitted infections (STIs) incidence in STD clinics. Participants recruited from STD clinics underwent STI testing at baseline and 6-month follow-up. TV testing was performed using Nucleic Acid Amplification Test. RESULTS: 1704 participants completed study assessments. Prevalence of TV was 14.6%, chlamydia 8.6%, gonorrhoea 3.0%, herpes simplex virus 2 44.7% and HIV 0.4%. Cumulative 6-month incidence of TV was 7.5%. Almost 50% of the incident TV cases had TV at baseline and had received treatment. Factors associated with incidence of TV were having chlamydia, TV and HIV at baseline: TV relative risk (RR)=3.37 (95% CI 2.35 to 4.83, p<0.001); chlamydia RR=1.92 (95% CI 1.23 to 2.99, p=0.04); and HIV=1.59 (95% CI 1.01 to 2.50, p=0.047). CONCLUSIONS: Prevalent and incident TV is common among STD clinic attendees; and baseline TV is the main risk factor for incident TV, suggesting high rates of reinfection or treatment failures. This supports the importance of rescreening women after treatment for TV, evaluating current treatment regimens and programmes to ensure treatment of sexual partners. CLINICAL TRIAL NUMBER: NCT01154296.


Asunto(s)
Consejo Dirigido , Parejas Sexuales , Vaginitis por Trichomonas/epidemiología , Trichomonas vaginalis/aislamiento & purificación , Adulto , Consejo Dirigido/métodos , Femenino , Humanos , Prevalencia , Factores de Riesgo , Conducta de Reducción del Riesgo , Vaginitis por Trichomonas/prevención & control , Vaginitis por Trichomonas/psicología , Estados Unidos/epidemiología
13.
Tunis Med ; 93(6): 376-80, 2015 Jun.
Artículo en Francés | MEDLINE | ID: mdl-26644101

RESUMEN

BACKGROUND: Trichomonas vaginalis infection is the most prevalent nonviral sexual transmitted infection. The World Health Organization estimates that its prevalence is 170 million cases worldwide each year. In women, he represents the third cause of vaginitis. AIM: to determine the prevalence, to evaluate predisposing factors and to study the clinical and parasitological characteristics of vulvovaginal trichomoniasis in a Tunisian population during a period of 18 months. METHODS: This is a transversal study concerning 924 women. We administered a questionnaire to obtain information about the possible risk factors of vulvovaginal trichomoniasis. Vaginal swabs were collected with the help of sterile transportable cotton swabs, followed by microscopic examination. Data were statistically analyzed. RESULTS: Trichomonas vaginalis infection was diagnosed in 3,5% of cases. The study various potential risk factors showed that trichomoniasis was significatively associated with multiple partners, long-term corticotherapy. However, the pregnancy was a protector factor. CONCLUSION: The research for factors allows not only to explain the appearance of this infection but also, and especially, to establish a disease prevention to avoid their second offense or, at best their arisen in women at risk.


Asunto(s)
Vaginitis por Trichomonas/diagnóstico , Vaginitis por Trichomonas/epidemiología , Trichomonas vaginalis/aislamiento & purificación , Adulto , Animales , Estudios Transversales , Femenino , Hospitales Universitarios , Humanos , Persona de Mediana Edad , Prevalencia , Factores de Riesgo , Conducta Sexual , Encuestas y Cuestionarios , Vaginitis por Trichomonas/parasitología , Vaginitis por Trichomonas/prevención & control , Túnez/epidemiología , Frotis Vaginal
14.
Trends Microbiol ; 23(7): 429-436, 2015 Jul.
Artículo en Inglés | MEDLINE | ID: mdl-25759332

RESUMEN

Every day, more than 1 million people are newly infected with sexually transmitted infections (STIs) that can lead to morbidity, mortality, and an increased risk of human immunodeficiency virus (HIV) acquisition. Existing prevention and management strategies, including behavior change, condom promotion, and therapy have not reduced the global incidence and prevalence, pointing to the need for novel innovative strategies. This review summarizes important issues raised during a satellite session at the first HIV Research for Prevention (R4P) conference, held in Cape Town, on October 31, 2014. We explore key STIs that are challenging public health today, new biomedical prevention approaches including multipurpose prevention technologies (MPTs), and the scientific and regulatory hurdles that must be overcome to make combination prevention tools a reality.


Asunto(s)
Anticoncepción , Infecciones por VIH/prevención & control , Complicaciones Infecciosas del Embarazo/prevención & control , Embarazo no Planeado , Enfermedades de Transmisión Sexual/prevención & control , Femenino , Infecciones por VIH/epidemiología , Infecciones por VIH/transmisión , Herpes Genital/epidemiología , Herpes Genital/prevención & control , Humanos , Infecciones por Papillomavirus/epidemiología , Infecciones por Papillomavirus/prevención & control , Embarazo , Complicaciones Infecciosas del Embarazo/epidemiología , Prevalencia , Enfermedades de Transmisión Sexual/epidemiología , Enfermedades de Transmisión Sexual/transmisión , Sudáfrica/epidemiología , Vaginitis por Trichomonas/tratamiento farmacológico , Vaginitis por Trichomonas/epidemiología , Vaginitis por Trichomonas/prevención & control
15.
J Infect Dis ; 212(2): 285-93, 2015 Jul 15.
Artículo en Inglés | MEDLINE | ID: mdl-25616405

RESUMEN

BACKGROUND: Complications related to the diagnosis and treatment of Trichomonas vaginalis infection, as well as the association between T. vaginalis infection and increased transmission of and susceptibility to human immunodeficiency virus, highlight the need for alternative interventions. We tested a human-safe, aluminum hydroxide-adjuvanted whole-cell T. vaginalis vaccine for efficacy in a BALB/c mouse model of vaginal infection. METHODS: A whole-cell T. vaginalis vaccine was administered subcutaneously to BALB/c mice, using a prime-boost vaccination schedule. CD4(+) T-cell infiltration in the murine vaginal tissue and local and systemic levels of immunoglobulins were measured at time points up to 4 weeks following infection. RESULTS: Vaccination reduced the incidence and increased the clearance of T. vaginalis infection and induced both systemic and local humoral immune responses. CD4(+) T cells were detected in vaginal tissues following intravaginal infection with T. vaginalis but were not seen in uninfected mice. The presence of CD4(+) T cells following T. vaginalis infection can potentially increase susceptibility to and transmission of human immunodeficiency virus. CONCLUSIONS: The vaccine induces local and systemic immune responses and confers significantly greater protection against vaginal infection than seen in unvaccinated mice (P < .005). These data support the potential for a human vaccine against T. vaginalis infection that could also influence the incidence of human immunodeficiency virus infection.


Asunto(s)
Linfocitos T CD4-Positivos/inmunología , Infecciones por VIH/transmisión , Vaginitis por Trichomonas/prevención & control , Trichomonas vaginalis/inmunología , Animales , Anticuerpos Antiprotozoarios/metabolismo , Movimiento Celular , Femenino , Infecciones por VIH/prevención & control , Humanos , Ratones Endogámicos BALB C , Vacunas Antiprotozoos/administración & dosificación , Vaginitis por Trichomonas/inmunología , Vaginitis por Trichomonas/metabolismo , Vacunación , Vagina/inmunología , Vagina/metabolismo , Vagina/parasitología
16.
Curr Opin Infect Dis ; 28(1): 72-9, 2015 Feb.
Artículo en Inglés | MEDLINE | ID: mdl-25485651

RESUMEN

PURPOSE OF REVIEW: To integrate a selection of the most recent data on Trichomonas vaginalis origins, molecular cell biology and T. vaginalis interactions with the urogenital tract microbiota with trichomoniasis symptoms and clinical management. RECENT FINDINGS: Transcriptomics and proteomics datasets are accumulating, facilitating the identification and prioritization of key target genes to study T. vaginalis pathobiology. Proteins involved in host sensing and cytoskeletal plasticity during T. vaginalis amoeboid transformation were identified. T. vaginalis was shown to secrete exosomes and a macrophage migration inhibitory factor-like protein that both influence host-parasite interactions. T. vaginalis co-infections with Mycoplasma species and viruses were shown to modulate the inflammatory responses, whereas T. vaginalis interactions with various Lactobacillus species inhibit parasite interactions with human cells. T. vaginalis infections were also shown to be associated with bacterial vaginosis. A broader range of health sequelae is also becoming apparent. Diagnostics for both women and men based on the molecular approaches are being refined, in particular for men. SUMMARY: New developments in the molecular and cellular basis of T. vaginalis pathobiology combined with data on the urogenital tract microbiota and immunology have enriched our knowledge on human-microbe interactions that will contribute to increasing our capacity to prevent and treat T. vaginalis and other sexually transmitted infections.


Asunto(s)
Antiprotozoarios/administración & dosificación , Lactobacillus plantarum/fisiología , Metronidazol/administración & dosificación , Vaginitis por Trichomonas/microbiología , Trichomonas vaginalis/aislamiento & purificación , Uretra/microbiología , Vagina/microbiología , Vacunas Bacterianas/inmunología , Coinfección , ADN Bacteriano , ADN Protozoario , Femenino , Interacciones Huésped-Parásitos , Humanos , Interacciones Microbianas , Técnicas de Diagnóstico Molecular , Filogenia , Prevalencia , ARN Bacteriano , Vaginitis por Trichomonas/inmunología , Vaginitis por Trichomonas/prevención & control , Trichomonas vaginalis/fisiología , Uretra/inmunología , Vagina/inmunología
17.
J Infect Dis ; 211(12): 1875-82, 2015 Jun 15.
Artículo en Inglés | MEDLINE | ID: mdl-25526757

RESUMEN

BACKGROUND: Vaginal infections are common, frequently recur, and may increase women's risk for sexually transmitted infections (STIs). We tested the efficacy of a novel regimen to prevent recurrent vaginal infections. METHODS: Human immunodeficiency virus (HIV)-negative women 18-45 years old with 1 or more vaginal infections, including bacterial vaginosis (BV), vulvovaginal candidiasis (VVC), or Trichomonas vaginalis (TV), were randomly assigned to receive vaginal suppositories containing metronidazole 750 mg plus miconazole 200 mg or matching placebo for 5 consecutive nights each month for 12 months. Primary endpoints, evaluated every 2 months, were BV (Gram stain) and VVC (positive wet mount and culture). RESULTS: Participants (N = 234) were randomly assigned to the intervention (N = 118) or placebo (N = 116) arm. Two hundred seventeen (93%) women completed an end-of-study evaluation. The intervention reduced the proportion of visits with BV compared to placebo (21.2% vs 32.5%; relative risk [RR] 0.65, 95% confidence interval [CI] .48-.87). In contrast, the proportion of visits with VVC was similar in the intervention (10.4%) versus placebo (11.3%) arms (RR 0.92, 95% CI .62-1.37). CONCLUSIONS: Monthly treatment with intravaginal metronidazole plus miconazole reduced the proportion of visits with BV during 12 months of follow-up. Further study will be important to determine whether this intervention can reduce women's risk of STIs.


Asunto(s)
Antiinfecciosos/administración & dosificación , Candidiasis Vulvovaginal/prevención & control , Metronidazol/administración & dosificación , Miconazol/administración & dosificación , Profilaxis Pre-Exposición/métodos , Vaginitis por Trichomonas/prevención & control , Vaginosis Bacteriana/prevención & control , Adolescente , Adulto , Quimioprevención/métodos , Femenino , Humanos , Persona de Mediana Edad , Placebos/administración & dosificación , Resultado del Tratamiento , Adulto Joven
19.
Sex Transm Infect ; 90(5): 363-9, 2014 Aug.
Artículo en Inglés | MEDLINE | ID: mdl-24898857

RESUMEN

OBJECTIVES: To estimate the effectiveness of candidate microbicides BufferGel and 0.5% PRO 2000 Gel (P) (PRO 2000) for prevention of non-ulcerative sexually transmitted infections (STIs). METHODS: Between 2005 and 2007, 3099 women were enrolled in HIV Prevention Trials Network (HPTN) protocol 035, a phase II/IIb evaluation of the safety and effectiveness of BufferGel and PRO 2000 for prevention of STIs, including Neisseria gonorrhoeae (NG), Chlamydia trachomatis (CT) and Trichomonas vaginalis (TV). Incidences of STIs were determined by study arm, and HRs of BufferGel and PRO 2000 versus placebo gel or no gel control groups were computed using discrete time Andersen-Gill proportional hazards model. RESULTS: The overall incidence rates were 1.6/100 person-years at risk (PYAR) for NG, 3.9/100 PYAR for CT and 15.3/100 PYAR for TV. For BufferGel versus placebo gel, HRs were 0.99 (95% CI 0.49 to 2.00), 1.00 (95% CI 0.64 to 1.57) and 0.95 (95% CI 0.71 to 1.25) for prevention of NG, CT and TV, respectively. For PRO 2000, HRs were 1.66 (95% CI 0.90 to 3.06), 1.16 (95% CI 0.76 to 1.79) and 1.18 (95% CI 0.90 to 1.53) for prevention of NG, CT and TV, respectively. CONCLUSIONS: The incidence of STIs was high during HIV Prevention Trials Network 035 despite provision of free condoms and comprehensive risk-reduction counselling, highlighting the need for effective STI prevention programmes in this population. Unfortunately, candidate microbicides BufferGel and PRO2000 had no protective effect against gonorrhoea, chlamydia or trichomoniasis. TRIAL REGISTRATION NUMBER: NCT00074425.


Asunto(s)
Resinas Acrílicas/administración & dosificación , Antiinfecciosos/administración & dosificación , Infecciones por Chlamydia/prevención & control , Gonorrea/prevención & control , Infecciones por VIH/prevención & control , Naftalenosulfonatos/administración & dosificación , Polímeros/administración & dosificación , Vaginitis por Trichomonas/prevención & control , Administración Tópica , Adulto , Infecciones por Chlamydia/tratamiento farmacológico , Condones/estadística & datos numéricos , Consejo Dirigido/métodos , Femenino , Gonorrea/tratamiento farmacológico , Infecciones por VIH/tratamiento farmacológico , Promoción de la Salud , Humanos , Malaui , Conducta de Reducción del Riesgo , Conducta Sexual , Sudáfrica , Resultado del Tratamiento , Vaginitis por Trichomonas/tratamiento farmacológico , Estados Unidos , Vagina , Zambia , Zimbabwe
20.
Sex Transm Dis ; 41(6): 369-76, 2014 Jun.
Artículo en Inglés | MEDLINE | ID: mdl-24825333

RESUMEN

Trichomonas vaginalis is the most common curable sexually transmissible infection worldwide, with high rates in women of reproductive age. There have been inconsistent findings about the impact of infection and its treatment in pregnancy. We conducted a meta-analysis to determine the association between T. vaginalis and perinatal outcomes. Electronic databases were searched to May 2013. Included studies reported perinatal outcomes in women infected and uninfected with T. vaginalis. Meta-analysis calculated a pooled relative risk (RR) and 95% confidence interval (CI) using either a fixed- or random-effects model. Study bias was assessed using funnel plots. Of 178 articles identified, 11 studies met the inclusion criteria. The study populations, outcomes, and quality varied. T. vaginalis in pregnancy was associated with an increased risk of preterm birth (RR, 1.42; 95% CI, 1.15-1.75; 9 studies; n = 81,101; I = 62.7%), preterm premature rupture of membranes (RR, 1.41; 95% CI,1.10-1.82; 2 studies; n = 14,843; I = 0.0%) and small for gestational age infants (RR, 1.51; 95% CI,1.32-1.73; 2 studies; n = 14,843; I = 0.0%). Sensitivity analyses of studies that accounted for coinfection with other sexually transmissible infection found a slightly reduced RR of 1.34 for preterm birth (95% CI, 1.19-1.51; 6 studies; n = 72,077; I = 11.2%), and in studies where no treatment was confirmed, the RR was 1.83 (95% CI, 0.98-3.41; 3 studies; n = 1795; I = 22.3%). Our review provides strong evidence that T. vaginalis in pregnancy is associated with an increased risk of preterm birth. Based on fewer studies, there were also substantial increases in the risk of preterm premature rupture of membranes and small for gestational age infants. Further studies that address the current gaps in evidence on treatment effects in pregnancy are needed.


Asunto(s)
Rotura Prematura de Membranas Fetales/etiología , Complicaciones Infecciosas del Embarazo/etiología , Nacimiento Prematuro/etiología , Vaginitis por Trichomonas/complicaciones , Trichomonas vaginalis/patogenicidad , Adulto , Femenino , Humanos , Recién Nacido , Recién Nacido Pequeño para la Edad Gestacional , Embarazo , Complicaciones Infecciosas del Embarazo/prevención & control , Riesgo , Vaginitis por Trichomonas/prevención & control
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