Clinical evidence for the role of Trichomonas vaginalis in regulation of secretory leukocyte protease inhibitor in the female genital tract

Division of Gynecology, Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio, USA.
The Journal of Infectious Diseases (Impact Factor: 5.78). 01/2013; 207. DOI: 10.1093/infdis/jit039
Source: PubMed

ABSTRACT Background. The secretory leukocyte protease inhibitor (SLPI) is responsible for regulating inflammatory damage and innate and adaptive immune responses of the vaginal mucosa. Depressed cervicovaginal SLPI levels have been correlated with both Trichomonas vaginalis (TV) and poor reproductive health outcomes.Methods. We measured levels of SLPI in 215 vaginal specimens collected from adolescent women ages 14-22. Log-transformed SLPI values were compared by ANOVA or by unpaired t test before and after adjusting for confounding effects through the propensity score method.Results. Women on hormonal contraceptives and those with abnormal vaginal pH had lower SLPI levels as compared to their peers. After propensity score adjustment for race, behavioral factors, hormonal use and other STIs, SLPI levels were lower in women with positive TV antigen test, pH>4.5, vaginal leukocytosis, recurrent compared to initial TV infection, and were lowest in those with highest TV load.Conclusions. SLPI was reduced by >50% in a TV load dependent manner. Future research should consider whether identifying and treating women with low levels of TV infection (before they become wet mount positive) would prevent the loss of SLPI and impaired vaginal immunity. SLPI could be used as a vaginal health marker to evaluate interventions and vaginal products.

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