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ABSTRACT: Trichomonas vaginalis is the most common curable sexually transmitted infection worldwide. T vaginalis infections in women can range from asymptomatic to acute inflammatory vaginitis. In men, this infection is typically asymptomatic but is increasingly being recognised as a cause of non-gonococcal urethritis. Diagnosis of T vaginalis has traditionally been made by direct microscopic examination of a wet mount of vaginal fluid or through the use of culture. The recent commercial availability of nucleic acid amplification tests for the detection of T vaginalis has seen these replace culture as the gold standard for diagnosis. Nitroimidazoles (ie, metronidazole and tinidazole) are the mainstay of therapy. In the case of treatment failure due to drug resistance or in the case of a severe nitroimidazole allergy, alternative intravaginal therapies exist, although their effectiveness has not been evaluated systematically. Novel systemic agents other than nitroimidazoles for the treatment of T vaginalis are needed, and efforts to promote and support antimicrobial drug development in this setting are necessary.
Sexually transmitted infections 03/2013; · 2.18 Impact Factor
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ABSTRACT: OBJECTIVE: Trichomoniasis vaginalis is a risk factor for the acquisition and transmission of HIV. The objective of this study was to determine the prevalence of T vaginalis (using culture) among HIV-infected women receiving gynaecological care at an university HIV clinic in Alabama in addition to predictors of infection. METHODS: Electronic medical record review of women presenting to the clinic for gynaecological care during 2006-2012 was performed. Demographic and sexual history data was abstracted in addition to absolute CD4 cell count, HIV-1 viral load and sexually transmitted infection (STI) (including T vaginalis) testing results. Analysis was conducted using Stata V.12. RESULTS: T vaginalis was prevalent in 17.4% (83/478) of HIV-infected women; other STIs were less prevalent. Among these women, 384 presented for routine STI screening, of which 12% (46/384) were T vaginalis-infected. Younger age, African-American race, lifetime history of tobacco and drug abuse, lack of HIV therapy, HIV-1 viral load >400 copies/ml, and report of seeking gynaecological care for reasons other than routine STI screening (ie, having symptoms) were significant predictors of T vaginalis in univariate analysis. Age, African American race, and report of seeking gynaecological care for reasons other than routine STI screening remained associated with T vaginalis in multivariable analysis. CONCLUSIONS: T vaginalis remains highly prevalent among HIV-infected women, a proportion of which may be asymptomatic. If left undiagnosed and untreated, these women may be more likely to transmit HIV. Increased emphasis on screening for high risk sexual behaviours, testing for T vaginalis, and risk reduction counselling is necessary for all HIV-infected women.
Sexually transmitted infections 02/2013; · 2.18 Impact Factor
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ABSTRACT: The random amplified polymorphic DNA technique was used to delineate the genetic relatedness of Trichomonas vaginalis isolates among 3 pairs of mutually infected women who have sex with women in sexual partnerships. One of the 3 pairs of women shared a T. vaginalis isolate with the same random amplified polymorphic DNA banding patterns. Shared use of washcloths to cleanse the vaginal area after receptive oral sex was the most likely method of T. vaginalis transmission among this pair of women.
Sexually transmitted diseases 07/2012; 39(7):556-8. · 2.58 Impact Factor
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ABSTRACT: Chlamydia trachomatis (CT), Mycoplasma genitalium (MG), and Trichomonas vaginalis (TV) are sexually transmitted infections (STIs) associated with nongonococcal urethritis (NGU). We assessed their predictors and persistence after treatment.
We analyzed data from an NGU treatment trial among symptomatic heterosexual men aged 16-45 years from STI clinics. Nucleic acid amplification tests detected CT, MG, and TV at baseline and at 1 and 4 weeks after therapy. Associations between variables and STI detection were investigated.
Among 293 participants, 44% had CT, 31% had MG, and 13% had TV at baseline. In multivariate analysis, CT infection was associated with young age and STI contact. Young age was also associated with MG, and having ≥ 1 new partner was negatively associated with TV. We detected persistent CT in 12% and MG in 44% of participants at 4 weeks after therapy, which were associated with signs and symptoms of NGU. Persistent CT was detected in 23% of participants after azithromycin treatment vs 5% after doxycycline treatment (P = .011); persistent MG was detected in 68% of participants after doxycycline vs 33% after azithromycin (P = .001). All but 1 TV infection cleared after tinidazole.
Persistent CT and MG after treatment of NGU are common, and were associated with clinical findings and drug regimen.
The Journal of Infectious Diseases 05/2012; 206(3):357-65. · 6.41 Impact Factor
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ABSTRACT: Trichomonas vaginalis (TV) infection is the most prevalent curable sexually transmitted infection in the United States and worldwide. Most TV infections are asymptomatic, and the accurate diagnosis of this infection has been limited by lack of sufficiently sensitive and specific diagnostic tests, particularly for men. To provide updates for the 2010 Centers for Disease Control and Prevention's Sexually Transmitted Diseases Treatment Guidelines, a PubMed search was conducted of all TV literature published from 9 January 2004 through 24 September 2008. Approximately 175 pertinent abstracts and articles were reviewed and discussed with national experts. This article describes advances in TV diagnostics which have led to an improved understanding of the epidemiology of this pathogen, as well as potential biologic and epidemiological interactions between TV and human immunodeficiency virus (HIV). New data on treatment outcomes, metronidazole-resistant TV, management of nitroimidazole-allergic patients, frequency of recurrent TV infection following treatment, and screening considerations for TV in certain populations are also presented.
Clinical Infectious Diseases 12/2011; 53 Suppl 3:S160-72. · 9.15 Impact Factor
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ABSTRACT: Trichomoniasis is a common sexually transmitted disease associated with preterm birth, low birth weight, and increased susceptibility to infection with other pathogenic sexually transmitted microorganisms. Nucleic acid amplification tests for Trichomonas vaginalis have improved sensitivity for detecting infected individuals compared to existing culture-based methods. This prospective, multicenter U.S. clinical trial evaluated the performance of the automated Aptima T. vaginalis assay for detecting T. vaginalis in 1,025 asymptomatic and symptomatic women. Vaginal swab, endocervical swab, ThinPrep PreservCyt, and urine specimens were collected. Subject infection status was determined by wet-mount microscopy and culture. Aptima T. vaginalis assay performance was determined for each specimen type by comparison to subject infection status. Of 933 subjects analyzed, 59.9% were symptomatic. Aptima T. vaginalis clinical sensitivity and specificity were, respectively, 100% and 99.0% for vaginal swabs, 100% and 99.4% for endocervical swabs, 100% and 99.6% in ThinPrep samples, and 95.2% and 98.9% in urine specimens. Aptima T. vaginalis performance levels were similar in asymptomatic and symptomatic subjects. This study validates the clinical performance of the Aptima T. vaginalis assay for screening asymptomatic and symptomatic women for T. vaginalis infection.
Journal of clinical microbiology 09/2011; 49(12):4106-11. · 4.16 Impact Factor
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ABSTRACT: Bacterial vaginosis (BV) is a common condition of unknown etiology and has been linked to adverse reproductive and obstetric health outcomes. Prior dietary research on BV has focused on specific macro- and micronutrients, but not dietary indices. We assessed the relationship between BV and selected dietary indicators among a cohort of 1735 nonpregnant women ages 15-44 y from Birmingham, Alabama. Annual intake was assessed with the Block98 FFQ, and the glycemic index, glycemic load (GL), and Healthy Eating Index were calculated by the Block Dietary Data System. The Naturally Nutrient Rich (NNR) score was also calculated. Vaginal flora was evaluated using Nugent Gram-stain criteria. Crude OR and adjusted OR were determined by multinomial and logistic regression in cross-sectional and prospective analyses, respectively. Participants were predominantly African American (85.5%) aged 25.3 ± 6.8 y (mean ± SD). Per 10-unit increase, GL was positively (adjusted OR = 1.01, 95% CI = 1.00-1.03) and NNR was negatively (adjusted OR = 0.93, 95% CI = 0.88-0.99) associated with BV compared to normal vaginal flora. In prospective analyses, only GL was associated with BV progression (adjusted OR = 1.03, 95% CI = 1.00-1.05) and persistence (adjusted OR = 1.02, 95% CI = 1.01-1.04) after adjustment. Both GL and NNR were associated with greater BV prevalence and GL was associated with an increase in BV persistence and acquisition. These results suggest that diet composition may contribute to vaginal flora imbalances and be important for elucidating the etiology of BV.
Journal of Nutrition 09/2011; 141(9):1698-704. · 3.92 Impact Factor
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ABSTRACT: Bacterial vaginosis (BV) was diagnosed in 72.5% of female participants. Among women with BV, 33.1% were colonized with yeast. Vulvovaginal candidiasis was observed in 15.7% of participants irrespective of BV status. Overall, the prevalence of BV/vulvovaginal candidiasis mixed infections among young women was observed to be 4.4%.
Sexually transmitted diseases 07/2011; 38(7):672-4. · 2.58 Impact Factor
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ABSTRACT: The purpose of this study was to compare the efficacy of 2 different doses of tinidazole with metronidazole for the treatment of bacterial vaginosis and to compare the side effects of the drugs.
Women were assigned randomly to receive metronidazole 500 mg twice daily, tinidazole 500 mg twice daily, or tinidazole 1 g twice, all for 7 days. Follow-up visits were conducted at days 14 and 28.
Five hundred ninety-three women were enrolled. There were no significant differences between the treatment arms. Overall cure rates were 76.8% at 14 days and 64.5% at 1 month. Women who admitted to engaging in sexual intercourse during the study were significantly more likely to have bacterial vaginosis at the follow-up visit. There were no significant differences in adverse events across treatment arms.
There were no differences in cure rates between metronidazole and either of the tinidazole dosing regimens that were studied. In addition, there were no important differences in the side-effect profiles of metronidazole and tinidazole.
American journal of obstetrics and gynecology 12/2010; 204(3):211.e1-6. · 3.28 Impact Factor
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ABSTRACT: We sought to assess the relationship between bacterial vaginosis (BV) assessed by Gram stain and incident trichomonal, gonococcal, and/or chlamydial genital infection.
This longitudinal study included 3620 nonpregnant women aged 15-44 years who presented for routine care at 12 clinics in Birmingham, Alabama. Participants were assessed quarterly for 1 year. Vaginal smears were categorized by the Nugent Gram stain score (0-3, normal; 4-6, intermediate state; 7-10, BV). Pooled logistic regression was used to estimate the hazard ratios for the comparison of trichomonal, gonococcal, and chlamydial infection incidence in participants by Nugent score at the prior visit. Participants were censored at their first visit with a positive test result for trichomonal, gonococcal, and/or chlamydial infection.
Of the 10,606 eligible visits, 37.96% were classified by BV and 13.3% by positive detection of trichomonal, gonococcal, and/or chlamydial infection. An intermediate state or BV at the prior visit was associated with a 1.5-2-fold increased risk for incident trichomonal, gonococcal, and/or chlamydial infection (adjusted hazard ratio [AHR] for intermediate state, 1.41 [95% confidence interval {CI}, 1.12-1.76]; AHR for BV, 1.73 [95% CI, 1.42-2.11]; P= .058 for trend). Estimates were similar for trichomonal-only, gonococcal-only, and chlamydial-only infection outcomes.
BV microbiota as gauged by Gram stain is associated with a significantly elevated risk for acquisition of trichomonal, gonococcal, and/or chlamydial genital infection.
The Journal of Infectious Diseases 11/2010; 202(12):1907-15. · 6.41 Impact Factor
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ABSTRACT: Trichomoniasis is associated with adverse pregnancy outcomes and increased risk for human immunodeficiency virus. Males are usually asymptomatic, and thus there is heavy reliance on partner notification for identifying infected male partners. The usual approach is partner referral but it is estimated that only a minority of men seek care. We conducted a randomized trial to compare the effectiveness of 3 methods of partner notification.
Women were randomized to self-referral of partners (PR), partner-delivered therapy (PDPT), or public health disease intervention (DIS) locating partners and delivering medication in the field, if needed. Test-of-cure visits were conducted at 5 to 9 days after enrollment. Repeat infections at 1 and 3 months of follow-up were the measure of effectiveness.
A total of 484 women were randomized. Initial cure rates were 95.3%. At the 1- and 3-month follow-up visits, there was no significant difference in repeat infection rates when PDPT or DIS were compared to the reference of PR. However, when PDPT was compared to DIS or PR/DIS combined, at 1 month the PDPT group had a lower repeat infection rate (5.8 vs. 15% and 5.8 vs. 12.5%, respectively). Of these, 80% of women randomized to PDPT reported delivering medication and 89% thought it likely that partners took the medication. No serious adverse events were reported.
PDPT for trichomoniasis was well accepted and safe in this study. Rates of repeat infection in women in this intervention were lower than those in the DIS arm and DIS/PR arm combined although when compared directly to PR there was no significant difference.
Sexually transmitted diseases 06/2010; 37(6):392-6. · 2.58 Impact Factor
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Jane R Schwebke
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ABSTRACT: Bacterial vaginosis (BV) is the most common vaginal infection worldwide. It has been linked to serious public health consequences including preterm birth, postoperative infections, and the acquisition and transmission of sexually transmitted diseases including HIV. The etiology of BV remains unknown. In this article, controversies about sexual transmission, microbial pathogens, and heterogeneity of BV as a disease entity are discussed.
Current Infectious Disease Reports 04/2009; 11(2):143-7.
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ABSTRACT: The etiology of bacterial vaginosis is unknown, and there are no long-term therapies for preventing this frequently recurring condition. Vaginal douching has been reported to be associated with bacterial vaginosis in observational studies. However, this association may be due to confounding by indication--that is, confounding by women douching in response to vaginal symptoms associated with bacterial vaginosis. The authors used marginal structural modeling to estimate the causal effect of douching on bacterial vaginosis risk while controlling for this confounding effect. In 1999-2002, nonpregnant women (n = 3,620) were recruited into a prospective study when they visited one of 12 public health clinics in Birmingham, Alabama, for routine care. Participants were assessed quarterly for 1 year. Bacterial vaginosis was based on a Nugent's Gram stain score of 7 or higher. Thirty-two percent of participants douched in every study interval, and 43.0% never douched. Of the 12,349 study visits, 40.2% were classified as involving bacterial vaginosis. The relative risk for regular douching as compared with no douching was 1.21 (95% confidence interval: 1.08, 1.38). These findings indicate that douching confers increased risk of disruption of vaginal flora. In the absence of a large randomized trial, these findings provide the best evidence to date for a risk of bacterial vaginosis associated with douching.
American journal of epidemiology 08/2008; 168(2):188-96. · 5.59 Impact Factor
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Sex Transm Dis 07/2008; 35(6):611-3. · 2.87 Impact Factor
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ABSTRACT: We report a case of Streptococcus pyogenes, beta-hemolytic Streptococcus, Lancefield group A vulvovaginitis in an otherwise healthy adult female patient experiencing lactational amenorrhea. Group A streptococcal infection is the infective cause of vulvovaginitis in 21% of prepubescent girls, but it is an uncommon cause of vulvovaginitis in adults. Group A streptococcal vulvovaginitis is frequently associated with households that have had a recent outbreak of respiratory or dermal infection. The case described here appears to be unusual in that it was sexually transmitted, and the lack of estrogen associated with anovualtion may have been a predisposing factor for this unusual sexually transmitted disease.
Clinical Infectious Diseases 06/2008; 46(10):e112-5. · 9.15 Impact Factor
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ABSTRACT: Although vaginal douching is associated with several adverse outcomes, the reasons why women douche have not been studied prospectively.
Non-pregnant (N = 3620) women aged 15 to 44 years presenting for routine care at 12 clinics in Birmingham, Alabama, participated in a longitudinal study of vaginal flora (1999-2003). Participants were assessed quarterly for 1 year. The authors applied conditional logistic regression in a case-crossover analysis to determine the individual-level factors that vary between a woman's douching and non-douching intervals. Findings were compared to a population-level analysis utilizing generalized estimating equations.
Thirty percent of participants douched in every interval; 28% douched in some but not all intervals. The case-crossover analysis indicated a woman was more likely to douche when reporting "fishy" vaginal odor (odds ratio [OR]:2.74; 95% confidence interval [CI]: 1.55, 1.84), vaginal irritation (OR: 1.52; 95% CI: 1.10, 2.11), summer month (OR: 1.37, 95% CI: 1.13, 1.67), or increase in number of sex partners (> or = 3, OR: 2.42, 95% CI: 1.11, 5.26). Bacterial vaginosis/trichomoniasis treatment (OR: 0.72, 95% CL: 0.59, 0.89) and absent menses (OR: 0.37, 95% CI: 0.28, 0.50) were negatively associated with douching. These ORs were farther from the null than comparable population-level estimates.
Programs targeting these predictors may decrease the untoward sequelae associated with douching. Furthermore, a case-crossover analysis applied to prospective studies can provide insights into time-varying factors.
Annals of Epidemiology 01/2008; 18(1):65-73. · 3.21 Impact Factor
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Sex Transm Dis 12/2007; 34(11):876-7. · 2.87 Impact Factor
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ABSTRACT: The effect that vaginal lactobacilli have on trichomoniasis is not known. At 3 clinics for treatment of sexually transmitted disease, we recruited 521 female patients with trichomoniasis and 176 control subjects. All participants underwent physical examinations and testing for sexually transmitted infection and completed questionnaires. Low levels of vaginal lactobacilli were associated with trichomoniasis (odds ratio [OR], 2.2 [95% confidence interval {CI}, 1.4-3.2]). After adjustment for covariables, this association remained in women with a higher educational level (OR, 4.6 [95% CI, 2.2-9.5]) but not in women with a lower educational level (OR, 1.6 [95% CI, 0.7-3.4]). Vaginal lactobacilli may be associated with trichomoniasis in women with higher levels of education or a related behavioral factor.
The Journal of Infectious Diseases 11/2007; 196(7):1102-7. · 6.41 Impact Factor
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ABSTRACT: Bacterial vaginosis (BV), a condition of altered vaginal flora, is associated with various adverse reproductive health outcomes. We evaluated the association between diet and the presence of BV in a subset of 1521 women (86% African-American) from a larger study of vaginal flora. Participants completed the Block Food Questionnaire and clinical assessments and self-report measures of sexual and hygiene behavior. A total of 42% of the women were classified as having BV (Nugent score > or = 7). Severe BV (Nugent score > or = 9 and vaginal pH > or = 5) was present in 14.9% of the women. BV was associated [adjusted OR (AOR)] with increased dietary fat (1.5, 1.1-2.4) after adjusting for other energy nutrients and behavioral and demographic covariates. Severe BV was associated with total fat (2.3, 1.3-4.3), saturated fat (2.1, 1.2-3.9), and monounsaturated fat (2.2, 1.2-4.1). Energy intake was only marginally associated (P = 0.05) with BV (1.4, 1.0-1.8). There were significant inverse associations between severe BV and intakes of folate (0.4, 0.2-0.8), vitamin E (0.4, 0.2-0.8), and calcium (0.4, 0.3-0.7). We conclude that increased dietary fat intake is associated with increased risk of BV and severe BV, whereas increased intake of folate, vitamin A, and calcium may decrease the risk of severe BV.
Journal of Nutrition 10/2007; 137(9):2128-33. · 3.92 Impact Factor
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ABSTRACT: The purpose of this study was to determine whether treatment of bacterial vaginosis (BV) decreases the incidence of sexually transmitted diseases (STDs).
Women with asymptomatic BV were studied prospectively to determine the effect of treatment of BV for the prevention of STD. Women were assigned randomly to observation or treatment and prophylaxis with intravaginal metronidazole gel. Women were screened monthly for STDs.
Women who were assigned randomly to receive metronidazole gel had a significantly longer time to the development of STDs compared with women in the observation group (P = .02). The 6-month STD rate was 1.58 per person-year (95% CI, 1.29, 1.87) for women in the metronidazole gel group vs 2.29 per person-year (95% CI, 1.95, 2.63) for women in the observational group. The difference in STD rates was driven by a significant difference in the number of chlamydial infections (P = .013).
Treatment and twice-weekly prophylactic use of intravaginal metronidazole gel resulted in significantly fewer cases of chlamydia.
American journal of obstetrics and gynecology 07/2007; 196(6):517.e1-6. · 3.28 Impact Factor
