[Show abstract][Hide abstract] ABSTRACT: Trichomonas vaginalis is the most prevalent nonviral sexually transmitted infection, affecting an estimated 3.7 million women and men in the United
States. Health disparities are prominent in the epidemiology of this infection, which affects 11% of women aged ≥40 years
and a disproportionately high percentage of black women. Particularly high prevalences have been identified among sexually
transmitted disease (STD) clinic patients and incarcerated individuals. This article reviews and updates scientific evidence
in key topic areas used for the development of the 2015 STD Treatment Guidelines published by the Centers for Disease Control
and Prevention. Current evidence is presented regarding conditions associated with Trichomonas vaginalis infection, including human immunodeficiency virus (HIV) and pregnancy complications such as preterm birth. Nucleic acid amplification
tests and point-of-care tests are newly available diagnostic methods that can be conducted on a variety of specimens, potentially
allowing highly sensitive testing and screening of both women and men at risk for infection. Usually, trichomoniasis can be
cured with single-dose therapy of an appropriate nitroimidazole antibiotic, but women who are also infected with HIV should
receive therapy for 7 days. Antimicrobial resistance is an emerging concern.
Full-text · Article · Dec 2015 · Clinical Infectious Diseases
[Show abstract][Hide abstract] ABSTRACT: Background:
Longitudinal studies have consistently found a significant association between bacterial vaginosis (BV) and acquisition of sexually transmitted diseases (STDs). However, there is limited prospective data to confirm these findings.
We conducted a prospective, randomized, open-label trial of home screening and treatment of young women with asymptomatic BV who were also at high risk for STD. These women were screened every 2 months for 12 months and randomized to treatment with oral metronidazole 500 mg twice daily for 7 days versus observation alone. The primary outcome was the incidence of gonorrhea and/or chlamydia.
1365 subjects were enrolled in the study across 10 sites. Adherence with mailing specimens obtained at home was excellent in both groups (84-88%). The incidence of gonorrhea and/or chlamydia was 19.1 per 100 person years (95% CI: 15.1-22.1) for the treatment group and 18.5 per 100 person-years (95% CI: 15.1-22.8) for the observation arm, a difference that was not statistically significant.
Young women were very amenable to home screening for BV, gonorrhea, and chlamydia. Treatment of asymptomatic BV with one week of oral metronidazole did not result in a decreased incidence of gonorrhea and/or or chlamydia.
No preview · Article · Nov 2015 · Clinical Infectious Diseases
[Show abstract][Hide abstract] ABSTRACT: Pelvic inflammatory disease (PID) remains an important source of preventable reproductive morbidity, but no recent studies have singularly focused on US sexually transmitted disease (STD) clinics in relationship to established guidelines for diagnosis and treatment.
Of the 83,076 female patients seen in 14 STD clinics participating in the STD Surveillance Network, 1080 (1.3%) were diagnosed as having PID from 2010 to 2011. A random sample of 219 (20%) women were selected, and medical records were reviewed for clinical history, examination findings, treatment, and diagnostic testing. Our primary outcomes were to evaluate how well PID diagnosis and treatment practices in STD clinic settings follow the Centers for Disease Control and Prevention (CDC) treatment guidelines and to describe age group-specific rates of laboratory-confirmed Chlamydia trachomatis (CT) and Neisseria gonorrhoeae (GC) in patients clinically diagnosed as having PID in the last 12 months, inclusive of the PID visit.
Among the 219 women, 70.3% of the cases met the CDC treatment case definition for PID, 90.4% had testing for CT and GC on the PID visit, and 68.0% were treated with a CDC-recommended outpatient regimen. In the last 12 months, 95.4% were tested for CT or GC, and positivity for either organism was 43.9% in women aged 25 years or younger with PID, compared with 19.4% of women older than 25 years with PID.
Compliance with CDC guidelines was documented for many of the women with PID, though not all. Our findings underscore the need for continued efforts to optimize quality of care and adherence to current guidance for PID management given the anticipated expertise of providers in these settings.
No preview · Article · Aug 2015 · Sexually transmitted diseases
[Show abstract][Hide abstract] ABSTRACT: Bacterial vaginosis (BV), a prevalent infection in women of reproductive age, is associated with increased risk of upper genital tract and sexually transmitted infections, and complications in pregnancy. Currently approved treatments include metronidazole, which requires once or twice daily intravaginal administration for 5 days or twice daily oral administration for 7 days. This phase 3 study determined the safety and efficacy of single-dose metronidazole vaginal gel (MVG) 1.3%.
In this double-blind, vehicle-controlled study, 651 women with clinical diagnosis of BV were randomized 1:1 to receive MVG 1.3% or vehicle vaginal gel. Primary efficacy measure was clinical cure (normal discharge, negative "whiff test," and <20% clue cells) at day 21. Secondary measures included therapeutic cure (both clinical and bacteriological; day 21) and bacteriologic cure (Nugent score <4), clinical cure, and time to resolution of symptoms (day 7).
A total of 487 participants were included in the primary analysis. Clinical and therapeutic cure rates (day 21) were higher in participants treated with MVG 1.3% compared with vehicle gel (37.2% vs. 26.6% [P = 0.010] and 16.8% vs. 7.2% [P = 0.001], respectively). Clinical and bacteriologic cure rates (day 7) were also higher in the MVG 1.3% group (46.0% vs. 20.0% [P < 0.001] and 32.7% vs. 6.3% [P < 0.001], respectively). The median time to resolution of symptoms was shorter in the MVG 1.3% (day 6) than vehicle group (not reached). No serious adverse events were reported, and incidence was similar across treatment groups.
Single-dose MVG 1.3% was safe and superior to vehicle gel in producing cure among women with BV.
[Show abstract][Hide abstract] ABSTRACT: Background/introduction In a multicenter clinical trial funded by BD, we observed less accurate clinician diagnosis of bacterial vaginosis (BV) based on clinical observations when Trichomonas vaginalis (TV) and/or Candida spp. were also detected by the trial Reference Methods than when only BV was detected.
Aim(s)/objectives To determine the sensitivity of each criterion and of the overall Amsel’s criteria (3/4 criteria met), the results of the Amsel’s corresponding to the sub-population of specimens that gave a Nugent score of 7–10 were analysed.
Methods Following informed consent, women with symptoms of vaginitis/vaginosis were included in the trial. The four Amsel’s criteria and the Nugent score were performed. Evaluation for trichomoniasis by wet mount and culture (InPouch™ TV, Biomed) were performed. Candida colonies were isolated (BBL™ Sabouraud Dextrose Agar, Emmons and BBL™ CHROMAgar™ Candida plate, BD) and identified by ITS-2 bi-directional sequencing (Accugenix®).
Results In total, 269/497 (54.1%) specimens gave a Nugent score of 7–10. Amongst them, TV and/or Candida spp. were found in 100 specimens (37.2%). The sensitivity of clue cells, amine test, vaginal pH, BV vaginal discharge, and overall Amsel’s criteria in absence of TV and/or Candida spp. was 86.3%, 82.7%, 91.1%, 71.0%, and 84.6% respectively. In presence of TV and/or Candida spp., the sensitivity was 63.6%, 64.0%, 75.0%, 42.0%, and 60.0% respectively (p values ≤ 0.0009 for all comparisons).
Discussion/conclusion The sensitivity of the Amsel’s criteria in women with BV decreases when TV and/or Candida spp. are present. The BV vaginal discharge is the least sensitive criterion.
Preview · Article · May 2015 · Sexually Transmitted Infections
[Show abstract][Hide abstract] ABSTRACT: 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.
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).
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).
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.
No preview · Article · Dec 2014 · The Journal of Infectious Diseases
[Show abstract][Hide abstract] ABSTRACT: As part of a larger study using 454 pyrosequencing to investigate the vaginal microbiota of women with BV, we found an association between a novel BV-associated bacterium (BVAB1) and high Nugent scores and propose that BVAB1 is the curved Gram-negative rod traditionally identified as Mobiluncus spp. in vaginal Gram stains.
No preview · Article · Sep 2014 · Diagnostic Microbiology and Infectious Disease
[Show abstract][Hide abstract] ABSTRACT: Background:
Trichomonas vaginalis (TV) is the most common nonviral sexually transmitted infection (STI) in the world. However, TV is not a reportable STI and, with the exception of HIV-positive women, there are no guidelines for screening in women or men. The objective of this study was to determine the added value of nucleic acid amplification tests (NAATs) for detection of TV in men and women at high risk for infection as well as correlates of infection.
This was a review of clinical and laboratory data of men and women presenting to the Jefferson County Department of Health Sexually Transmitted Diseases (STD) Clinic and receiving a TV NAAT.
During 2012-2013, 6335 patients (3821 women and 2514 men) received a TV NAAT on endocervical, urethral, or urine specimens. Overall TV prevalence was 20.2%; 27.0% in women and 9.8% in men. Correlates of TV among men included age >40 years, African American race, and ≥5 polymorphonuclear cells per high-power field on urethral Gram stain. Age >40 years, African American race, leukorrhea on wet mount, elevated vaginal pH, positive whiff test, and concurrent gonococcal infection were positively associated with TV among women. TV NAAT detected approximately one-third more infections among women than wet mount alone.
TV prevalence among men and women was high in this study, suggesting that both groups should be routinely screened, including those aged >40 years. Improved detection of TV by routine implementation of NAATs should result in better control of this common, treatable STI.
Preview · Article · Jun 2014 · Clinical Infectious Diseases
[Show abstract][Hide abstract] ABSTRACT: The ESwab collection device was compared to the collection swab provided as part of the Affirm VPIII microbial identification
test kit for testing vaginal specimens with the Affirm test system. There was excellent agreement between the two sampling
devices for Candida spp., Gardnerella vaginalis, and Trichomonas vaginalis.
Preview · Article · Feb 2014 · Journal of clinical microbiology
[Show abstract][Hide abstract] ABSTRACT: Background:
Bacterial vaginosis (BV) is the most common cause of vaginal discharge and is associated with important public health complications such as preterm birth and acquisition or transmission of human immunodeficiency virus and sexually transmitted infections. Continued controversy concerning the pathogenesis of BV has led to a lack of progress in prevention and management of this infection.
Development of a conceptual model for the pathogenesis of BV based on review of past and current research.
Our model suggests that BV is initiated by the sexual transmission of Gardnerella vaginalis, which has the appropriate virulence factors to adhere to host epithelium, create a biofilm community, and successfully compete with lactobacilli for dominance in the vaginal environment. The genetic diversity of G. vaginalis may result in virulent and avirulent strains. Symbiotic relationships with normally dormant vaginal anaerobes lead to increases in the latter which contribute to the symptoms of BV.
G. vaginalis is the pathogen responsible for the initiation of BV. Future research should focus on preventing its transmission and improved therapeutics for the biofilm infection that is caused by this pathogen and host anaerobes.
Preview · Article · Feb 2014 · The Journal of Infectious Diseases
[Show abstract][Hide abstract] ABSTRACT: The contribution of sexual transmission to genital Candida infection remains unclear. This study sought to investigate whether sexual behaviours were associated with the presence of genital Candida species among a cohort of women who have sex with women (WSW) in addition to determining the genetic concordance of genital Candida spp. among WSW in sexual partnerships.
WSW ≥18 years of age presenting to the Mississippi State Department of Health STD Clinic during 2009-2010 completed a sexual behaviour survey. Culture of vaginal fluid was performed for Candida spp. identification; associations with participant characteristics were determined using logistic regression analysis. Random amplified polymorphic DNA (RAPD) PCR was performed on DNA extracted from yeast cultures of WSW in sexual partnerships in which both partners had isolates of Candida spp. identified and among a set of age/sexual behaviour matched controls. RAPD genetic fingerprints were evaluated by hierarchical cluster analysis for concordance.
Genital Candida spp. were isolated in 105/196 (53.6%) of women: 13/105 (12.4%) had symptomatic vulvovaginal candidiasis while 92/105 (87.6%) had asymptomatic vaginal colonisation. Bisexual identity, sex with women and men during the past 12 months and numbers of male sexual partners during the past 12 months were the only significant predictors of genital Candida spp. in bivariate analysis. 13 pairs of WSW in sexual partnerships in which both partners had genital Candida spp. and 11 WSW with genital Candida spp. not in sexual partnerships were identified. Candida spp. RAPD banding patterns were discordant for all isolates among WSW within partnerships and in controls.
This study found no evidence supporting sexual transmission of genital Candida spp. between women.
No preview · Article · Jan 2014 · Sexually transmitted infections
[Show abstract][Hide abstract] ABSTRACT: Trichomonas vaginalis is the most prevalent non-viral sexually transmitted infection worldwide and improved diagnostics are critical to controlling this pathogen. Diagnostic assays that can be used in conjunction with routine chlamydia/gonorrhea nucleic acid-based screening are likely to have the most impact on disease control. Here we describe the performance of the new BD TVQ(x) amplified DNA Assay (TVQ) that can be performed on the automated BD Viper System. We focus on data from vaginal swab samples since this is the specimen type routinely used for traditional trichomonas testing and the recommended specimen type for chlamydia/gonorrhea screening. Vaginal swabs were obtained from women attending STD or family planning clinics at 7 sites. A patient collected vaginal swab was tested by TVQ; APTIMA TV (ATV) testing was performed using a clinician obtained vaginal swab. Additional clinician obtained vaginal swabs were used for wet mount and culture. Analyses included comparison against the patient infection status (PIS), defined by either a wet mount or culture positive result; head-to-head comparisons assessed by κ-scores; and latent class analysis (LCA) as an unbiased estimator of test accuracy. Data from 838 women, 116 of whom were infected with TV, were analyzed. TVQ sensitivity and specificity estimates based on the PIS were 98.3% and 99.0%, respectively. TVQ performed similarly to ATV (κ=0.938) in head-to-head analysis. LCA estimated TVQ sensitivity and specificity at 98.3 and 99.6%, respectively. The TVQ assay performed well using self-obtained vaginal swabs, the optimal sample type as recommended by the CDC for chlamydia/gonorrhea screening among women.
Preview · Article · Jan 2014 · Journal of clinical microbiology
[Show abstract][Hide abstract] ABSTRACT: This report describes a case of suspected heterosexual transmission of bacterial vaginosis to a woman from a male partner who had undergone a radical prostatectomy. The most likely method of transmission in this case was through contact with infected desquamated epithelial cells from the male partner's distal urethra or coronal sulcus.
No preview · Article · Jan 2014 · Sexually transmitted diseases