Bacterial vaginosis and trichomoniasis: prevalence, associated factors, and performance of diagnostic tests

Introduction: Bacterial vaginosis and vaginal trichomoniasis are frequent causes of health care demand. Objective: To estimate the prevalence, identify associated factors, and investigate the performance of diagnostic tests for bacterial vaginosis and trichomoniasis. Methods: Cross-sectional study with participants over 18 years old. All of them were submitted to an interview and gynecological examination with evaluation of vaginal secretion, pH verification, collection of material for Pap smear, wet mount test, Whiff test, bacterioscopy, and polymerase chain reaction for trichomoniasis detection. Logistic regression analysis was applied to identify associated factors with bacterial vaginosis. Diagnostic performance for bacterial vaginosis was evaluated following Amsel criteria, the Ison and Hay score, and the Pap smear, considering the Nugent score as the gold standard. As for trichomoniasis, diagnostic performance was evaluated through the Pap smear and the wet mount test, using the polymerase chain reaction as the gold standard. Results: The prevalence of bacterial vaginosis was 33.7%, and for trichomoniasis, 0.5%. The complaint of abnormal vaginal secretion was associated with the diagnosis of bacterial vaginosis (odds ratio 2.2). The diagnostic accuracy by Amsel criteria, the Ison and Hay score, and the Pap smear was 35.6, 97.0, and 84.2%, respectively. The sensitivity for trichomoniasis through wet mount test was 0.0%, and through the Pap smear, 100%. Conclusion: The prevalence of bacterial vaginosis was high, and trichomoniasis was low. The only associated factor with bacterial vaginosis was the report of abnormal vaginal secretion. The methods with the most accurate diagnostic performance for bacterial vaginosis were the Ison and Hay score and the Pap smear and, for trichomoniasis, the Pap smear

How a discerning cytological examination can aid in the diagnosis of infectious diseases: case reports

Infections caused by uncommon and resistant pathogens in unusual sites have been increasingly reported in medical literature. We describe four cases of rare cytological findings and clinical impact for patients. In the first case, Aspergillus sp and Pneumocystis jirovecii were observed in the bronchoalveolar lavage of a patient with severe systemic lupus. In the second and third cases, we describe the presence of Trichomonas sp and Strongyloides sp larvae in samples of pleural and peritoneal fluid, respectively. The fourth report is about a patient with a wrist subcutaneous nodule whose synovial aspiration and cytology revealed the presence of brown septate hyphae. The early identification of the infectious agent in the cytological examination was essential for the introduction and/or re-adaptation of therapy in the four cases described. Patients in this report were immunocompromised with severe comorbidities, conditions often associated with unfavorable clinical outcomes.

Cribado de infecciones cervicales de transmisión sexual en mujeres embarazadas y su relación con la microbiota vaginal / Screening of cervical sexually transmitted infections in pregnant women and the relation with the vaginal microbiota

Resumen Introducción: La mujer embarazada está expuesta anumerosas infecciones de transmisión sexual (ITS), las que pueden producir aborto, enfermedad en el feto y/o en el recién nacido, además de alteraciones en el curso normal del embarazo. Objetivo: Realizar tamizaje de infección cervical asintomática en mujeres embarazadas y su relación con la microbiota. Pacientes y Métodos: Se enrolaron 85 mujeres embarazadas sin cervicitis clínica que consultaron en control de rutina de embarazo (47 pacientes) o que fueron derivadas a una unidad de ITS (38 pacientes). Se tomaron muestras de fondo de saco vaginal, que fueron analizadas por técnicas clásicas de microscopía y cultivo corriente y reacción de polimerasa en cadena para Neisseria gonorrhoeae, Trichomonas vaginalis y Chlamydia trachomatis. Resultados: Se encontró 12,9% de infección por C. trachomatis, 2,4% de T. vaginalis. En este estudio no se encontró N. gonorrhoeae. El 23,3% de pacientes con microbiota alterada (vaginosis bacteriana y microbiota intermedia) fue positiva para C. trachomatis. Conclusión: En este trabajo, encontramos una alta frecuencia de infección por C. trachomatis, que se relaciona en forma significativa con la presencia de microbiota alterada. Esta alta frecuencia debería promover estrategias preventivas en los controles de salud de la mujer embarazada.

Background: Pregnant woman is exposed to many sexual transmitted infections (STI). Many of these infections may produce diseases in the fetus and newborn, and also alteration in the normal course of the pregnancy. Aim: Screening of asymptomatic cervical infection in pregnant woman and its relationship with the vaginal microbiota. Patients and Methods: 85 pregnant women without clinical cervicitis who consult in the routine pregnant control (47 patients) and women derived from STI service (38 patients). The samples were obtained from the vaginal fund sac and were analyzed with optic microscopy, cultures and PCR of Neisseria gonorrhoeae, Trichomonas vaginalis and Chlamydia trachomatis. Results: 12,9% of the enrolled women were positive for C. trachomatis, 2,4% for T. vaginalis. In this study, we did not found N. gonorrhoeae. We observed 23,3% of patients with altered microbiota (bacterial vaginosis and intermediate microbiota) was positive for C. trachomatis. Conclusions: In this study, we found a high frequency of C. trachomatis infection, that correlates with the presence of altered microbiota. This high frequency would promote preventive strategies in the pregnant women routine controls.

Utilidad de la reacción de polimerasa en cadena convencional para la detección de Mycoplasma hominis, Ureaplasma spp. y Trichomonas vaginalis en muestras genitales de mujeres en consulta ambulatoria / Usefulness of conventional polymerase chain reaction for the detection of Mycoplasma hominis, Ureaplasma spp. and Trichomonas vaginalis in female outpatient's genital samples

Introduction: Trichomonas vaginalis, Mycoplasma hominis and Ureaplasma spp. are microorganisms responsible for genitourinary and pregnancy pathologies. Nucleic acid amplification methods have shown several advantages, but have not been widely studied for the detection of these microorganisms. Aim: To implement a conventional polymerase chain reaction (PCR) for the detection of the microorganisms and to compare its results versus the methods currently used at our laboratory. Material and Methods: 91 available samples were processed by PCR, culture (M. hominis y Ureaplasma spp.) and wet mount (T vaginalis). Results were compared and statistically analyzed by kappa agreement test. Results: 85, 80 and 87 samples resulted in agreement for the detection of M. hominis, Ureaplasma spp. y T. vaginalis, respectively. For M. hominis and Ureaplasma spp., agreement was substantial, whereas for T. vaginalis it was moderate, however, for the latter, PCR detected more cases than wet mount. Conclusion: We recommend the implementation of PCR for detection of T. vaginalis whereas culture kit is still a useful method for the other microorganisms.

Introducción: Trichomonas vaginalis, Mycoplasma hominis y Ureaplasma spp. son microorganismos causantes de patología genito-urinaria y durante el embarazo. Los métodos de amplificación de ácidos nucleicos han demostrado numerosas ventajas, pero no han sido ampliamente estudiados para la detección de estos microorganismos. Objetivo: Implementar una reacción de polimerasa en cadena convencional (RPC) para su detección y comparar sus resultados con los métodos actuales de nuestro laboratorio. Material y Métodos: Se procesaron 91 muestras mediante RPC, cultivo (M. hominis y Ureaplasma spp.) y observación microscópica al fresco (T. vaginalis). Los resultados fueron comparados y analizados estadísticamente mediante el test de concordancia kappa. Resultados: 85, 80 y 87 muestras tuvieron resultados concordantes para la detección de M. hominis, Ureaplasma spp. y T. vaginalis, respectivamente. Para M. hominis y Ureaplasma spp. el nivel de concordancia fue considerable mientras que para T. vaginalis fue moderado; sin embargo, para esta última, la RPC detectó más casos que la microscopia al fresco. Conclusión: Se recomienda la implementación de la RPC para la detección de T. vaginalis. Para M. hominis y Ureaplasma spp. el kit de cultivo continúa siendo un buen método.

COMPARISON OF PERMANENT STAINING METHODS FOR THE LABORATORY DIAGNOSIS OF TRICHOMONIASIS

Trichomonas vaginalis is the etiologic agent of trichomoniasis, the most common non-viral sexually transmitted disease (STD) in the world. The diagnosis is based on wet mount preparation and direct microscopy on fixed and stained clinical specimens. The aim of this study was to compare the performance of different fixing and staining techniques used in the detection of T. vaginalis in urine. The smears were fixed and submitted to different methods of permanent staining and then, the morphological aspects of the parasites were analyzed and compared. The Papanicolaou staining with ethanol as the fixative solution showed to be the best method of permanent staining. Our data suggest that staining techniques in association with wet mount examination of fresh specimens contribute to increase the sensitivity in the diagnosis of trichomoniasis.

Trichomonas Vaginalis Infection Among Women Attending in the Public Service in Rio Grande do Sul,Brazil: Frequency, Risk Factors and Clinical Signs / Infecção por Trichomonas Vaginalis em Mulheres a Tendidas pelo Serviço Público no Rio Grande do Sul, Brasil: Frequência, Fatores de Risco e Sinais Clínicos

Trichomoniasis is a cosmopolitan disease that can affect the female fertility, and is commonly underdiagnosed, both in private practices and in public health services, because of the low sensitivity of the wet mount exam used routinely. Objective: To understand the occurrence of T. vaginalis infection by means of in vitro culture in women receiving care in a public health unit, in the city of Pelotas, Rio Grande do Sul, Brazil, as well as to identify the possible risk factors associated with this infection. Methods: Cross­sectional study was carried out, which included 201 women undergoing interview and gynecological exam, with the collection of vaginal discharge in the Gynecology Ambulatory at the School of Medicine of Universidade Federal de Pelotas. The material collected was examined in the form of fresh smears and cultivated in Diamond's medium. Epidemiological data were obtained by means of patient interviews and clinical trials, from the medical records. The results were statistically analyzed through χ 2 and Fisher's exact tests, using version 9.0 of the Statistix program. Results: The occurrence of T. vaginalis infection was 7% (14/201). In the wet mount exam, used routinely for the diagnosis of this agent, only 42.85% of the infected women (6/14) were positive. It was noted that 21.4% of the infected women were asymptomatic, and 89.05% were not aware of the existence of the Trichomonas vaginalis infection. Factors independently associated with the infection were the smoking habit (odds ratio [OR] = 11.8), not having a stable sexual partner (OR = 6.36), presence of vaginal discharge with odor (OR = 5.65), and altered vaginal microbiota (OR = 5.31). Conclusion : T. vaginalis infection was present among the women studied, being underestimated because of the diagnostic technique, and because many of them were asymptomatic. The smoking habit, not having a stable sexual partner, having fetid discharge, and altered vaginal microbiota are the risk factors for infection.

A tricomoníase é cosmopolita, pode afetar a fertilidade feminina, e geralmente é subdiagnosticada, tanto em consultórios particulares, quanto em serviços públicos, devido à baixa sensibilidade do exame a fresco, usado rotineiramente. Objetivo: Conhecer a ocorrência de infecção por Trichomonas vaginalis , através de cultivo in vitro , em mulheres atendidas em unidade pública, na cidade de Pelotas, Rio Grande do Sul, além de identificar os possíveis fatores de risco associados a essa infecção. Métodos: Estudo de corte transversal que incluiu 201 mulheres, submetidas a entrevista e exame ginecológico, com coleta de conteúdo vaginal, no Ambulatório de Ginecologia da Faculdade de Medicina da Universidade Federal de Pelotas. O material coletado foi examinado a fresco e cultivado em meio de Diamond. Foram obtidos dados epidemiológicos através de entrevista, e clínicos, nos prontuários. Os resultados foram analisados estatisticamente através dos testes do χ 2 e exato de Fisher, utilizando o programa Statistix versão 9.0. Resultados: A ocorrência da infecção por T. vaginalis foi de 7% (14/201). No exame a fresco, usado como rotina para o diagnóstico desse agente, apenas 42,85% das infectadas (6/14) foram positivas. Constat ou­se que 21,4% das mulheres infectadas são assintomáticas, e que 89,05% desconhecia a existência da tricomoníase. Os fatores independent emente associados com a infecção foram o hábito de fumar (OR=11,8), não ter companheiro fixo (OR=6,36), apresentar corrimento vaginal fétido (OR=5,65) e microbiota vaginal alterada (OR=5,31). Conclusão: A infecção por T. vaginalis está presente entre as mulheres estudadas, e sendo subestimada, devido à técnica de diagnóstico e por muitas serem assintomáticas. O hábito de fumar, não ter companheiro fixo, ter corrimento fétido e microbiota vaginal alterada são fatores de risco para a infecção.

Prevalence of Trichomonas vaginalis by PCR in Men Attending a Primary Care Urology Clinic in South Korea

Trichomonas vaginalis, a causative agent of trichomoniasis, may trigger symptomatic or asymptomatic nongonococcal urethritis and chronic prostatitis in men. Despite the availability of highly sensitive diagnostic tests, such as nucleic acid amplification tests, including PCR, few prospective studies present data on male T. vaginalis infection in South Korea. In the present study, the prevalence of T. vaginalis and associated clinical conditions were evaluated in 201 male patients from a primary care urology clinic in South Korea. The prevalence of T. vaginalis infection in our cohort was 4% (8/201) by PCR. T. vaginalis infection was common in men older than 40 years (median age, 52 years). Among the 8 Trichomonas-positive patients, 87.5% (7/8) had prostatic diseases, such as prostatitis and benign prostatic hyperplasia, and 25.0% (2/8) and 12.5% (1/8) were coinfected with Chlamydia trachomatis and Mycoplasma genitalium, respectively. Our results suggest that T. vaginalis infection is not rare in men attending primary care urology clinics in South Korea, especially in those older than 40 years, in whom it may explain the presence of prostatic disease. The possibility of T. vaginalis infection should be routinely considered in older male patients with prostatic diseases in South Korea.

PCR for Diagnosis of Male Trichomonas vaginalis Infection with Chronic Prostatitis and Urethritis

The aim of this study was to assess the usefulness of PCR for diagnosis of Trichomonas vaginalis infection among male patients with chronic recurrent prostatitis and urethritis. Between June 2001 and December 2003, a total of 33 patients visited the Department of Urology, Hanyang University Guri Hospital and were examined for T. vaginalis infection by PCR and culture in TYM medium. For the PCR, we used primers based on a repetitive sequence cloned from T. vaginalis (TV-E650). Voided bladder urine (VB1 and VB3) was sampled from 33 men with symptoms of lower urinary tract infection (urethral charge, residual urine sensation, and frequency). Culture failed to detect any T. vaginalis infection whereas PCR identified 7 cases of trichomoniasis (21.2%). Five of the 7 cases had been diagnosed with prostatitis and 2 with urethritis. PCR for the 5 prostatitis cases yielded a positive 330 bp band from bothVB1 and VB3, whereas positive results were only obtained from VB1 for the 2 urethritis patients. We showed that the PCR method could detect T. vaginalis when there was only 1 T. vaginalis cell per PCR mixture. Our results strongly support the usefulness of PCR on urine samples for detecting T. vaginalis in chronic prostatitis and urethritis patients.

Frequency of trichomoniasis in patients admitted to outpatient clinics in Hamadan [2007] and relationship between clinical diagnosis and laboratory findings

Trichomoniasis is recognized as a major sexually transmitted disease [STD] in the world and has the highest prevalence and incidence of STD. The prevalence strongly is related to cultural and social norms in different societies, in relation to sexual partnership, monogamy, or polygamy. Our objective was to describe the frequency and natural history of infection and correlation of clinical signs with parasite detection. From February 2006 to March 2007, in a cross sectional study, clinical and wet mount examination of vaginal smear along with culture were performed on 683 women attending to private outpatient clinics in Hamada, western Iran. Tricomoniasis was diagnosed based on major clinical symptoms. Diagnosis was confirmed using wet mount microscopically and culture in Diamond medium. Only 2.2% of patients with clinically diagnosed trichomonal vaginitis were positive for Trichomonas vaginalis by wet smear and culture. The mean age of patients was 33.6 +/- 9.7 yr, and majority of them were married and non-pregnant. Some [5 patients] infected cases were divorced and others [7 patients] husband were car diver. There was not statistically significant relationship between clinical diagnosis and laboratory findings [P>0.5], because the most of patients diagnosed trichomoniasis, were infected by Candida or other vaginal infections. Because of special cultural background, the vaginal trichomoniasis has minor importance problem in this population and clinical diagnosis is not efficient for treatment decision

Challenges in detecting trichomoniasis in a cosmopolitan setup. Is it under control or under-diagnosed?

Trichomoniasis is caused by the flagellated eukaryote Trichomonas vaginalis, one of the most common sexually transmitted infections in humans. The aim of this study was to survey the prevalence of trichomoniasis in two different clinics in Kuala Lumpur using different diagnostic methods and to relate the acquisition of this infection with different risk factors in a prospective, observational study, 380 women attending the family planning [LPPKN] clinic and sexually transmitted diseases [STD] clinic in Kuala Lumpur between january-2008 and November- 2008 were enrolled. Patient's information was obtained from the standardized medical records and voluntarily completed questionnaires. Three vaginal swabs from posterior fornix were taken from each patient examined. Different staining methods and cultivation in diamonds medium were performed for the collected samples. Study subjects recruited in this survey were mostly young, with a mean age of 37.31 years [LPPKN clinic] and 32.06 years [STD clinic]. Malay, Chinese, Indians and others ethnic groups accounted for 91%, 4%, 2% and 3% respectively at LPPKN clinic. At STD clinic, almost all subjects were Chinese. The prevalence of trichomoniasis was 0.36% at LPPKN clinic and 0.0% at std clinic. No association between contraceptive methods used and trichomoniasis infection at LPPKN clinic was found. At STD clinic, it was observed that high risk for STIs acquisition was not associated with trichomoniasis positivity. Prevalence of trichomoniasis was very low at LPPKN clinic and even absent at STD clinic suggesting that this potential severe infection is under control in our cosmopolitan setup. On the other hand, the high prevalence rates of other STIs among sex workers found from this survey suggested the need for more active interventions focused on this group

Prevalence and Comparison of Diagnostic Methods for Trichomonas vaginalis Infection in Pregnant Women in Argentina

The objectives of this study were to conduct a prevalence survey of trichomoniasis in pregnant women and to evaluate the utility of different methods for its diagnosis. A total of 597 vaginal exudates from pregnant women who were examined at the Hospital de Clinicas in Buenos Aires, Argentina from 1 August 2005 to 31 January 2007, were prospectively and consecutively evaluated. The investigation of Trichomonas vaginalis was made by different microscopic examinations, and culture on liquid medium. The sensitivity and specificity of the microscopic examinations were assessed considering culture on liquid medium as the "gold standard". The prevalence of T. vaginalis obtained by culture on liquid medium was 4.0% (24/597). The prevalence of T. vaginalis obtained by direct wet smear, prolonged May-Grunwald Giemsa staining, and sodium acetate-formalin (SAF)/methylene blue staining-fixing technique was 1.8%, 2.3% and 2.5%, respectively. The sensitivity of the direct wet smear was 45.8%, that of the prolonged May-Grunwald Giemsa staining was 58.3%, and that of the SAF/methylene blue method was 62.5%. Considering the 3 microscopic examinations altogether, the sensitivity rose to 66.7% and the specificity was 100% for all of them. This is the first time that the prevalence data of T. vaginalis by culture in pregnant women are published in Argentina. Due to the low sensitivity obtained by microscopy in asymptomatic pregnant women, the use of the liquid medium is recommended during pregnancy, in order to provide an early diagnosis and treatment.

Urethral trichomoniasis in Iraqi females

Trichomonas vaginalis has long been recognized as a cause of infectious vaginitis in women. Different studies have demonstrated a significant burden of the parasite to cause urethritis as well. It has been assumed that the localization of parasite in the urethra may be responsible for the recurrence of vaginal infection. To evaluate the infection rate of urethral trichomoniasis and to evaluate two different laboratory methods used in the diagnosis. The present study consisted of 420 female patients presented with vaginal discharge with or without itching or disorient, investigated for urethral trichomoniasis who were compared to 50 females represented the control group. Each female was asked to collect first 10-20 ml of urine in a sterile screw capped bottle; the deposits were examined microscopically by: 1. Wet mount method for Trichomonas vaginalis. 2. Culture in a specific ready made culture media. At the same time high vaginal swabs were taken and examined by both wet mount and culture methods for vaginal trichomoniasis. Among 420 female patients examined for both urine sediments and vaginal swabs, 80 [19.04%] females were found to be positive for T. vaginalis by vaginal swabs. The parasite was seen either in the vagina alone in 39 [9.28%] or in the vagina and urethra in 41[9.76%], but it was never isolated from urethra alone. Trichomonas vaginalis is a common parasite of female urethra as well as of the vagina, the localization of this flagellate in the urethra may be responsible for the recurrence of vaginal infection, since it may survive in the urethra, possibly in the paraurethral glands [skene's] so when the treatment is limited to the vagina, this will often fail to reach the urethra and the trichomonads may contaminate the vagina following urination or serial intercourse, that is why systemic rather than local treatment is indicated

Tricomoníase: aspectos gerais e diagnóstico pela colpocitologia de papanicolaou / Trichomoniasis: general aspects and diagnosis by papanicolaou colpocytology

A tricomoníase, infecção causada pelo parasita Trichomonas vaginalis, é a doença sexualmente transmissível (DST) não viral mais comum no mundo. Existem evidências crescentes de que o parasita seja um importante patógeno, devido à morbidade direta associada a infecção, à sua função na promoção de ruptura prematura de membranas, parto prematuro e recém-natos de baixo peso, bem como por facilitar a transmissão do HIV e de outros agentes de DSTs. O número de mulheres sexualmente ativas que realizam periodicamente seu exame de Papanicolaou (Pap) é altamente significativo e a esta metodologia apresenta um grande potencial para o diagnóstico da tricomoníase, auxiliando no controle dessa infecção. Com isso, as bases morfológicas dessa patologia para o diagnóstico citológico devem ser cuidadosamente revisadas e conhecidas pelos citologistas, com o intuito de serem corretamente aplicadas e não ocorrerem diagnósticos pseudopositivos ou negativos, buscando auxiliar na maximização da eficiência morfológica. Dessa forma, o presente trabalho teve por intuito levantar aspectos gerais do parasita e infestação, bem como descrever de maneira completa os critérios citológicos de diagnóstico da tricomoníase...

Trichomoniasis / Trichomoniasis

Las trichomonas vaginales fueron descritas por primera vez por Donné en 1836, pero no es hasta 1950 que es relacionada con las enfermedades de transmisión sexual. Trichomonas vaginalis es el más sencillo de todos los parásitos protozoos. Sólo existe en forma de trofozoito. Es unicelular y cosmopolita y se localiza en el tracto genitourinario de la mujer y el hombre. Según la Organización Mundial de la Salud (OMS) se tiene un estimado anual de 180 000000 de personas afectadas en el planeta. Se asocia con cervicitis, colpitis, enfermedad inflamatoria pélvica y uretritis. Además de haberse encontrado relación con resultados perinatales desfavorables como: bajo peso al nacer, parto pretermino y sepsis perinatal. Otro aspecto de interes es su asociación con otras enfermedades de transmisión sexual, como las moniliasis, las vaginosis bacterianas, infecciones por HPV, VIH SIDA y papiloma virus. Muchos han sido los medios de diagnóstico utilizados para este protozoos desde las escuelas que la diagnóstican y tratan por la clínica hasta otro que han ido mas allá de los medios convencionales de diagnóstico y han creado clip de diagnósticos rápidos. Igualmente se han probado varios tipos de tratamientos, pero los que mejor resultados han dado son los que se logran con tratamientos con los 5 imidazoles; no obstante, hay ya evidencias que reportan pobres resultados perinatológicos en los casos que se trata la entidad, sobre todo si es en las formas asintomáticas

Use of PCR reactions (polymerase chain reaction) on Trichomonas vaginalis diagnosis in patients from Araraquara region (State of Säo Paulo, Brazil)

Trichomonas vaginalis é um protozoário flagelado da família TRICHOMONADIDAE, responsável por uma doença que ataca o sistema genito-urinário, causando, em mulheres, vaginites e cervicites, dentre outras complicaçöes, e, em homens, prostatites, uretrites e síndrome genito-urinárias menores. Em funçäo de que diagnósticos precisos säo uma importante ferramenta para o tratamento apropriado e prevençäo da transmissäo da doença,este trabalho possibilitou a padronizaçäo da reaçäo de PCR e avaliaçäo de seu emprego no diagnóstico deste parasita. Na padronizaçäo da reaçäo, utilizou-se DNA genômico de diferentes cepas de T. vaginalis mantidas em laboratório e o protocolo da PCR foi realizado de acordo com os parâmetros propostos por Riley e colaboradores. Secreçöes vaginais foram coletadas e amplificadas pela mesma metodologia. Cento e oitenta amostras clínicas foram analisadas por 3 métodos diferentes, o PCR e os métodos tradicionais exame a fresco e cultura do parasita em meio de Diamond. Dessas amostras, 6 foram positivas pela PCR, das quais duas foram detectadas apenas por PCR, uma por PCR e cultura, duas por PCR e exame fresco e uma pelos 3 métodos usados. Esses resultados demonstraram que a reaçäo de PCR pode ser convenientemente padronizada nas condiçöes do laboratório e seu uso efetivo como método diagnóstico de tricomoníase foi confirmado.

Detecção da tricomoníase através da colpocitologia de rotina / Detection of trichomoniasis through routine colpocytology

Trichomonas vaginalis causa doença sintomática ou assintomática no sistema genital feminino e masculino, sendo a detecção de tal infestação bastante sensível por meio da colpocitologia de Papanicolaou. Desta forma, este trabalho teve por objetivo avaliar através de exames colpocitológicos de rotina a freqüência de tricomoníase, as faixas etárias de maior prevalência, a freqüência de queixas de corrimentos vaginais e prurido vulvar, a flora bacteriana associada, e a intensidade das alterações celulares inflamatórias e da reação leucocitária. Foram analisadas 6129 amostras colpocitológicas coletadas de pacientes com idade entre 15 e 75 anos atendidas pelo setor de Citologia Clínica do Laboratório de Ensino e Pesquisa em Análises Clínicas (LEPAC) da Universidade Estadual de Maringá. Do total de amostras analisadas, 2,2 por cento (n=135) apresentaram infestação por tricomonas e a faixa etária mais acometida foi a de 26-30 anos. Das pacientes infectadas, 74 por cento queixaram-se de corrimento vaginal e 40,7 por cento de prurido vulvar. A intensidade da reação leucocitária mais incidente foi a acentuada em 74,3 por cento das amostras, o mesmo para as alterações celulares inflamatórias, cuja intensidade acentuada representou 59,3 por cento . A determinação da incidência de tricomoníase feminina e das faixas etárias mais acometidas é de extrema importância como base para a realização de futuros programas de saúde para controle desta parasitose. Com a determinação da freqüência de queixas de corrimento vaginal e prurido vulvar, das intensidades da reação leucocitária e das alterações celulares inflamatórias, bem como do tipo de flora bacteriana associada, ficou evidente que tais critérios são de grande relevância para a correta diagnose

Strategies by which some pathogenic trichomonads integrate diverse signals in the decision-marking process

The interaction between each one of Trichomonas vaginalis and Tritrichomonas foetus with their hosts is a complex process in which components associated to the cell surfaces of both parasites and host epithelial cells, and also to soluble components found in vaginal/urethral secretions, are involved. Either cytoadhesion or the cytotoxicity exerted by parasites to host cells can be dictated by virulence factors such as adhesins, cysteine proteinases, laminin-binding proteins, integrins, integrin-like molecules, a cell detachment factor, a pore-forming protein, and glycosidases among others. How trichomonads manipulate informations from the extracellular medium, transduce such informations, and respond to them by stimulating the activities of some surface molecules and/or releasing enzymes are the aspects concerning trichomonal virulence which are here briefly reviewed and discussed.

Prevalencia de vaginitis y vaginosis bacteriana en pacientes con flujo vaginal anormal en el Hospital Nacional Arzobispo Loayza / Prevalence of vaginitis and bacterial vaginosis in patient with abnormal vaginal discharge, at Hospital Arzobispo Loayza, Lima Peru

Objetivo: Determinar la prevalencia de vaginitis y vaginosis bacteriana en pacientes con flujo vaginal y su asociación con características clínicas y de laboratorio. Material y Métodos: Se llevó a cabo un estudio transversal. Se estudiaron 370 pacientes que acudieron a la consulta ginecológica del Hospital Nacional Arzobispo Loayza de enero a marzo de 1998. A todas las pacientes se les tomó muestras de flujo vaginal para la medición del pH, del test de amina y la identificación microscóoica de "células clave", trichomonas vaginalis, levaduras e hifas. Resultados: la prevalencia de infección vaginal fue de 42.2 por ciento; siendo vaginosis bacteriana la infección más frecuente (23.24 por ciento9, seguido de candidiasis vaginal (16.2 por ciento) y tricomoniasis vaginal (7.8 por ciento). Vaginosis bacteriana estuvo asociada a mal olor postcoidal, ausencia de signos inflamatorios en vagina, flujo vaginal blanquecino, lechosos, homogéneo y fétido. La candidiasis vaginal estuvo asociada a prurito, ardor vulvovaginal, eritema vulvar y vaginal, flujo vaginal amarillento, grumoso sin olor, test de amina negativo; así como ausencia de relaciones sexuales, ningún compañero sexual en el último año, ninguna gestación, una vida sexual menor de dos años y paridad de ninguno a un hijo. La tricomoniasis vaginal estuvo asociada a eritema vaginal, flujo vaginal amarillo verdoso, espumoso, homogéneo y fétido y test de amina positivo. Conclusión: Un diagnóstico correcto y portuno de las infecciones vaginales no debe basarse sólo en las características clínicas sino en la confirmación con métodos sencillos de laboratorio.