Vaginitis: Review on Drug Resistance.

Female genital tract infections have a high incidence among different age groups and represent an important impact on public health. Among them, vaginitis refers to inflammation of the vulva and/or vagina due to the presence of pathogens that cause trichomoniasis, bacterial vaginosis, and vulvovaginal candidiasis. Several discomforts are associated with these infections, as well as pregnancy complications and the facilitation of HIV transmission and acquisition. The increasing resistance of microorganisms to drugs used in therapy is remarkable, since women report the recurrence of these infections and associated comorbidities. Different resistant mechanisms already described for the drugs used in the therapy against Trichomonas vaginalis, Candida spp., and Gardnerella vaginalis, as well as aspects related to pathogenesis and treatment, are discussed in this review. This study aims to contribute to drug design, avoiding therapy ineffectiveness due to drug resistance. Effective alternative therapies to treat vaginitis will reduce the recurrence of infections and, consequently, the high costs generated in the health system, improving women's well-being.

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

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.

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.

Prevalence and genetic diversity of Trichomonas vaginalis in the general population of Granada and co-infections with Gardnerella vaginalis and Candida species.

PURPOSE: Purulent or exudative genitourinary infections are a frequent cause of consultation in primary and specialized healthcare. The objectives of this study were: to determine the prevalence of Trichomonas vaginalis and co-infections with Candida spp. and Gardnerella vaginalis in vaginal secretion; and to use multilocus sequence typing (MLST) to analyse the genetic diversity of T. vaginalis strains. METHODOLOGY: The samples were submitted for analysis (n=5230) to a third-level hospital in Granada (Southern Spain) between 2011 and 2014; eight T. vaginalis strains isolated during 2015 were randomly selected for MLST analysis. Culture and nucleic acid hybridization techniques were used to detect microorganisms in the samples. RESULTS: The prevalence of T. vaginalis was 2.4 % between 2011 and 2014, being higher during the first few months of both 2011 and 2012. Among samples positive for T. vaginalis, co-infection with G. vaginalis was detected in 29 samples and co-infection with Candida spp. in 6, while co-infection with all three pathogens was observed in 3 samples. The only statistically significant between-year difference in co-infection rates was observed for T. vaginalis with G. vaginalis due to an elevated rate in 2011. MLST analysis results demonstrated a high genetic variability among strains circulating in our setting. CONCLUSION: These findings emphasize the need for the routine application of diagnostic procedures to avoid the spread of this sexually transmitted infection.

Trichocystatin-2 (TC-2): an endogenous inhibitor of cysteine proteinases in Trichomonas vaginalis is associated with TvCP39.

The causal agent of trichomoniasis is a parasitic protist, Trichomonas vaginalis, which is rich in proteolytic activity, primarily carried out by cysteine proteases (CPs). Some CPs are known virulence factors. T. vaginalis also possesses three genes encoding endogenous cystatin-like CP inhibitors. The aim of this study was to identify and characterize one of these CP inhibitors. Using two-dimensional gel electrophoresis (2-DE) and mass spectrometry (MS), a cystatin-like peptidase inhibitor dubbed Trichocystatin-2 (TC-2) was identified in the T. vaginalis active degradome in association with TvCP39, a 39kDa CP involved in cytotoxicity. To characterize the TC-2 inhibitor, we cloned and expressed the tvicp-2 gene, purified the recombinant protein (TC-2r), and produced a specific polyclonal antibody (α-TC-2r). This antibody recognized a 10kDa protein band by western blotting. An indirect immunofluorescence assay (IFA) and cell fractionation assays using the α-TC-2r antibody showed that TC-2 was localized in the cytoplasm and lysosomes and that it colocalized with TvCP39. TC-2r showed inhibitory activity against papain, cathepsin-L, and TvCP39 in trichomonad extracts and live parasites but not legumain-like CPs. Live trichomonads treated with TC-2r showed reduced trichomonal cytotoxicity to HeLa cell monolayers in a TC-2r-concentration-dependent manner. In this study, we identified and characterized an endogenous cystatin-like inhibitor in T. vaginalis, TC-2, which is associated with TvCP39 and appears to regulate the cellular damage caused by T. vaginalis.

Identification and characterization of the immunogenic cytotoxic TvCP39 proteinase gene of Trichomonas vaginalis.

TvCP39 is a 39 kDa cysteine proteinase (CP) involved in Trichomonas vaginalis cytotoxicity that has been found in vaginal secretions and is immunogenic in patients with trichomonosis. The goal of this work was to identify, clone, express, and characterize the tvcp39 gene. The tvcp39 gene was identified using a proteomic approach, and the complete gene was amplified using PCR, cloned, and sequenced. TvCP39 is encoded by a 915-bp cathepsin L-like CP gene. A fragment corresponding to the mature region (TvCP39r) was expressed, purified, and used to produce rabbit polyclonal antibodies and in functional assays. In one- and two-dimensional western blot assays, the anti-TvCP39r antibody reacted with two protein bands of ~28 and 27 kDa and three spots of ~28, 27, and 24 kDa in trichomonad proteinase-rich extracts that could correspond to the mature and processed fragments of the TvCP39 peptidase. The anti-TvCP39r antibody reacted with the parasitic surface and the native TvCP39 present in vaginal washes from patients with trichomonosis. Moreover, the recombinant TvCP39 protein bound to the surface of HeLa cells and protected HeLa cell monolayers from trichomonal destruction in a concentration-dependent manner. In conclusion, our data support TvCP39 as one of the surface proteinases that is glycosylated and is involved in trichomonal cytotoxicity. Thus, TvCP39 is the first glycosylated cysteine proteinase detected in T. vaginalis.

Incidencia de infecciones vaginales diagnósticadas por citolog¡a cervicovaginal: en mujeres mayores de 40 años: Hospital Miliar Dr. Carlos Arvelo / Incidence of vaginal infections diagnosed by cervicovaginal cytology in women older than 40 years: Hospital Militar Dr. Carlos Arvelo

Las infecciones son probablemente, la patología más frecuente de consulta en ginecología. La abundante y molesta sintomatología que suele acompañar a estos procesos lleva a la mujer a consultar con su médico. Las infecciones vaginales o vaginitis se puede ocasionar por virus, bacterias, hongos o parásitos, estos gérmenes pueden estar en la vagina solos o asociados. Clínicamente pueden distinguirse según los síntomas y signos, pero el diagnóstico definitivo se establece por citología y/o microbiología. Los cambios hormonales durante la pubertad, en la adolescencia, el ambarazo y la menopausia, predisponen a la mujer a contraer vaginitis, al igual que la falta de higiene adecuada, sensibilidad a ciertos jabones, utilización de anticonceptivos, entre otros. En este tarbajo se presenta la casuística de esta patología en las pacientes examinadas entre enero y diciembre de 2004 en el Departamento de Ginecología y Obstetricia de nuestro hospital.

[Trichomonas in pleural empyema]. / Trichomonas en un empiema pleural.

Trichomonas sp. was found in a patient with empyema and chronic obstructive pulmonary disease. This is a uncommon finding. A wet mount of pleural fluid is recommended to be observed by light microscopy.

Trichomonas en un empiema pleural / Trichomonas in pleural empyema

Trichomonas sp. was found in a patient with empyema and chronic obstructive pulmonary disease. This is a uncommon finding. A wet mount of pleural fluid is recommended to be observed by light microscopy

[280 patients with urethritis]. / Estudio de 280 pacientes con uretritis.

A study of 280 male patients with urethritis is presented. The frequency of infections caused by Neisseria gonorrhoeae, Trichomonas vaginalis, Candida albicans and Mycoplasma "T" is reported. Some clinical characteristics of patients regarding the type of urethritis are described. Literature on non-gonoccal urethritis is reviewed.