T. Vaginalis Research Articles

Adolescent Girls and Young Women in Kenya Demonstrate Rapid STI Incidence Following First Sex: Data From a Longitudinal Cohort

PurposeAdolescent girls and young women (AGYW) are disproportionately affected by STIs. Observation of life course events can describe behavioral and biological factors associated with STI risk. MethodsSexually inexperienced AGYW aged 16–20 years in Kenya were followed for five years. Quarterly visits assessed for C. trachomatis (CT), N. gonorrhea (GC), and T. vaginalis (TV), bacterial vaginosis (BV), HSV-2, and HIV. Sexual activity was self-reported but amended if incongruent with results from STI, pregnancy, or any other testing. Cox regression and Generalized Estimating Equation models were used to determine hazard ratios (HRs) and relative risks (RRs) of STI. ResultsDuring follow-up, 293 of 400 participants reported sex, 163 AGYW experienced an STI, and 72 participants had multiple STIs. Among 163 participants that experienced an STI, there were a total of 259 visits where STIs were detected, 78% (n = 201) of which included CT. Cox regression found participants with BV had over two-fold higher risk of first STI acquisition (adjusted hazard ratio (aHR): 2.35; 95% confidence interval (CI) 1.43–3.88; p = .001). Increased risk for first STI episode was associated with a new partner (aHR: 3.16; 95% CI 1.59–6.28; p = .001). AGYW who did not disclose sexual activity had the highest risk (aHR: 3.60; 95% CI 1.93–6.70; p < .001). Condom use was low, with 21% reporting condom use with sex. GEE analysis of all STIs including incident, prevalent, and recurrent, confirmed these risk factors. DiscussionDuring the critical years after first sex, AGYW with BV, new sexual partners, and those who did not disclose sexual activity were at highest risk for STI events, especially CT.

Prevalence and risk factors for Trichomonas vaginalis infection in pregnant women in South Africa.

There are insufficient data on the prevalence of Trichomonas vaginalis infection in pregnant women in South Africa. The present study aims to determine the prevalence of T. vaginalis (TV) in pregnant women and identify the risk factors associated with this infection in pregnancy. This was a cross-sectional study which included 362 pregnant women attending the antenatal clinic at the King Edward VIII Hospital in Durban, South Africa. A self-collected vaginal swab was provided by the enrolled women for laboratory diagnosis by real-time polymerase chain reaction. The protozoan load was determined as the logarithm of gene copies per milliliter. The prevalence of TV infection was 12.9% and 59.6% of the women who tested positive were asymptomatic ( p = 0.011). Women who presented with abnormal vaginal discharge had a 4.6 times likelihood of testing positive for TV infection (odds ratio 4.62; 95% confidence interval 1.83 to 11.70; p = 0.001). TV infection was high amongst pregnant women. Therefore, routine testing for this sexually transmitted infection is encouraged for proper management.

Aberrant cervical innate immunity predicts onset of dysbiosis and sexually transmitted infections in women of reproductive age.

Sexually transmitted infections (STIs) and vaginal dysbiosis (disturbed resident microbiota presenting with abnormal Nugent score or candidiasis) have been associated with mucosal inflammation and risk of HIV-1 infection, cancer and poor reproductive outcomes. To date, the temporal relationships between aberrant cervical innate immunity and the clinical onset of microbial disturbance have not been studied in a large population of reproductive age women. We examined data from a longitudinal cohort of 934 Ugandan and Zimbabwean women contributing 3,274 HIV-negative visits who had complete laboratory, clinical and demographic data. Among those, 207 women later acquired HIV, and 584 women were intermittently diagnosed with C. trachomatis (CT), N. gonorrhoeae (NG), genital herpes (HSV-2), T. vaginalis (TV), candidiasis, and abnormal intermediate (4–6) or high (7–10) Nugent score, i.e. bacterial vaginosis (BV). Immune biomarker concentrations in cervical swabs were analyzed by generalized linear and mixed effect models adjusting for site, age, hormonal contraceptive use (HC), pregnancy, breastfeeding, genital practices, unprotected sex and overlapping infections. High likelihood ratios (1.5–4.9) denoted the values of cervical immune biomarkers to predict onset of abnormal Nugent score and candidiasis at the next visits. When controlling for covariates, higher levels of β-defensin-2 were antecedent to BV, CT and HSV-2, lower anti-inflammatory ratio IL-1RA:IL-1β–to intermediate Nugent scores and candida, lower levels of the serine protease inhibitor SLPI–to candida, lower levels of the adhesion molecule ICAM-1 –to TV, and lower levels of the oxidative stress mitigator and endothelial activation marker VEGF–to NG. Changes in innate immunity following onset of dysbiosis and infections were dependent on HC use when controlling for all other covariates. In conclusion, imminent female genital tract dysbiosis or infection can be predicted by distinct patterns of innate immunity. Future research should characterize biotic and abiotic determinants of this pre-existing innate immunity state.

Clinical Evaluation of the Cepheid Xpert TV Assay for Detection of Trichomonas vaginalis with Prospectively Collected Specimens from Men and Women

ABSTRACTTrichomoniasis is the most prevalent curable sexually transmitted disease (STD). It has been associated with preterm birth and the acquisition and transmission of HIV. Recently, nucleic acid amplification tests (NAAT) have been FDA cleared in the United States for detection of Trichomonas vaginalis in specimens from both women and men. This study reports the results of a multicenter study recently conducted using the Xpert TV (T. vaginalis) assay to test specimens from both men and women. On-demand results were available in as little as 40 min for positive specimens. A total of 1,867 women and 4,791 men were eligible for inclusion in the analysis. In women, the performance of the Xpert TV assay was compared to the patient infected status (PIS) derived from the results of InPouch TV broth culture and Aptima NAAT for T. vaginalis. The diagnostic sensitivities and specificities of the Xpert TV assay for the combined female specimens (urine samples, self-collected vaginal swabs, and endocervical swabs) ranged from 99.5 to 100% and 99.4 to 99.9%, respectively. For male urine samples, the diagnostic sensitivity and specificity were 97.2% and 99.9%, respectively, compared to PIS results derived from the results of broth culture for T. vaginalis and bidirectional gene sequencing of amplicons. Excellent performance characteristics were seen using both female and male specimens. The ease of using the Xpert TV assay should result in opportunities for enhanced screening for T. vaginalis in both men and women and, hopefully, improved control of this infection.

P08.08 Expanding the macaque model oftrichomonas vaginalisinfection

Introduction The pigtailed macaque model for trichomonal infection was used to compare T. vaginalis (TV) detection technologies, to describe infection status in younger versus older populations, and to test whether TV reinfection after antibiotic clearance is possible in this model. Methods Thirty-six macaques received a single vaginal TV inoculation (ATCC 50148; ~6E5), followed by five weekly visits to document infection. Eighteen animals were 4–7 years old; eighteen were over 13 years old. Infection status was documented by culture (InPouchTV) and by NAAT (AptimaTV). Colposcopy was performed to assess tissue reaction to infection. Animals underwent antibiotic treatment (metronidazole) and test-of-cure. Five macaques from the younger cohort were later re-inoculated with the same TV strain and followed for three weeks to document reinfection. Results All but one (older) animal were successfully infected after the initial vaginal challenge. Among 295 matched samples (culture/NAAT), 22 did not share confirmatory results. In this experimental setting, with weekly vaginal swabs providing a timeline of trichomonal presence in each animal, we can infer infectious status for some discrepant samples. It is likely that 10–12 instances can be attributed to false culture readings, and 3–5 to false NAAT results. Self-limited infections were noted more frequently among younger macaques. Friable tissue was noted more frequently among older animals. Four of the five animals that were re-challenged with TV developed infection. Conclusions The NAAT gave fewer false results, when we had the luxury of a timeline of serial samples to refer to for determining test accuracy. Similar infection rates were observed in both age cohorts. Older animals had a greater incidence of cervicovaginal irritation evidenced primarily by friability in this study, and younger animals tended to self-clear T. vaginalis infection faster than older animals. Finally, TV re-infection is possible in the macaque model. Disclosure of interest statement This research was supported by NIH Contract Number HHSN266200700013C and by the Office of Research Infrastructure Programs (ORIP) of the National Institutes of Health through Grant Number P51 OD010425 Washington National Primate Research Centre. No pharmaceutical grants were received in the development of this study.

P04.20 Incident sexually transmitted infection and post-infection partner change

Introduction Sex partner change is necessary to maintain STI within a population. However, most people change partners relatively infrequently, and the timing of partner changes relative to incident STI is poorly understood. Methods 272 participants without STI at enrollment (18–29 years of age; 126 (46%) men/146 (54%) women) from a high STI population completed a 12-week study of daily reports of partner-specific sexual behaviours. None reported commercial sex work. Weekly self-obtained vaginal or urine samples were tested (and treated, if positive) at the end of 12-weeks for C trachomatis (CT), N gonorrhoeae (GC), and T vaginalis (TV) using commercially available NAAT. Survival analysis techniques were used to describe time to first partner change following first NAAT+. Results 15, 12, and 23 participants acquired an incident CT+, GC+, or TV+ NAAT. Partner change after the first NAAT+ test was seen for 7 (47%), 6 (50%), and 3 (13%) participants with CT+, GC+, or TV+ NAAT, respectively. Median time to partner change after first NAAT+ 7.6 and 4.6 weeks following CT+ or GC+, respectively. Among 231 participants with no incident NAAT+ during 12 weeks of followup, 89 (39%) changed partners. Conclusion Persons with incident STI have higher rates of partner change than those without incident STI. Rapid partner change is common following a new CT or GC infection, but less common for TV. Interventions focused on short-term partner change could be especially effective approaches to CT and GC control efforts. Disclosure of interest statement This research was funded by the National Institute of Child Health and Human Development. The authors have no relevant conflict of interest to disclose.

P14.17 Surveillance for sexually transmitted infections among female sex workers in inner-city johannesburg

Introduction Sexually transmitted infection (STI) surveillance informs empiric antibiotic recommendations for syndromic management. Asymptomatic STIs are an important source of new infections which increase the risk of HIV transmission and acquisition. As female sex-workers (FSW) are key HIV/STI transmitters, microbiological studies within this population provide critical HIV/STI strategic information. Methods Female sex workers (FSW) attending a sex-worker clinic or outreach brothel services, between March and December 2014 in inner-city Johannesburg were enrolled. A questionnaire and clinical examination were completed. Specimens were collected from the throat, urethra, cervix, vagina and rectum. Laboratory investigations included (i) culture for Neisseria gonorrhoeae (NG) with susceptibility testing for cefixime and ceftriaxone, (ii) DNA amplification using a multiplex PCR for NG, C. trachomatis (CT), M. genitalium (MG) and T. vaginalis (TV), (iii) microscopic examination for bacterial vaginosis (BV), and (iv) serological testing for syphilis, hepatitis B and HIV. Participants with STIs were treated either at the initial visit (symptomatics) or following recall (asymptomatics). Results The mean age of the 268 enrolled FSW was 31.5(IQR 27–35) and mean duration of sex work was 4.9 years (range 2 months–30 years). Condom use was consistent among 88(32.8%) FSW. The self-reported mean number of sexual partners in the past 4 weeks was 125(range 8–440) translating to 33,496 sex acts/month overall. HIV prevalence was 76.0%. Infectious hepatitis B was present in 13 (4.9%) and treponemal antibodies were detected in 54(20.1%). Most (73.7%) of 196 FSW tested had evidence of one or more genital tract infection with: BV 173 (88.3%), MG 57 (29.1%), NG 28 (14.3%), TV 23 (11.7%) and CT 16 (8.2%). Only 49 (25%) FSW with laboratory-confirmed infections would qualify for syndromic management. All 21 cultured gonococci were susceptible to cephalosporins. Conclusion There is a high prevalence of HIV and STIs among those FSW tested. The majority of STIs are asymptomatic. Disclosure of interest statement The study was funded by USAID/PEPFAR and AIDS Fonds. SD bioline tests were provided by SD diagnostics.

P3.347 Estimated Prevalence of T. Vaginalis and C. Trachomatis Among Young Adults: A Local Perspective

BackgroundScreening for C. trachomatis in the U.S. is recommended among women 25 years of age and younger. T. vaginalis (TV) is not a reportable disease, but has been associated with...

O06.6 A Randomised, Double-Blind, Controlled Study to Assess the Efficacy and Safety of Nifuratel in the Treatment of Trichomoniasis

BackgroundTrichomoniasis is the most prevalent non-viral sexually transmitted disease and there is a clear need for identifying oral therapies that are effective against 5-nitroimidazole-resistant T. vaginalis (TV) infections. A randomised,...

Prevalence and predictors of cervicitis in female sex workers in Peru: an observational study

BackgroundCervicitis is a syndrome of cervical inflammation and a common condition in female sex workers (FSW), a subpopulation vulnerable to sexually transmitted infections. Local data is essential for guiding syndromic management of cervicitis in FSW working in Peru. We sought to describe the prevalence and etiologies of cervicitis in this population. We also aimed to identify sociodemographic, behavioral and biological factors associated with cervicitis, including bacterial vaginosis (BV), a condition with a possible role in cervicitis.MethodsFSW 18 years of age or older presenting to a free public sexual health clinic in Callao-Lima, Peru were eligible for inclusion upon consent. 467 participants completed a face-to-face questionnaire and underwent genital examination. Vaginal, endocervical and blood samples were collected and tested for C. trachomatis (CT), N. gonorrhea (GC), T. vaginalis (TV), BV, HIV and Human T-Cell Lymphotropic Virus −1. Logistic regression was used to determine whether sociodemographic, behavioral, or other sexual health related characteristics were associated with the diagnosis of cervicitis.ResultsCervicitis was detected in 99 (24.9%) of 397 FSW. The presence of cervicitis was unable to be determined in 70 participants. In women with cervicitis, CT was present in 4.6% (4/87), TV in 4.0% (4/99), GC in 0% (0/87) and no pathogen was detected on cervical microbiology in 91.9% (91/99). BV was detected on vaginal microbiology in 36.9% (31/84) of cervicitis cases. BV was more common in women with cervicitis, however this association did not reach statistical significance (aOR = 1.47 [0.87, 2.48], p = 0.15). Other STI were not associated with cervicitis. Regular clinic attendance (aOR = 0.54 [0.34, 0.87], p = 0.01) and Ecuadorian nationality (aOR = 0.31 [0.13, 0.76], p = 0.01) were associated with reduced risk of cervicitis.ConclusionsCervicitis was common in FSW working Peru and was predominantly nongonococcal and non-chlamydial in etiology. Further study is warranted to clarify the role of BV and other emerging cervicitis pathogens in this population. The current Peruvian program of free health checks for FSW may be effective for reducing rates of cervicitis. The protective effect of Ecuadorian nationality prompts further study.

APTIMA® Trichomonas vaginalis, a transcription-mediated amplification assay for detection of Trichomonas vaginalis in urogenital specimens

The APTIMA®Trichomonas vaginalis (APTIMA TV; Gen-Probe Inc.) assay is the only amplification-based assay for T. vaginalis (TV) currently cleared by the US FDA. The assay was cleared in April 2011. APTIMA TV utilizes target capture specimen processing, transcription-mediated amplification and chemiluminescent probe hybridization for the qualitative detection of TV ribosomal RNA. The assay is used for the screening/diagnosis of trichomoniasis in women. Specimen types that can be used include physician-collected endocervical swabs, vaginal swabs, endocervical specimens collected in PreservCyt® (Thin Prep, Hologic Incorporated, MA, USA) solution and female urine specimens. The APTIMA TV assay has shown superior performance in side-by-side comparisons with other diagnostic methods in all patient populations and specimen types tested. Clinical sensitivity and specificity are >95 and 98%, respectively. The APTIMA TV assay fills a significant void in sexually transmitted infection diagnostics.

O1-S05.04 Increased risk for Trichomonas vaginalis in an urban population of young adults

BackgroundThe epidemiology of T vaginalis (TV) in the general population is not well understood, although it is reported to be the most common curable sexually transmitted infection worldwide. Surveillance data...

LBP-1.04 International validation of AmpliSens NAAT systems manufactured in Russia for diagnosis of Neisseria gonorrhoeae, Chlamydia trachomatis, Mycoplasma genitalium and Trichomonas vaginalis

ObjectivesData regarding the performance characteristics of STI diagnostic tests used in Eastern Europe are very scarce. The objective of this study was to validate the AmpliSens test systems (Central Research...

P3-S1.23 Mycoplasma genitalium in South African men with and without symptoms of urethritis: diagnosis and bacterial load

ObjectivesTo diagnose causes of urethritis in symptomatic men and evaluate the role of Mycoplasma genitalium by calculating bacterial loads in urine specimens from symptomatic and asymptomatic men.MethodsUrine specimens from 94...

Comparison of APTIMA Trichomonas vaginalis transcription-mediated amplification to wet mount microscopy, culture, and polymerase chain reaction for diagnosis of trichomoniasis in men and women

We evaluated the performance characteristics of APTIMA Trichomonas vaginalis (ATV) transcription-mediated amplification (TMA) for diagnosis of T vaginalis (TV) infection from female vaginal swab, endocervical swab, and urine specimens and from male urethral swab and urine specimens. Performance of ATV TMA was compared with wet mount microscopy, culture, and polymerase chain reaction (PCR). In all, 296 female and 298 male subjects who attended the Jefferson County Health Department sexually transmitted diseases clinic were enrolled in the study and provided specimens for each test. Results were analyzed using 3 interpretative algorithms. For women, vaginal swab ATV TMA was significantly more sensitive than wet mount or culture. In male subjects, urethral swab ATV TMA was significantly more sensitive than culture or PCR. ATV TMA provides a sensitive, commercially available nucleic acid amplification test for improved diagnosis of TV in male and female patients.