Unusually high prevalence of Trichomonas vaginalis observed in pre-/perimenopausal women

Substantial population of older women harbor Trichomonas vaginalis without being aware of the infection reports the results of retrospective observational study to be published in the American Journal of Obstetrics & Gynecology.

As women progress into pre- and perimenopausal years, the prevalence of T. vaginalis increases, with the highest incidence found around 47 to 53 years of age, while the prevalence of Chlamydia trachomatis peaks around 10 years to 27 years and then slowly declined.

Quantitative real-time polymerase chain reactions were used in analyzing 1,554,966 and 1,999,077 cervicovaginal samples collected during gynecological examinations from women aged 10 to 79 years  for presence of T. vaginalis and C trachomatis, respectively. 

It was seen that T. vaginalis has a bimodal distribution with the first peak at age 22 years (4.1%) and another at age 48 (5.8%).  The prevalence of T. vaginalis also remained high at 4% in women aged 54 to 60 years.

A state-wide analysis showed that Mississippi (9.0%) has the highest prevalence for T. vaginalis while C.trachomatis was most common in Maine(6.4%).

This study is important because T. vaginalis is most common non-viral sexually transmitted disease but the physicians are not required to report the cases. Hence, not much is known about it distribution and prevalence.  

In about 1.5% T. vaginalis positive specimens were associated with ntr6_TV polymorphism, but it was not related to the age distribution pattern seen in the study.

The authors concluded that it may be good idea to test older women for T. vaginalis infection, who are least suspected of harboring a sexually transmitted infection.

Abstract

Media Courtesy: http://araratnews.am/medical-trichomonas/?lang=en

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New use of old drug: Sildenafil Citrate (Viagra) improves amniotic fluid index in oligohydramnios.

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Link to the article: https://obgynupdated.blogspot.com/2017/03/new-use-of-old-drug-sildenafil-citrate.html

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Link to the article: https://obgynupdated.blogspot.com/2017/03/ethicon-enseal-x1-large-jaw-tissue.html

Trichomonas vaginalis Infection: Is it time to reconsider the single dose treatment?

Women receiving the recommended single dose therapy for Trichomonas vaginalis are 1.8 times more likely to have relapse of infection as compared to women receiving multi dose treatment says results of a recent Meta-analysis published in Journal of American Sexually Transmitted Disease Association.

Link to the article: https://obgynupdated.blogspot.com/2017/03/trichomonas-vaginalis-infection-is-it.html

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The U.S. Food and Drug Administration today approved Noctiva (desmopressin acetate) nasal spray for adults who have to go for urination at least two times per night, a condition known as nocturnal polyuria. [1]

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Link to the article: https://obgynupdated.blogspot.com/2017/03/fda-approves-noctiva-first-treatment.html

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Link to the article: https://obgynupdated.blogspot.com/2017/03/biodegradable-sanitary-napkins-from.html

Trichomonas vaginalis Infection: Is it time to reconsider the single dose treatment ?

Pap Test-Trichomonas

Women receiving the recommended single dose therapy for Trichomonas vaginalis are 1.8 times more likely to have relapse of infection as compared to women receiving multi dose treatment says results of a recent Meta-analysis published in Journal of American Sexually Transmitted Disease Association.

Trichomonas vaginalis

Trichomonas vaginalis (TV) is the most common nonviral sexually transmitted infection in US and worldwide. It is an important public health problem because it acts as a facilitator for HIV transmission, besides other reproductive morbidities like PROM, preterm delivery and low birth weight.

WHO estimated that there occurred 276.4 million cases of Trichomonas globally in 2008, with 90% of these occurring in low resource population.[1] In the United States, an estimated 3.7 million people have trichomoniasis.[2]

Since, 40 years, Metronidazole has been the corner stone for treatment of TV infection along with tinidazole (TNZ) and seconidazole.

The World Health Organization (WHO) and the United States Centers for Disease Control and Prevention (CDC) guidelines for treatment of TV include: MTZ or TNZ 2 gm single dose as the recommended regimens, and MTZ 500 mg BID 7-day dose as the alternative treatment regimen.[3] 

CDC also advocates “Concurrent treatment of all sex partners is critical for symptomatic relief, microbiologic cure, and prevention of transmission and reinfections.”

The Meta- analysis found 487 articles that were relevant to study criteria. Out of which 6 were included in the final analysis.

The pooled data analysis of nearly 1,300 participants showed 1.87 times the risk of treatment failure in women that were treated with single dose of Metronidazole as compared to multi dose. (95% confidence interval, 1.23–2.82; P < 0.01).

The study has many drawbacks of including studies conducted at least 30 years back and the diagnosis of T.vaginalis infection made with saline microscopy instead of culture or DNA testing. The study also did not follow whether the sexual partner was adequately treated.

The authors advocate the need of more recent   RCTs utilizing modern diagnostic techniques and keeping records of partner follow up.But, for the time being until such studies are conducted, the authors conclude that the same multi dose treatment strategy should be applied to women without HIV infection to prevent relapse instead of single dose regimen.

The current guidelines recommend different dosing strategy for HIV patients infected with TV. As per CDC “women with HIV infection who receive a diagnosis of T. vaginalis infection should be treated with metronidazole 500 mg orally twice daily for 7 days (rather than with a 2-g single dose of metronidazole).

The abstract of the article can be accessed here.

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[1] World Health Organization W. Global incidence and prevalence of selected curable sexually transmitted infections. 2008. ISBN 978 92 4 150383 9 accessed online on March 5, 2017

[2] https://www.cdc.gov/std/trichomonas/stats.htm accessed online on March 5, 2017

[3] https://www.cdc.gov/std/tg2015/trichomoniasis.htm