The prevalence of trichomoniasis and associated factors among women treated at a university hospital in southern Brazil

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Abstract

Background

Trichomoniasis is the most prevalent non-viral sexually transmitted disease (STD) in the world; however, it remains a neglected parasitic disease. This study aimed to determine the prevalence of trichomoniasis and its associated epidemiological factors among women treated at a hospital in southern Brazil.

Methodology/Principal findings

A cross-sectional study was performed to determine the prevalence of this infection in women treated at Hospital Universitário (HU) in Rio Grande, Rio Grande do Sul, Brazil, between January 2012 and January 2015. This study consisted a self-administered questionnaire regarding demographic, clinical, and behavioural data and a molecular diagnosis with polymerase chain reaction (PCR) using the TVK3/7 primer set, which was confirmed with sequence analysis. Of the 345 women surveyed, the overall prevalence of Trichomonas vaginalis ( T. vaginalis) was 4.1% (14/345). The prevalence rates were 5.9% among pregnant women, 8.5% among HIV-positive women, and 10.1% among HIV-positive pregnant women. The rates for groups with other significant demographic and clinical features were as follows: 6.6% among women with white skin, 12.3% among women with an income below the minimum monthly wage, 7.4% among women with a vaginal pH greater than or equal to 4.6, and 7.9% among women with a comorbid STD. The multivariate analysis confirmed that pregnant women who were HIV-positive (p = 0.001) and had low incomes (p = 0.026) were the most likely to have this infection.

Conclusions

A multivariate analysis confirmed that HIV-positive pregnant women with low incomes were the participants most likely to have trichomoniasis. These results are important because this Brazilian region presents a high prevalence of HIV-1 subtype C, which is associated with greater transmissibility. Additionally, low family income reveals a socioeconomic fragility that might favour the transmission of this STD.

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Most cited references 39

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Vaginal pH and Microbicidal Lactic Acid When Lactobacilli Dominate the Microbiota

Deirdre E. O’Hanlon, Thomas R Moench, Richard Cone (2013)

Lactic acid at sufficiently acidic pH is a potent microbicide, and lactic acid produced by vaginal lactobacilli may help protect against reproductive tract infections. However, previous observations likely underestimated healthy vaginal acidity and total lactate concentration since they failed to exclude women without a lactobacillus-dominated vaginal microbiota, and also did not account for the high carbon dioxide, low oxygen environment of the vagina. Fifty-six women with low (0-3) Nugent scores (indicating a lactobacillus-dominated vaginal microbiota) and no symptoms of reproductive tract disease or infection, provided a total of 64 cervicovaginal fluid samples using a collection method that avoided the need for sample dilution and rigorously minimized aerobic exposure. The pH of samples was measured by microelectrode immediately after collection and under a physiological vaginal concentration of CO2. Commercial enzymatic assays of total lactate and total acetate concentrations were validated for use in CVF, and compared to the more usual HPLC method. The average pH of the CVF samples was 3.5 ± 0.3 (mean ± SD), range 2.8-4.2, and the average total lactate was 1.0% ± 0.2% w/v; this is a five-fold higher average hydrogen ion concentration (lower pH) and a fivefold higher total lactate concentration than in the prior literature. The microbicidal form of lactic acid (protonated lactic acid) was therefore eleven-fold more concentrated, and a markedly more potent microbicide, than indicated by prior research. This suggests that when lactobacilli dominate the vaginal microbiota, women have significantly more lactic acid-mediated protection against infections than currently believed. Our results invite further evaluations of the prophylactic and therapeutic actions of vaginal lactic acid, whether provided in situ by endogenous lactobacilli, by probiotic lactobacilli, or by products that reinforce vaginal lactic acid.

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Clinical and microbiological aspects of Trichomonas vaginalis.

Dino Petrin, Kiera Delgaty, Renuka Bhatt … (1998)

Trichomonas vaginalis, a parasitic protozoan, is the etiologic agent of trichomoniasis, a sexually transmitted disease (STD) of worldwide importance. Trichomoniasis is the most common nonviral STD, and it is associated with many perinatal complications, male and female genitourinary tract infections, and an increased incidence of HIV transmission. Diagnosis is difficult, since the symptoms of trichomoniasis mimic those of other STDs and detection methods lack precision. Although current treatment protocols involving nitroimidazoles are curative, metronidazole resistance is on the rise, outlining the need for research into alternative antibiotics. Vaccine development has been limited by a lack of understanding of the role of the host immune response to T. vaginalis infection. The lack of a good animal model has made it difficult to conduct standardized studies in drug and vaccine development and pathogenesis. Current work on pathogenesis has focused on the host-parasite relationship, in particular the initial events required to establish infection. These studies have illustrated that the pathogenesis of T. vaginalis is indeed very complex and involves adhesion, hemolysis, and soluble factors such as cysteine proteinases and cell-detaching factor. T. vaginalis interaction with the members of the resident vaginal flora, an advanced immune evasion strategy, and certain stress responses enable the organism to survive in its changing environment. Clearly, further research and collaboration will help elucidate these pathogenic mechanisms, and with better knowledge will come improved disease control.

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A systematic review of the epidemiologic interactions between classic sexually transmitted diseases and HIV: how much really is known?

J Røttingen, D W Cameron, G Garnett (2001)

Many studies have explored the role of "classic" sexually transmitted diseases (STDs) in determining the pattern of HIV epidemics. However, the many different STDs may contribute in different ways, at different magnitudes. To review available studies on the bidirectional interactions of HIV and STDs to explore the extent of current knowledge on the different influences of the varied STDs in heterosexual HIV epidemics. Longitudinal studies on susceptibility and controlled studies on infectiousness and duration of disease identified on electronic databases through reference lists and citation indices up to the end of 1999 were systematically reviewed, including meta-analyses assessing the influence of STDs on susceptibility to HIV. Studies have a clear publication bias with a significant result that hinders robust interpretation. However, genital ulcerative disease appears to have a greater impact than nonulcerative disease, and men are more affected than women by the effects of STDs on susceptibility to HIV. There is evidence that STDs increase the infectiousness of HIV from men to women, whereas the evidence is more equivocal for the infectiousness of women. Few studies identify the impact of different STDs, and there is a marked lack of studies investigating the impact of HIV infection on the transmission of other STDs. A large body of work has measured the association between STDs and HIV. However, publication bias and gaps in the focus of studies mean that a detailed, quantitative understanding of the interaction requires much more attention.

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Author and article information

Contributors

Caroline Mitchell: Role: Editor

Journal

Journal ID (nlm-ta): PLoS One

Journal ID (iso-abbrev): PLoS ONE

Journal ID (publisher-id): plos

Journal ID (pmc): plosone

Title: PLoS ONE

Publisher: Public Library of Science (San Francisco, CA USA )

ISSN (Electronic): 1932-6203

Publication date (Electronic): 27 March 2017

Publication date Collection: 2017

Volume: 12

Issue: 3

Electronic Location Identifier: e0173604

Affiliations

[1 ]Laboratory of Parasitology, Medical School, Federal University of Rio Grande, Rio Grande do Sul, Brazil

[2 ]Laboratory of Molecular Biology, Medical School, Federal University of Rio Grande, Rio Grande do Sul, Brazil

[3 ]Obstetrics and Gynaecology Centre, University Hospital, Federal University of Rio Grande, Rio Grande do Sul, Brazil

Massachusetts General Hospital, UNITED STATES

Author notes

Competing Interests: The authors have declared that no competing interests exist.

Conceptualization: FAAG CVG CJS.
Data curation: FAAG CVG CJS.
Formal analysis: FAAG CVG CJS.
Investigation: FAAG EC FSRG PCS GBK GRO AVG AMBM CVG CJS.
Methodology: FAAG AVG AMBM CVG CJS.
Project administration: FAAG AVG CVG CJS.
Resources: FAAG EC FSRG GBK GRO.
Supervision: FAAG CVG CJS.
Validation: FAAG EC FSRG PCS GBK GRO AVG AMBM CVG CJS.
Writing – original draft: FAAG CVG CJS.
Writing – review & editing: FAAG PCS AVG CVG CJS.

* E-mail: fafagatti@ 123456gmail.com

Author information

Fabiane Aguiar dos Anjos Gatti http://orcid.org/0000-0002-1477-9022

Article

Publisher ID: PONE-D-16-29144

DOI: 10.1371/journal.pone.0173604

PMC ID: 5367685

PubMed ID: 28346531

SO-VID: 356470f5-1cd2-4f35-b9cc-d8fa8ffcbb1f

License:

This is an open access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited.

History

Date received : 20 July 2016

Date accepted : 23 February 2017

Page count

Figures: 0, Tables: 5, Pages: 11

Funding

The author(s) received no specific funding for this work.

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The prevalence of trichomoniasis and associated factors among women treated at a university hospital in southern Brazil

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Most cited references 39

Vaginal pH and Microbicidal Lactic Acid When Lactobacilli Dominate the Microbiota

Clinical and microbiological aspects of Trichomonas vaginalis.

A systematic review of the epidemiologic interactions between classic sexually transmitted diseases and HIV: how much really is known?

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