Trichomoniasis
PATHOGENIC MICROBIOLOGY
IMMUNOLOGY
MICROBIAL GENETICS
Symptoms
For men
smeeling vaginal discharge-white,gray,yellow
genital redness,burning and itching
pain in urination
pain when sexual intercouse
For women
itching or irritation inside the penis
burning after urination or ejaculation
discharge from penis
urgue to urinate frequently
How pathogen evades
Mucus is lowest in complement and during menses the blood plasma has the lowest levels of complement
Although cysteine proteases degrade the C3 portion of complement on the trichomonad surface the organism is protected against the lytic effects of complement.
Cysteine proteases also degrade IgG, IgM and IgA, which blunts the antibody response.
T. vaginalis secretes highly immunogenic soluble antigens and these may neutralize antibody or cytotoxic T cells.
T. vaginalis is able to become “invisible” to the immune system by coating its surface with host plasma proteins.
How is the disease transmitted
Transmitted sexually from one person to another person Through penis to vagina or the other around and from vulva to vulva
Spreads through semen, pre-cum & Vaginal fluid that get on or enters inside of the genital organ (Planned Parenthood,2018)
Humans are the only natural host of Trichomonas vaginalis
Non-sexual transmission: contaminated toilet seats or any other pathways that allows the Trichomonas find their way into the genital organ
In rare cases, T.vaginalis can be found in semen in urine or even in the swimming pool after hours of expansion
Through pregnant women: infects the newborn babies of the infected mother where T.vaginalis attacks the urinary tract of the baby or even cause vaginal infection to the child.
Epidemiology
In the United States, an estimated 3.7 million people have the infection. However, only about 30% develop any symptoms of trichomoniasis.
Infection is more common in women than in men.
Older women are more likely than younger women to have been infected with trichomoniasis because of low immunity in an older women.
War between the pathogen and host
What immune respones involves
Detection using immunology method
Immunoinflammatory response in pregnant woman towards T.vaginalis
neutrophils and vaginal cytokine protein (interleukin-1 beta) increases
anti inflammatory mediators (leukocyte protease inhibitor) decreases
Increase in nitrogen intermediates production
Immunity in vivo & in vitro
increase in IgA,IgG, t-lymphocytes (th-1 cytokines) & increase in production of nitrogen intermediates
However immunity won't last long
this is due to T.vaginalis that have cystein proteases and the cystein proteases in the vaginal secretion degrades the antibody
the cystein proteases induces apoptosis in the vaginal epithelial cell.
Treatment
Medication
Pills consumption by mouth
Safe for pregnant women
Treated patient can be reinfected. To avoid getting reinfected, make sure that all your sex partners has undergone the treatment
Wait for 7-10 days after getting treatment to have sex again
Single dose of prescription antibiotic medication
Metronidazole - 2 g orally in a single dose (recommended)
Tinidazole - 2 g orally in a single dose (recommended)
Metronidazole - 500 mg orally twice a day for 7 days (alternative)
T. vaginalis destroys epithelial cells by direct contact and by release of cytotoxic substances, to colonize the human host
T. vaginalis binds to host plasma proteins, thereby preventing recognition by the alternative complement pathway and by host proteinases
Infection by T. vaginalis increases vaginal pH, and also the number of polymorphonuclear leukocytes, PMNs ( type of white blood cell and predominant host defense mechanism )
Heat shock protein 90 is responsible for the growth of the protozoa
Genomic sequence of Trichomoniasis (https://www.ncbi.nlm.nih.gov/gene/4763189)
Immune based tecnique
circulating antibodies to T.vaginalis by:
complement fixation
fluorescent antibody
agglutination
ELISA
rapid
sensitive
employ affinity purified rabbit anti-T.vaginalis antibodies
in sandwich configuration
the culture based and slide technique of diognosis is another methode despite from using immunology technique
Direct wet-mount of fresh material and culture techniques are the most widely used techniques
Genetic manipulation for vaccine development
Molecular methods for detection
DNA technique
Rubino et al found a 2.3 Kb T vaginalis DNA fragment in all strains obtained from diverse geographic areas.
used this clone as a probe for the detection of T vaginalis DNA in vagina
probe was specific for T vaginalis DNA
not react with other microbial flora of the vaginal tract, and was as sensitive as culture.
Malaysia Epidemiology
Run by Universiti Kebangsaan Malaysia Medical Centre
Results
Conclusion
Method
A total of 139 high vaginal swabs were taken from the subjects and sent to the laboratory in Amies gel transport media. The specimens were examined for the presence of Trichomonas vaginalis using wet mount, Giemsa staining and cultured in Diamond's medium. Sociodemographic characteristics and gynaecological complaints were obtained in private using structured questionnaire applied by one investigator.
The median age was 32 years, with an interquartile interval of 9.96. Most of the subjects were Malays (76.9%) and the remaining were Chinese (15.1%), Indians (2.2%) and other ethnic groups (5.8%). One hundred and thirty eight (99.3%) of the women were married and 98.6% had less than 6 children. More than half (75.5%) of the women's last child birth was less than 6 years ago. Forty seven percent of them were involved in supporting administrative work and 64.7% of the women gave a history of previous or current vaginal discharge.
The present study reported zero incidence rate of trichomoniasis. The low incidence rate was postulated due to all women who participated in this study were categorized into a low-risk group.
Recombinant α-actinin subunit antigens of Trichomonas vaginalis as potential vaccine candidates in protecting against trichomoniasis
Expression in microbial cells of genes from pathogens that encode surface antigens capable of inducing neutralizing antibodies in the host of the pathogen involved.
In Malaysia, there little cases or report has been made but is still possible for all three major ethnic groups
The majority of women (85 %) and men (77 %) with T. vaginalis are asymptomatic.
The overall prevalence rate of T. vaginalis infection in Iranian population was estimated to be minimally 0.4% and maximally 42%. The present review showed that T. vaginalis infection rate is relatively high among the Iranian population.
T. vaginalis in the hosts causes damage to host tissue mediated by parasite killing of host cells, disruption of steady-state vaginal microbial ecology, and eliciting inflammation by activating the host immune response
Recent Tv research has uncovered new players that contribute to multifactorial mechanisms of host-parasite adherence and killing, and has examined the relationship between T. vaginalis and vaginal bacteria.
PCR Using Vaginal Swab Samples
to target a well-conserved region in the beta-tubulin genes of T. vaginalis
All strains (15 of 15) of T. vaginalis tested were successfully detected by PCR giving a single predicted product of 112 bp in gel electrophoresis
An optimal analytical sensitivity of one T. vaginalis organism per PCR was achieved
caused by Trichomonas vaginalis
T.vaginalis video(under microscope)
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