ObjectivesTrichomonas vaginalis is thought to be the most common non-viral sexually transmitted infection worldwide. We investigated the prevalence, risk factors and protozoan load of T. vaginalis infection in South African women.MethodsA cross-sectional study of 604 women was conducted at 25 primary healthcare facilities in rural South Africa (Mopani district). T. vaginalis DNA was detected in vaginal and rectal swabs. In univariate and multivariate analyses, the T. vaginalis infection was investigated in relation to demographic characteristics, medical history and behavioural factors. The T. vaginalis load was determined as the logarithm of DNA copies per microlitre sample solution.ResultsCollected vaginal and rectal swabs were tested for T. vaginalis DNA. Prevalence of vaginal T. vaginalis was 20% (95% CI 17.0% to 23.4%) and rectal 1.2% (95% CI 0.6% to 2.4%). Most women (66%) with a vaginal infection were asymptomatic. Factors associated with T. vaginalis infection were a relationship status of single (OR 2.4; 95% CI 1.5 to 4.0; p<0.001) and HIV positive infection (OR 1.6; 95% CI 1.0 to 2.6; p=0.041). Women with vaginal T. vaginalis infection were more likely to have concurrent Chlamydia trachomatis rectal infection than those without vaginal infection (12%vs3%; p<0.001; OR 4.1). A higher median T. vaginalis load was observed among women with observed vaginal discharge compared with those without vaginal discharge (p=0.025).ConclusionsVaginal trichomoniasis is highly prevalent in rural South Africa, especially among single women and those with HIV infection, and often presents without symptoms.
h We analyzed data of 263 women with at least one genital or anorectal sexually transmitted infection from a cross-sectional study conducted in rural South Africa. We provide new insights concerning the concurrence of Chlamydia trachomatis, Neisseria gonorrhoeae, Mycoplasma genitalium, and Trichomonas vaginalis infections as well as the characteristics of bacterial loads. Chlamydia trachomatis and Neisseria gonorrhoeae are the most prevalent bacterial sexually transmitted infections (STI) in the world (1). The course of these infections is unpredictable and diverse (2-7). Most infections in women are asymptomatic and frequently remain unrecognized, which increases the risk for reproductive tract complications (6,(8)(9)(10). Insight into the mechanisms that drive the burden of these infections is essential for disease control. In addition to age, HIV infection, and behavioral factors, microbiological characteristics, including bacterial load, may play an important role in the risk of transmission, clinical presentation, and course of infection (6,(11)(12)(13)(14). Chlamydial load has been associated with clinical presentation, severity of infection, and transmissibility in animal models and in patients with ocular C. trachomatis infection (15-17). Gonorrheal loads have been shown to differ between anatomic locations and associated clinical presentations in men (18). Although real-time PCR and quantitation of DNA load have the potential of revealing new insights into the characteristics of infection, there is only limited literature about the relevance of bacterial load and frequency of concurrent STI in women (19,20). Knowledge about microbiological characteristics of infection could possibly help to improve understanding of the differences in STI prevalences at the population level. This study aimed to evaluate the concurrence and bacterial loads of genital and anorectal C. trachomatis and N. gonorrhoeae infections in South African women from a setting of high HIV prevalence.This study was a subanalysis of a previously described crosssectional study of 604 women in rural Mopani District, South Africa (21). In brief, consenting women 18 to 49 years of age who reported sexual activity during the previous 6 months were eligible. Questionnaires were completed and vaginal, anorectal and pharyngeal swabs (Copan Diagnostics, Brescia, Italy) were obtained by health care workers and stored at Ϫ20°C. Menses on the day of recruitment and refusal to have all three anatomic sites tested were exclusion criteria. Symptomatic women were treated the same day according to local treatment protocols, which include a notification slip for the partner. Asymptomatic women with an STI proven by molecular detection were called to return to the clinic for specific treatment. For the evaluation presented in this article, we selected all women (n ϭ 263) vaginally and/or anorectally infected with at least one of the following pathogens: C. trachomatis (n ϭ 107), N. gonorrhoeae (n ϭ 66), Mycoplasma genitalium (n ϭ 66), and Trichomonas vagina...
BackgroundBacterial infections in the genital tract frequently result in morbidity through a variety of inflammation based symptoms. One component of the bacteria that may trigger host inflammatory response is their DNA. CpG motifs in this DNA are known targets for Toll-like receptor 9 (TLR9), which is a pathogen-recognition receptors focusing on CpG DNA. The activation of TLR9 induces the NF-κB inflammatory pathway. This study aims to provide a broad view of the inflammatory potential of CpG DNA motifs in bacteria related to genital diseases: C. trachomatis, E. coli, N. gonorrhoeae, G. vaginalis, H. ducreyi, L. crispatus, L. gasseri, M. hominis, M. genitalium, T. pallidum, and U. urealyticum.MethodsPublicly available genomic sequences of the bacterial species and strains have been analyzed in silico to produce a CpG index number. This CpG index number shows the relative inflammatory potential of the genome and has previously been used in a study by Lundberg et al. (2003). Higher CpG index values suggest a strong CpG induced inflammation potential during infection and vice versa.ResultsThe highest observed CpG index belongs to G. vaginalis with a value of 26,2, suggesting a strong pro-inflammatory potential when in contact with TLR9. The lowest index belongs to N. gonorrhoeae with a value of −79,5, suggesting a strong immunoinhibitory effect on TLR9 contact. Interestingly, Lactobacilli showed a mean CpG index value of 4,2, suggesting a weak inflammatory potential.DiscussionOur results show varying CpG index values between bacterial species. Comparison of CpG indices with the clinical course of several pathogens shows the CpG index helps clarify the clinical course of infection. However, we found no links between CpG index values and either obligate pathogenicity or facultative pathogenicity through bacterial vaginosis. Lactobacilli showed relatively low CpG indices which do suggest a lower inflammatory potential from these bacteria.ConclusionsOur results show varying CpG index values between bacterial species, which may help clarify the clinical course of infection, and may help diagnosis.
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