Trichomonas vaginalis

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Trichomonas vaginalis
Trichomonas vaginalis observed by scanning electron microscopy.jpg
Trichomonas vaginalis observed by scanning electron microscopy showing the axostyle (ax), the anterior flagella (af) and the undulating membrane (rf). [1]
Scientific classification OOjs UI icon edit-ltr.svg
Domain: Eukaryota
Phylum: Metamonada
Order: Trichomonadida
Family: Trichomonadidae
Genus: Trichomonas
Species:
T. vaginalis
Binomial name
Trichomonas vaginalis
(Donné 1836)

Trichomonas vaginalis is an anaerobic, flagellated protozoan parasite and the causative agent of a sexually transmitted disease called trichomoniasis. It is the most common pathogenic protozoan that infects humans in industrialized countries. [2] Infection rates in men and women are similar but women are usually symptomatic, while infections in men are usually asymptomatic. Transmission usually occurs via direct, skin-to-skin contact with an infected individual, most often through vaginal intercourse. It is estimated that 160 million cases of infection are acquired annually worldwide. [3] The estimates for North America alone are between 5 and 8 million new infections each year, with an estimated rate of asymptomatic cases as high as 50%. [4] Usually treatment consists of metronidazole and tinidazole. [5]

Contents

Clinical

Trichomonas vaginalis protozoa. Colorized SEM Trichomonas vaginalis (20).png
Trichomonas vaginalis protozoa. Colorized SEM
Trichomonas vaginalis protozoa.SEM Trichomonas vaginalis (21).JPG
Trichomonas vaginalis protozoa.SEM
The structure of Trichomonas vaginalis Trichomonas vaginalis (02).png
The structure of Trichomonas vaginalis

History

Trichomonas vaginalis from a vaginal swab. This is a heavy infection; there were probably thousands of trichomonads in the vagina.

Alfred Francois Donné (1801–1878) was the first to describe a procedure to diagnose trichomoniasis through "the microscopic observation of motile protozoa in vaginal or cervical secretions" in 1836. He published this in the article entitled, "Animalcules observés dans les matières purulentes et le produit des sécrétions des organes génitaux de l'homme et de la femme" in the journal, Comptes rendus de l'Académie des sciences. [6] With it, he created the binomial name of the parasite as Trichomonas vaginalis. [7] 80 years after the initial discovery of the parasitic protozoan, Hohne declared Trichomoniasis as a clinical entity in 1916. [8]

Signs and symptoms

Pap smear, showing infection by Trichomonas vaginalis. Papanicolaou stain, 400x Pap test trichomonas.JPG
Pap smear, showing infection by Trichomonas vaginalis. Papanicolaou stain, 400×

Most women (85%) and men (77%) with infected with T. vaginalis do not have symptoms. Half of these women can develop symptoms within 6 months and can have vaginal erythema, dyspareunia, dysuria, and vaginal discharge, which is often diffuse, malodorous, and yellow-green, along with itching in the genital region. “Strawberry cervix,” occurs in about 5% of women. In men, it can cause urethritis, epididymitis and prostatitis. [9]

Complications

Some of the complications of Trichomonas vaginalis in women include: preterm delivery, low birth weight, and increased mortality as well as predisposing to human immunodeficiency virus infection, AIDS, and cervical cancer. [10] Trichomonas vaginalis can be seen in diverse locations within the body, such as," in the urinary tract, fallopian tubes, and pelvis and can cause pneumonia, bronchitis, and oral lesions." [11]

Diagnosis

A single trichomonas by phase contrast microscopy
Trichomonas vaginalis Gram stain (arrows) TV in Gram.jpg
Trichomonas vaginalis Gram stain (arrows)

Classically, with a cervical smear, infected women may have a transparent "halo" around their superficial cell nucleus but more typically the organism itself is seen with a, "slight cyanophilic tinge, faint eccentric nuclei, and fine acidophilic granules." [12] It is unreliably detected by studying a genital discharge or with a cervical smear because of their low sensitivity. Trichomonas vaginalis is also routinely diagnosed via a wet mount, in which motility is observed. Currently, the most common method of diagnosis is via overnight culture, [13] [14] with a sensitivity range of 75–95%. [15] Newer methods, such as rapid antigen testing and transcription-mediated amplification, have even greater sensitivity, but are not in widespread use. [15]

Treatment

Infection is treated and cured with metronidazole [16] or tinidazole. The CDC recommends a one time dose of 2 grams of either metronidazole or tinidazole as the first-line treatment; the alternative treatment recommended is 500 milligrams of metronidazole, twice daily, for seven days if there is failure of the single-dose regimen. [17] Medication should be prescribed to any sexual partner(s) as well because they may be asymptomatic carriers. [18]

Morphology

Trichomonas vaginalis May-Grunwald-Giemsa staining. The spike-like axostyle can be seen on the left. Trichomonas vaginalis May-Grunwald-Giemsa staining.jpg
Trichomonas vaginalis May-Grünwald-Giemsa staining. The spike-like axostyle can be seen on the left.

Trichomonas vaginalis exists in only one morphological stage, a trophozoite, and cannot encyst (or form cysts.) This protozoan does not typically adhere to one shape, as in different conditions, the parasite has the ability to change. When in culture separate from the host, it usually displays a more "pear" or oval shaped morphology, but when present in a living host, specifically on the epithelial cells of the vaginal wall, the shape is more "amoeboid". [19] It is slightly larger than a white blood cell, measuring 9 × 7  μm. In both forms, Trichomonas vaginalis has five flagella – four protruding from the front or anterior of the parasite and the fifth on the back or posterior end. [20] The functionality of the fifth flagellum is not known. In addition, a barb-like axostyle projects opposite the four-flagella bundle. All of these flagella are connected to an "undulating" membrane. [21] The axostyle may be used for attachment to surfaces and may also cause the tissue damage seen in trichomoniasis. [22] The nucleus is usually elongated, and is located near the anterior end of the protozoan within the cytoplasm which contains many hydrogenosomes (closed-membrane organelle with the ability to produce both adenosine triphosphate and hydrogen while in anaerobic conditions.) [23]

While Trichomonas vaginalis does not have a cyst form, the organism can survive for up to 24 hours in urine, semen, or even water samples. A nonmotile, round, pseudocystic form with internalized flagella has been observed under unfavorable conditions. [24] This form is generally regarded as a degenerate stage as opposed to a resistant form, [24] although viability of pseudocystic cells has been occasionally reported. [25] The ability to revert to trophozoite form, to reproduce and sustain infection has been described, [26] along with a microscopic cell staining technique to visually discern this elusive form. [27]

Metabolism

Trichomonas vaginalis from a human vagina x 400

Trichomonas vaginalis is an anaerobe. [28] There is an absence of cytochrome C and mitochondria, thus making oxygen uptake and synthesis of adenosine triphosphate via oxidative phosphorylation difficult. [28] Although it contains no mitochondria, an analogous structure called a hydrogenosome, which is the site of fermentative oxidation of pyruvate, carries out many of the same metabolic processes. Carbohydrates, specifically those with alpha1,4- glycosidic linkages, are metabolized and eventually fermented to produce products such as acetate, lactate, malate, glycerol and CO2 under aerobic conditions. Hydrogen is produced under anaerobic conditions. [29] Outside the hydrogenosome, carbohydrate metabolism also occurs freely in the cytoplasm. The Embden-Meyerhof-Parnas pathway. [29] is used to convert glucose into phosphoenolpyruvate which ultimately becomes pyruvate.

Virulence factors

Although Trichomonas vaginalis exists as a trophozoite in its infective form, its amoeboid form is also an important characteristic that adds to how well it is able to infect its host. The amoeboid form, which is pancake shaped, allows for greater surface area contact with epithelial cells of the vagina, cervix, urethra, and prostate. [30] The pseudocyst form is also a way in which the microbe can infect more efficiently, but this only induced when exposed to cold and other stressors. [30] These various forms are accompanied with differing protein phosphorylation profiles which are triggered by environmental pressures. [30]

One of the hallmark features of Trichomonas vaginalis is the adherence factors that allow cervicovaginal epithelium colonization in women. The adherence that this organism illustrates is specific to vaginal epithelial cells being pH, time, and temperature dependent. [31] A variety of virulence factors mediate this process some of which are the microtubules, microfilaments, bacterial adhesins (4), and cysteine proteinases. The adhesins are four trichomonad enzymes called AP65, AP51, AP33, and AP23 that mediate the interaction of the parasite to the receptor molecules on vaginal epithelial cells. [32] The best characterized surface molecule associated with one of the four adhesins is called Trichomonas vaginalis lipoglycans. [30] This molecule is the most abundant on the surface of Trichomonas vaginalis, aids in sticking to vaginal epithelial cells, and can also influence how the human immune system responds, affecting inflammatory responses and macrophages in the body. [30] Cysteine proteinases may be another virulence factor because not only do these 30 kDa proteins bind to host cell surfaces but also may degrade extracellular matrix proteins like hemoglobin, fibronectin or collagen IV. [31]

Genome sequencing and statistics

The Trichomonas vaginalis genome is approximately 160 megabases in size [33] – ten times larger than predicted from earlier gel-based chromosome sizing. [34] (The human genome is ~3.5 gigabases by comparison. [35] ) As much as two-thirds of the Trichomonas vaginalis sequence consists of repetitive and transposable elements, indicative of a recent drastic, evolutionarily expansion of the genome. The total number of predicted protein-coding genes is ~60,000, with the genome being around 65% repetitive (virus-like, transposon-like, retrotransposon-like, and unclassified repeats, all with high copy number and low polymorphism). [36] Approximately 26,000 of the protein-coding genes have been classed as 'evidence-supported' (similar either to known proteins, or to expressed sequence tags), while the remainder have no known function. [36] These extraordinary genome statistics are likely to change downward as the genome sequence, currently very fragmented due to the difficulty of ordering repetitive DNA, is assembled into chromosomes, and as more transcription data (expressed sequence tags, microarrays) accumulate. [36]

TrichDB.org was launched as a free, public genomic data repository and retrieval service devoted to genome-scale trichomonad data. The site currently contains all of the Trichomonas vaginalis sequence project data, several expressed sequence tag libraries, and tools for data mining and display. [37] TrichDB is part of the EupathDB functional genomics database project funded by the National Institutes of Health and National Institute of Allergy and Infectious Diseases. [37]

Genetic diversity

Recent studies into the genetic diversity of Trichomonas vaginalis has shown that there are two distinct lineages of the parasite found worldwide; both lineages are represented evenly in field isolates. The two lineages differ in whether or not Trichomonas vaginalis virus infection is present. Trichomonas vaginalis virus infection is clinically relevant in that, it has an effect on parasite resistance to metronidazole, a first line drug treatment for human trichomoniasis. [38]

Increased susceptibility to human immunodeficiency virus

The damage caused by Trichomonas vaginalis to the vaginal epithelium increases a woman's susceptibility to infection by human immunodeficiency virus. In addition to inflammation that Trichomonas vaginalis causes, the parasite also causes lysis of epithelial cells and red blood cells in the area leading to more inflammation and disruption of the protective barrier usually provided by the epithelium. Having Trichomonas vaginalis also may increase the chances of the infected woman transmitting human immunodeficiency virus to her sexual partner(s). [39] [40]

Evolution

The biology of Trichomonas vaginalis has implications for understanding the origin of sexual reproduction in eukaryotes. Trichomonas vaginalis is not known to undergo meiosis, a key stage of the eukaryotic sexual cycle. However, when Malik et al. [41] examined Trichomonas vaginalis for the presence of 29 genes known to function in meiosis, they found 27 homologous genes to the ones found in animals, fungi, plants and other protists, including eight of nine genes that are specific to meiosis in model organisms. [41] These findings suggest that Trichomonas vaginalis has the capability for meiotic recombination, and hence "parasexual" reproduction. [41] 21 of the 27 meiosis genes were also found in another parasite Giardia lamblia (also called Giardia intestinalis), indicating that these meiotic genes were present in a common ancestor of Trichomonas vaginalis and G. intestinalis. [41] Since these two species are descendants of lineages that are highly divergent among eukaryotes, these meiotic genes were likely present in a common ancestor of all eukaryotes. [41]

See also

Related Research Articles

<span class="mw-page-title-main">Bacterial vaginosis</span> Excessive growth of bacteria in the vagina

Bacterial vaginosis (BV) is an infection of the vagina caused by excessive growth of bacteria. Common symptoms include increased vaginal discharge that often smells like fish. The discharge is usually white or gray in color. Burning with urination may occur. Itching is uncommon. Occasionally, there may be no symptoms. Having BV approximately doubles the risk of infection by a number of sexually transmitted infections, including HIV/AIDS. It also increases the risk of early delivery among pregnant women.

<i>Neisseria gonorrhoeae</i> Species of bacterium

Neisseria gonorrhoeae, also known as gonococcus (singular) or gonococci (plural), is a species of Gram-negative diplococci bacteria first isolated by Albert Neisser in 1879. As an obligate human pathogen, it primarily colonizes the mucosal lining of the urogenital tract; however, it is also capable of adhering to the mucosa of the nose, pharynx, rectum, and conjunctiva. It causes the sexually transmitted genitourinary infection gonorrhea as well as other forms of gonococcal disease including disseminated gonococcemia, septic arthritis, and gonococcal ophthalmia neonatorum.

<span class="mw-page-title-main">Trichomoniasis</span> Medical condition

Trichomoniasis (trich) is an infectious disease caused by the parasite Trichomonas vaginalis. About 70% of affected people do not have symptoms when infected. When symptoms occur, they typically begin 5 to 28 days after exposure. Symptoms can include itching in the genital area, a bad smelling thin vaginal discharge, burning with urination, and pain with sex. Having trichomoniasis increases the risk of getting HIV/AIDS. It may also cause complications during pregnancy.

<i>Giardia duodenalis</i> Parasitic microorganism that causes giardiasis

Giardia duodenalis, also known as Giardia intestinalis and Giardia lamblia, is a flagellated parasitic protozoan microorganism of the genus Giardia that colonizes the small intestine, causing a diarrheal condition known as giardiasis. The parasite attaches to the intestinal epithelium by an adhesive disc or sucker, and reproduces via binary fission. Giardiasis does not spread to other parts of the gastrointestinal tract, but remains confined to the lumen of the small intestine. The microorganism has an outer membrane that makes it possible to survive even when outside of its host, and which can render it tolerant to certain disinfectants. Giardia trophozoites are anaerobic, and absorb their nutrients from the intestinal lumen. If the organism is stained, its characteristic pattern resembles the familiar "smiley face" symbol.

<i>Gardnerella vaginalis</i> Species of bacterium

Gardnerella vaginalis is a species of Gram-variable-staining facultative anaerobic bacteria. The organisms are small non-spore-forming, nonmotile coccobacilli.

Vaginitis, also known as vulvovaginitis, is inflammation of the vagina and vulva. Symptoms may include itching, burning, pain, discharge, and a bad smell. Certain types of vaginitis may result in complications during pregnancy.

<span class="mw-page-title-main">Giardiasis</span> Parasitic disease that results in diarrhea

Giardiasis is a parasitic disease caused by Giardia duodenalis. Infected individuals who experience symptoms may have diarrhoea, abdominal pain, and weight loss. Less common symptoms include vomiting and blood in the stool. Symptoms usually begin one to three weeks after exposure and, without treatment, may last two to six weeks or longer.

<i>Trichomonas</i> Genus of parasitic, flagellated protists

Trichomonas is a genus of anaerobic excavate parasites of vertebrates. It was first discovered by Alfred François Donné in 1836 when he found these parasites in the pus of a patient suffering from vaginitis, an inflammation of the vagina. Donné named the genus from its morphological characteristics. The prefix tricho- originates from the Ancient Greek word θρίξ (thrix) meaning hair, describing Trichomonas’s flagella. The suffix -monas, describes its similarity to unicellular organisms from the genus Monas.

<span class="mw-page-title-main">Vaginal discharge</span> Medical condition

Vaginal discharge is a mixture of liquid, cells, and bacteria that lubricate and protect the vagina. This mixture is constantly produced by the cells of the vagina and cervix, and it exits the body through the vaginal opening. The composition, amount, and quality of discharge varies between individuals and can vary throughout the menstrual cycle and throughout the stages of sexual and reproductive development. Normal vaginal discharge may have a thin, watery consistency or a thick, sticky consistency, and it may be clear or white in color. Normal vaginal discharge may be large in volume but typically does not have a strong odor, nor is it typically associated with itching or pain. While most discharge is considered physiologic or represents normal functioning of the body, some changes in discharge can reflect infection or other pathological processes. Infections that may cause changes in vaginal discharge include vaginal yeast infections, bacterial vaginosis, and sexually transmitted infections. The characteristics of abnormal vaginal discharge vary depending on the cause, but common features include a change in color, a foul odor, and associated symptoms such as itching, burning, pelvic pain, or pain during sexual intercourse.

An axostyle is a sheet of microtubules found in certain protists. It arises from the bases of the flagella, sometimes projecting beyond the end of the cell, and is often flexible or contractile, and so may be involved in movement and provides support for the cell. Axostyles originate in association with a flagellar microtubular root and occur in two groups, the oxymonads and parabasalids; they have different structures and are not homologous. Within trichomonads the axostyle has been theorised to participate in locomotion and cell adhesion, but also karyokinesis during cell division.

Antiprotozoal agents is a class of pharmaceuticals used in treatment of protozoan infection.

<i>Tritrichomonas foetus</i> Species of protozoan parasite

Tritrichomonas foetus is a species of single-celled flagellated parasites that is known to be a pathogen of the bovine reproductive tract as well as the intestinal tract of cats. In cattle, the organism is transmitted to the female vagina and uterus from the foreskin of the bull where the parasite is known to reside. It causes infertility, and, at times, has caused spontaneous abortions in the first trimester. In the last ten years, there have been reports of Tritrichomonas foetus in the feces of young cats that have diarrhea and live in households with multiple cats. Tritrichomonas foetus looks similarly to Giardia and is often misdiagnosed for it when viewed under a microscope.

<span class="mw-page-title-main">Vaginal flora</span> Microorganisms present in the vagina

Vaginal flora, vaginal microbiota or vaginal microbiome are the microorganisms that colonize the vagina. They were discovered by the German gynecologist Albert Döderlein in 1892 and are part of the overall human flora. The amount and type of bacteria present have significant implications for an individual's overall health. The primary colonizing bacteria of a healthy individual are of the genus Lactobacillus, such as L. crispatus, and the lactic acid they produce is thought to protect against infection by pathogenic species.

<span class="mw-page-title-main">Protozoan infection</span> Parasitic disease caused by a protozoan

Protozoan infections are parasitic diseases caused by organisms formerly classified in the kingdom Protozoa. These organisms are now classified in the supergroups Excavata, Amoebozoa, Harosa, and Archaeplastida. They are usually contracted by either an insect vector or by contact with an infected substance or surface.

<span class="mw-page-title-main">Sexually transmitted infection</span> Infection transmitted through human sexual behavior

A sexually transmitted infection (STI), also referred to as a sexually transmitted disease (STD) and the older term venereal disease (VD), is an infection that is spread by sexual activity, especially vaginal intercourse, anal sex, oral sex, or sometimes manual sex. STIs often do not initially cause symptoms, which results in a risk of transmitting them on to others. The term sexually transmitted infection is generally preferred over sexually transmitted disease or venereal disease, as it includes cases with no symptomatic disease. Symptoms and signs of STIs may include vaginal discharge, penile discharge, ulcers on or around the genitals, and pelvic pain. Some STIs can cause infertility.

Female genital disease is a disorder of the structure or function of the female reproductive system that has a known cause and a distinctive group of symptoms, signs, or anatomical changes. The female reproductive system consists of the ovaries, fallopian tubes, uterus, vagina, and vulva. Female genital diseases can be classified by affected location or by type of disease, such as malformation, inflammation, or infection.

In biology, a pathogen, in the oldest and broadest sense, is any organism or agent that can produce disease. A pathogen may also be referred to as an infectious agent, or simply a germ.

<i>Trichomonas tenax</i> Species of single-celled organism

Trichomonas tenax, or oral trichomonas, is a species of Trichomonas commonly found in the oral cavity of humans. Routine hygiene is generally not sufficient to eliminate the parasite, hence its Latin name, meaning "tenacious". The parasite is frequently encountered in periodontal infections, affecting more than 50% of the population in some areas, but it is usually considered insignificant. T. tenax is generally not found on the gums of healthy patients. It is known to play a pathogenic role in necrotizing ulcerative gingivitis and necrotizing ulcerative periodontitis, worsening preexisting periodontal disease. This parasite is also implicated in some chronic lung diseases; in such cases, removal of the parasite is sufficient to allow recovery.

Patricia Jean Johnson is an American microbiologist.

<span class="mw-page-title-main">Lactobacillus vaccine</span> Vaccine using an inactivated strain of Lactobacillus

Lactobacillus vaccines are used in the therapy and prophylaxis of non-specific bacterial vaginitis and trichomoniasis. The vaccines consist of specific inactivated strains of Lactobacilli, called "aberrant" strains in the relevant literature dating from the 1980s. These strains were isolated from the vaginal secretions of patients with acute colpitis. The lactobacilli in question are polymorphic, often shortened or coccoid in shape and do not produce an acidic, anti-pathogenic vaginal environment. A colonization with aberrant lactobacilli has been associated with an increased susceptibility to vaginal infections and a high rate of relapse following antimicrobial treatment. Intramuscular administration of inactivated aberrant lactobacilli provokes a humoral immune response. The production of specific antibodies both in serum and in the vaginal secretion has been demonstrated. As a result of the immune stimulation, the abnormal lactobacilli are inhibited, the population of normal, rod-shaped lactobacilli can grow and exert its defense functions against pathogenic microorganisms.

References

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