UDP-xylose and UDP-galactose synthesis in Trichomonas vaginalis

The presence of xylose and galactose residues in the structure of trichomonad lipoglycans was indicated by previous studies and the modification of any glycoconjugate with either monosaccharide requires the respective presence of the nucleotide sugars, UDP-xylose and UDP-galactose. Biosynthesis of UDP-xylose de novo is mediated by UDP-xylose synthase (UXS; UDP-glucuronic acid decarboxylase), which converts UDP-glucuronic acid to UDP-xylose, whereas UDP-galactose can be generated from UDP-glucose by UDP-galactose epimerases (GalE). Trichomonas vaginalis cDNAs, encoding proteins with homology to these enzymes from other eukaryotes, were isolated. The recombinant T. vaginalis UDP-xylose synthase and UDP-galactose epimerase were expressed in Escherichia coli and tested via high pressure liquid chromatography to demonstrate their enzymatic activities. Thereby, in this first report on enzymes involved in glycoconjugate biosynthesis in this organism, we demonstrate the existence of xylose and galactose synthesising pathways in T. vaginalis.     

Viability of Trichomonas vaginalis in Copan universal transport medium and eSwab transport medium

We compared the use of universal transport medium and eSwab transport medium held at room temperature or 37°C to bedside inoculation and immediate incubation of culture media for the detection of Trichomonas vaginalis. There were no significant culturable differences in the sensitivity of either of the transport media to that of bedside inoculation.     

Trichomonas vaginalis polyamine metabolism is linked to host cell adherence and cytotoxicity

Trichomonas vaginalis secretes putrescine that is readily detected in vaginal secretions. We wanted to examine the effect of decreased putrescine synthesis by inhibition of ornithine decarboxylase (ODC) on T. vaginalis. One reason is because inhibition of Tritrichomonas foetus ODC results in growth arrest, destruction of hydrogenosomes, and decreased amounts of hydrogenosomal enzymes. Treatment of T. vaginalis T016 with >/=20 mM 1,4-diamino-2-butanone (DAB) to inhibit ODC resulted in growth arrest, which was reversed by addition of exogenous putrescine. No similar reversal of growth arrest was achieved with the polyamines spermine or spermidine or with iron. Electron microscopic examination of control versus DAB-treated trichomonads did not reveal any adverse effects on the number and integrity of hydrogenosomes. Further, the adhesins AP65, AP51, and AP33 mediating binding to immortalized vaginal epithelial cells (VECs) share identity to enzymes of the hydrogenosome organelle, and there was no difference in amounts of adhesins between control versus DAB-treated T. vaginalis parasites. Likewise, similar patterns and extent of fluorescence were evident for the prominent AP65 adhesin. Surprisingly, DAB treatment increased by 4- to 20-fold above untreated trichomonads handled identically the level of adherence mediated by adhesins. Interestingly, the enhanced attachment to VECs was reversed by exogenous putrescine added to DAB-treated trichomonads. Equally noteworthy was that DAB-treated T. vaginalis with enhanced adherence did not possess the previously reported ability to kill host cells in a contact-dependent fashion mediated by cysteine proteinases, and total cysteine proteinase activity patterns were identical between control and DAB-treated trichomonads. Overall, these data suggest that polyamine metabolism and secreted putrescine are linked to host cell adherence and cytotoxicity.     

Comparison of Diamond''s medium modified and Kupferberg medium for detection of Trichomonas vaginalis.

Diamond's medium modified, the commercially available version of the Klaas modification of Diamond's medium, was compared to Kupferberg medium and to direct wet-mount examination for detection of trichomonads in symptomatic patients. Diamond's medium was found to be superior to both Kupferberg medium (P less than 10(-4) and wet mount (P less than 10(-6].     

Trichomonas vaginalis and Tritrichomonas foetus secrete neuraminidase into the culture medium

Supernatants taken from axenic cultures of Trichomonas vaginalis and Tritrichomonas foetus contain a neuraminidase activity, the detection of which is augmented when the trichomonad culture media are supplemented with 30% supernatant of confluent epithelial cultures. The enzyme was active against human erythrocytes, which became highly reactive to peanut agglutinin lectin. The specificity of the enzyme was checked by using a substrate specific to neuraminidase: 2'-(4-methylumbelliferyl)-alpha-D-N-acetylneuramic acid.     

Modified thioglycolate medium: a simple and reliable means for detection of Trichomonas vaginalis.

Despite the declining rate of sexually transmitted diseases in developed countries, trichomoniasis is still one of the most common venereal infections. While diagnosis of this condition is commonly based on the microscopic wet-mount method, culture remains the most accurate single procedure for detecting the presence of Trichomonas vaginalis in clinical samples. In the present study, the efficacy of a modified formula of the commonly available thioglycolate medium was compared with that of the standard Diamond's medium for detection of T. vaginalis in samples from 176 women with vaginal symptoms. Thioglycolate medium supplemented with yeast extract, horse serum, and antimicrobial agents was as reliable as Diamond's medium for detection of T. vaginalis in vaginal fluid samples. Modified thioglycolate medium may be used as a readily available, low-cost substitute for the standard medium for culturing T. vaginalis.     

Infection with Trichomonas vaginalis in a black population

Trichomonas vaginalis infection (TVI) was found by examination of Pap smears in 25% of 3,005 unselected urban black women being screened for cancer of the cervix and vagina. The incidence was 22% in the group under 29 years of age; 69% in those between 30 and 59; and 9% in those over 60. Women who had had a hysterectomy had 16% lower incidence of TVI than did the controls. Class 1 reports (atypia, metaplasia, hyperplasia) were obtained in 10% of the entire group. Cytologic changes were present in 19% of the women with TVI. Women who had had hysterectomy had a 40% less chance of having a class 1 report compared with controls. Class 1 reports occurred 2.7 times more frequently in TVI than in uninfected controls.     

Hydrogenosome-localization of arginine deiminase in Trichomonas vaginalis

The arginine dihydrolase (ADH) pathway has an analogous function to the urea cycle in mitochondria-containing cells, by removing nitrogen from amino acids and generating ATP. Subcellular localization of the ADH pathway enzymes in Trichomonas vaginalis revealed that arginine deiminase (ADI) localizes to the hydrogenosome, a mitochondrion-like organelle of anaerobic protists. However the other enzymes of the ADH pathway, ornithine carbamyltransferase and carbamate kinase localize to the cytosol. Three gene sequences of T. vaginalis ADI (ADI 1-3) were identified in the T. vaginalis genome, all having putative mitochondrial targeting sequences. The ADI sequences were cloned and used to probe T. vaginalis using a carboxyterminal di-hemogglutinin epitope tag which demonstrated co-localization with malic enzyme confirming the hydrogenosome localization of this enzyme.     

Viability of Trichomonas vaginalis in Transport Medium

The ability of Amies gel agar transport medium to maintain the viability of Trichomonas vaginalis was determined by comparing transported vaginal specimens to specimens immediately inoculated into culture medium. The prevalence of trichomonosis in the study population was 26% (68 of 260 women). The immediate inoculation method detected infections in 64 of 68 infected women (sensitivity of 94.1%). The transport method detected 62 of 68 infections (sensitivity of 91.2%). There was no significant difference between the two methods.     

Clinical and Microbiological Aspects of Trichomonas vaginalis

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.     

A comparison of current laboratory methods and a new semi-solid culture medium for the detection of Trichomonas vaginalis

A comparison of three different laboratory methods currently in use for the detection of Trichomonas vaginalis indicated that each method had some disadvantages. Examination of a wet preparation was the simplest method but yielded the lowest proportion of positive results; the cultural method, although more fruitful, was relatively slow and failed to detect non-viable trichomonads; examination of a Leishman-stained film yielded the highest proportion of positive results but probably failed to detect trichomonads when they were present in very small numbers. The best combination of methods was found to be Leishman film and culture: the positive yield was 99%.     

Isolation of a cell-detaching factor of Trichomonas vaginalis.

The pathogenetic role of soluble products of Trichomonas vaginalis growth in culture is controversial. To evaluate this role, T. vaginalis was grown in broth and cell culture and the cell-free filtrate was applied to fresh cell culture monolayers. When adjusted to pH 6.5, filtrates obtained from 22-h culture growth totally disrupted McCoy, HEp-2, human foreskin fibroblast, and Chinese hamster ovary cell monolayers within 6 h. These detached cells remained greater than 90% viable. This cell-detaching factor (CDF) was heat and acid labile, with a pH optimum of 6.5. CDF has trypsinlike activity which disrupts monolayer cells, but cells do not die if the pH is controlled. CDF was purified by ethanol precipitation, ammonium sulfate fractionation, and ion-exchange and gel filtration column chromatography. A 200,000-molecular-weight glycoprotein which was also immunogenic by immunoblot with human sera reactive to T. vaginalis was isolated in this manner. This confirms the presence of a specific soluble CDF derived from T. vaginalis whose application may be important as a diagnostic tool and in further studies of pathogenesis.     

Correlation of Leukorrhea and Trichomonas vaginalis Infection

Trichomonas vaginalis is a common sexually transmitted infection (STI) causing vaginitis. Microscopy has poor sensitivity but is used for diagnosis of trichomoniasis in resource-poor settings. We aimed to provide a more reliable diagnosis of trichomoniasis by investigating an association with leukorrhea. Women presenting for evaluation of vaginal discharge, STI exposure, or preventative gynecologic examination were evaluated for Trichomonas infection. Vaginal pH was determined and microscopy was performed by the provider, who recorded the number of polymorphonuclear leukocytes (PMNLs) per epithelial cell and the presence of clue cells, yeast, and/or motile trichomonads. Leukorrhea was defined as greater than one PMNL per epithelial cell. Culture and a nucleic acid amplification test (NAAT) were used to detect T. vaginalis. Patients were evaluated for Chlamydia trachomatis and Neisseria gonorrhoeae using NAATs and bacterial vaginosis using Gram stains. Two hundred ninety-four women were enrolled, and 16% were found to have Trichomonas (46/294). Trichomonas infection was more common in parous non-Hispanic, black women, who reported low rates of contraceptive use (33% versus 17%; P = 0.02) and a STI history (85% versus 55%; P = 0.002). These women were more likely to report vaginal discharge (76% versus 59%; P = 0.02) and have an elevated vaginal pH (87% versus 48%; P < 0.001) and gonorrhea infection (15% versus 4%; P = 0.002). Leukorrhea was associated with a 4-fold-increased risk of Trichomonas infection. Leukorrhea on microscopy was associated with Trichomonas vaginitis. Patients with leukorrhea should be evaluated with more-sensitive tests for T. vaginalis, preferably NAATs, if microscopy is negative.     

Effect of beta-estradiol on production of the cell-detaching factor of Trichomonas vaginalis.

Despite over 40 years of study, the pathogenetic mechanisms of Trichomonas vaginalis are just starting to be elucidated. We have recently reported that T. vaginalis produces a virulence factor, cell-detaching factor (CDF), that likely causes the cell sloughing seen in clinical disease. This 200-kDa glycoprotein is acid and heat labile and correlates with clinical symptoms. We applied a McCoy cell culture system to study the effects of various concentrations of beta-estradiol (10(-6) to 10(-10) M) on T. vaginalis growth and CDF production. T. vaginalis growth was unaffected by the different concentrations of beta-estradiol studied, in comparison with the growth of control cultures without beta-estradiol. However, beta-estradiol significantly diminished the activity of CDF at all concentrations and did so most profoundly at 10(-7) and 10(-8) M (P less than 0.0001). This suggests that the symptoms of T. vaginalis infection may be influenced by the vaginal concentration of estrogens, and further studies of the interactions between T. vaginalis and estrogens are warranted.     

Identification of a surface antigen of Trichomonas vaginalis.

A major surface antigen of Trichomonas vaginalis was purified by using three independently derived monoclonal antibodies (two immunoglobulin M and one immunoglobulin G1) prepared against T. vaginalis PHS-2J. A 115,000-molecular-weight antigen and one or more components with a molecular weight of 58,000 to 64,000 were recovered when any of the three antibodies was used as an immunoadsorbent. The purified antigen reacted with all three monoclonal antibodies in an enzyme-linked immunosorbent assay, indicating that the antibodies recognized the same antigen but not necessarily the same determinant. The purified antigen was sensitive to both pronase digestion and periodate oxidation. The antigen was shown to be on the external surface of some but not all T. vaginalis isolates by agglutination of live organisms with the monoclonal antibodies.     

Detection of Trichomonas vaginalis in endocervical and ectocervical smears

The objective of this study was to determine the relative sensitivity of detecting Trichomonas vaginalis in endocervical as compared to ectocervical Papanicolaou-stained smears. The average number of organisms in 10 (200×) high-power fields (hpf) per smear was used for comparing the presence of trichomonads in the two smear types. In every pair of ectocervical-endocervical smears, there were always more trichomonads in the ectocervical smear. Fifty percent of cases showed at least 25 more trichomonads per 200× hpf in the ectocervical smear than in the endocervical smear. In 20 of 50 cases (40%), trichomonads were present only in the ectocervical smear. The organisms were found only in the endocervical smears of women with a heavier ectocervical trichomonad burden. In conclusion, trichomonads are detected in the Papanicolaou-stained ectocervical smear more often than in the endocervical smear; therefore, examination of an adequate ectocervical smear has greater utility than the endocervical smear for the diagnosis of trichomoniasis. Diagn Cytopathol 1996;14:273–276. © 1996 Wiley-Liss, Inc.