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Gonorrhoea was diagnosed in 258 of 1500 women. The diagnosis was made from urethral plus cervical cultures in only 184 cases (71.3%). The percentage of positive diagnoses rose to 96.5% when cervical smear microscopy was also performed. This highlights the need to carry out all three investigations. Concurrent Trichomonas infection was present in 14% of cases.
Consecutive cervical smears examined in 1980 were divided into those from women using intrauterine contraceptive devices (IUDs) (757) and those not using them (11,711). Actinomycetes were not found in the non-IUD group but were present in 7.0% of the IUD group and were significantly more common in women with plastic IUDs (11.7%) than in those with copper ones (2.1%). Cervical intraepithelial neoplasia (CIN), grade 3, was significantly more common in the IUD group (1.06%) than in the non-IUD group (0.34%). Trichomonas infection was significantly more common in women with IUDs and actinomycetes (9.4%), in those with IUDs and without actinomycetes (1.6%) and in those without IUDs attending the clinic for sexually transmitted disease (STD) (5.9%) than in non-IUD, non-STD women (0.7%). Candida infection was not more common in women with IUDs (with or without actinomycetes) (1.2%) than in non-IUD, non-STD women (2.1%) but was significantly more common in STD women (3.8%). A repeat study in 1981 showed a similar prevalence of CIN 3: 1.03% of the IUD group (485) and 0.33% of the non-IUD group (10,850).
The aim of the present study was to investigate the effect of various types of contraceptives on morphological finding of Pap smear results. Pap smear results of 7,753 fertile women who presented to 15 different family planning services in Fars Province (south of Iran) were analyzed according to their methods of contraception. The population consisted of 2241 women who used intrauterine device (IUD) as a contraceptive method (Group 1), 2521 women who were oral contraceptive (OCP) users (Group 2), and the control group, which consisted of women who used other methods of contraceptive. Comparison between the Pap smear results showed a higher number of benign cellular changes among Group 1 (22.4%) than Group 2 (19.3%), and the differences were statistically significant (p = 0.009). In addition, 80.6% women who used oral contraceptive pill (OCP) as contraceptive showed cellular changes within normal limits, while it were 77.6% for intrauterine device (IUD) users. Compared with Group 2, Group 1 had a significantly higher percentage of metaplastic cells in their Pap smear results (G1 7.4%, G2 5.8%, p < 0.05). No epithelial abnormalities were reported in Pap smears. Trichomonas vaginalis was higher in G1 than the other groups (p < 0.005), but the difference was not statistically significant for candidiasis. It may be concluded that in this population, IUD and OCP had no effect on morphological pattern of the Pap smears, but there was a significant increased rate of trichomonas infection in IUD users.
The rescreening of cervical cytology smears, although inadequate both for checking the reliability of an individual screener and for the detection of false negatives, nonetheless represents an indispensable tool for assessing morphologic diagnostic criteria and monitoring laboratory performance. Interobserver and intraobserver concordance in a given laboratory determine the reliability of diagnostic criteria and disclose the possibility of improving diagnostic consistency. The various aspects of rescreening are discussed, and a simple statistical procedure for a quantitative comparison of screening reproducibility is described. This procedure, with calculation of phi-values and mean prevalence rates, was applied to screening and rescreening data from the Cyt-U-Universitair Cytology Laboratory from 1978 to 1983, in which the morphologic findings in each smear were recorded in detail using the QISO (Quality, Infection, Squamous epithelium and Other abnormalities) coding. The reproducibility of the reported presence of endocervical cells not only steadily improved over the years assessed, but also reached a sufficiently high level that diagnostic variability should not hamper its clinical utility. The same was true of the diagnosis of Trichomonas infection and moderate atypia of squamous cells. On the other hand, the reproducibility of the diagnosis of endometrial cells in smears did not significantly improve. However, since the intraobserver concordance on this criterion was good, it seems likely that the definitions of screeners in this area can still be brought into closer agreement. Conversely, the diagnosis of "abnormal endocervical cells" had such a high level of variability even at the intraobserver level as to question its use as a diagnostic criterion. Similar variability was seen in the distinction between atypical squamous metaplasia and mild dysplasia. Use of this statistical technique for the quality control of cytologic diagnoses frees that assessment from histopathologic control, which does not address the problem of variation within the cytologic or histologic diagnoses themselves.
This paper reports on a patient in whom the clinical diagnosis of obstructive azoospermia was made according to clinical observations, i.e. azoospermia, normal andrological examination, normal follicle stimulating hormone and a misleading histopathological report of a testicular biopsy. Microsurgical vasoepididymostomy failed to restore fertility, and as a last resort, microsurgical sperm aspiration was performed. Although flagellated cells were observed in the epididymal aspiration, no spermatozoa were observed and wet preparation of multiple testicular biopsies failed to demonstrate any spermatozoon. This patient was diagnosed to have a non-obstructive azoospermia, resulting from maturation arrest associated with trichomonas infection at the level of the epididymis.
Trichomonas infections of the abdominal cavity are uncommon and case histories have not been published previously. A patient to whom reference is made this paper developed a combined immunodeficiency syndrome and portal hypertension with ascites on the basis of a cirrhosis of the liver. This seems to have been the precondition for a peritonitis caused by a Trichomonas species.
BACKGROUND: Screening for cervical infection is difficult in developing countries. Screening strategies must be improved for high-risk women, such as female sex workers. GOAL: To evaluate the sensitivity and specificity of screening algorithms for cervical infection pathogens among female sex workers in Accra, Ghana. STUDY DESIGN: A cross-sectional study among female sex workers was conducted. Each woman underwent an interview and a clinical examination. Biologic samples were obtained for the diagnosis of HIV, syphilis, bacterial vaginosis, yeast infection, Trichomonas vaginalis, Neisseria gonorrhoeae, and Chlamydia trachomatis infection. Signs and symptoms associated with cervicitis agents were identified. Algorithms for the diagnosis of cervical infection were tested by computer simulations. RESULTS: The following prevalences were observed: HIV, 76.6%; N. gonorrhoeae, 33.7%; C. trachomatis, 10.1%; candidiasis, 24.4%; T. vaginalis, 31.4%; bacterial vaginosis, 2.3%; serologic syphilis, 4.6%; and genital ulcers on clinical examination, 10.6%. The best performance of algorithms were reached when using a combination of clinical signs and a search for gram-negative diplococci on cervical smears (sensitivity, 64.4%; specificity, 80.0%). CONCLUSIONS: In the algorithms, examination of Gram-stained genital smears in female sex workers without clinical signs of cervicitis improved sensitivity without altering specificity for the diagnosis of cervical infection.
Vaginal trichomoniasis poses a difficult therapeutic challenge when metronidazole is ineffective or contraindicated. We conducted a retrospective study of 6.25% paromomycin cream in the treatment of nine women referred with cases of vaginal trichomoniasis where metronidazole resistance or allergy was present. Results obtained immediately and 1 month after treatment were reviewed. The median age of the patients was 46 years; four women were nulliparous. The median symptom duration was 1 year. Five women were allergic to metronidazole. In four cases, resistance to high doses of metronidazole was demonstrated. Smears or cultures were positive immediately after treatment for three patients; a fourth relapsed 2 weeks later. Of these patients for whom treatment failed, one was cured with a 3-week course of paromomycin cream, and another was successfully treated with paromomycin cream and oral tinidazole. Three patients developed vaginal ulcerations that resolved spontaneously. Adverse effects may be a result of local formulation. Paromomycin cream was useful for treatment of cases of trichomonas infection where metronidazole resistance or allergy was encountered.
Clinical and laboratory studies were made in 2259 persons by using serological assays, including cultural and bacterioscopic assays in 1824 and 363 persons, respectively, in order to indicate Trichomonas infection among men, women, and 2-15-year-old children who had chronic inflammation of the urogenital system, as well as among children aged 2 months to 16 years who had a severe somatic disease. Parasitic cenoses of the urogenital tract were studied in women with trichomoniasis and reproductive dysfunction. Trichomonas invasion is an etiological factor of inflammatory small pelvic diseases, chronic prostatitis, reproductive dysfunction in males and females. Furthermore, trichomoniasis is an essential factor, that predisposes to recurrent viral infections: genital herpes and pointed condyloma, and substantially increases the risk of birth of babies with clinical manifestations of intrauterine infection. According to the studies, a laboratory diagnosis of trichomoniasis should be made by cultural assay due to the low sensitivity of bacterioscopy by sampling a biological material from females in the periovulatory period that corresponds to the hyperestrogenicity, which substantially increases the number of isolated cultures and characterizes the depth of integration of metabolic processes of a parasite and its host.
Because of the striking similarity between histopathological pictures of chronic trichomonal cervicitis uteri, the tissue reaction after subcutaneous inoculation of Trichomonas culture in experimental animals and female breast diseased by fibrocystic mastopathy, the detection of Trichomonads was undertaken in surgically removed diseased breast parts. In 12 FCM patients, subjected to segmental breast resection, the imprint smears were prepared from dissected specimens and after supravital staining immediately examined by light microscopy. The mucous content from dilated ducts was inoculated in the culture media. The dissected tissues have been further histologically analysed by standard method. In nine out of 12 examined FCM cases the direct microscopy revealed aflagellary, pseudocystic, leucocytoid form of Trichomonads. The cultures were positive in 4 cases: in 3 patients Trichomonas tenax was identified and in the last one T vaginalis. Histopathological findings in all 12 examined cases have shown the changes characteristic for FCM. On the basis of the accumulated knowledge about pathogenic capacity of Trichomonads, it can be with great certainty claimed that these protozoa, even in their pseudocystic form are able to cause the all appearances characteristic for FCM. This first report about Trichomonas infection in the middle of FCM process gives the unexpected hope in solving of its etiology and new insight into antitrichomonal host reaction which is frequently associated with epithelial dysplasia and unrarely with precancerous lesions as earlier observed in cervix uteri.
We report a case of an extremely-low-birth-weight premature infant with Trichomonas vaginalis infection of the vagina and urinary tract. Her mother is also infected with Trichomonas vaginalis but is asymptomatic. The patient's illness started as an asymptomatic pyuria and later on at early infancy developed profuse malodorous vaginal discharge. Her vaginal discharge was positive for Trichomonas vaginalis, both on wet mount and Papanicolaou smear, and the infection responded well to treatment with metronidazole. Infants with recurrent vaginal discharge presenting beyond the neonatal period may be attributed to T. vaginalis infection.
OBJECTIVE: To investigate the incidence of the association of Trichomonas and Pneumocystis in the lung. STUDY DESIGN: Sixty-six bronchoalveolar lavage fluid (BALF) samples from immunocompromised patients with pneumocystosis were retrospectively examined microscopically. RESULTS: Trichomonads were found as coinfecting agents in 60% of BALF samples. The frequency and abundance of trichomonads was increased, up to 100%, in cases rich in Pneumocystis. CONCLUSION: The data suggest that pulmonary Trichomonas infection occurs frequently in the course of Pneumocystis pneumonia. The role of trichomonads in causing alveolar damage during Pneumocystis pneumonia is hypothetical.
Metronidazole is currently approved for use against Trichomonas infection and amebiasis. It is also effective against giardiasis, "nonspecific vaginitis," and anaerobic infections and bactericidal against almost all obligately anaerobic organisms; Actinomyces, Arachnia, and Propionibacterium are exceptions. Metronidazole diffuses well into all tissues and penetrates the central nervous system well. It normally has only a relatively minor impact on the colonic flora. The drug is well tolerated. Adverse reactions include reversible neutropenia, peripheral neuropathy, and disulfiram-like reaction when taken with alcohol. Of more concern are its mutagenicity and carcinogenicity in some, but not all, animals. These are considered low risks, and follow-up studies of patients treated to date do not reveal an increased incidence of cancer, but physicians and patients must decide whether the benefit from therapy outweighs the potential risk. Metronidazole should only be used for approved indications, except in the research setting, and should not be used prophylactically, although it is effective.
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Ronidazol is often used in racing pigeons for the treatment of Trichomonas infections and diseases. Therefore, in this study, the compatibility of the drug was examined by oral application over 7 days. For this purpose a randomized blind study was performed using four different groups (control group, 10 mg = therapy-group, 20 mg = double-dose-group and 40 mg = high-dose-group) of pigeons (Columba livia f. domestica) with 6 male and 6 female birds each. All birds were clinically healthy and between 6 and 12 weeks of age. The application of ronidazol at a dose of 10 mg/racing pigeon did show no side-effect within the duration of the study, e.g. no influence could be seen on clinical, haematological, blood-chemical and pathological parameters. Low-to middle-grade clinical alterations of the gastro-intestinal tract occurred in the high-dose group at day 6 and 7 of the application of the drug. Therefore a fourfold overdosing of ronidazol should be avoided.
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