Advertisement

Der Gynäkologe

, Volume 51, Issue 12, pp 1071–1078 | Cite as

Trichomoniasis – wer kennt sie überhaupt noch?

  • Herbert HofEmail author
Frauengesundheit in der Praxis
  • 196 Downloads

Zusammenfassung

Weltweit ist die Trichomoniasis immer noch die häufigste nichtvirale Geschlechtskrankheit. In Deutschland wird die Prävalenz ziemlich unterschätzt, weil der kulturelle Nachweis der Protozoen in Vaginalabstrichen nur eine ganz geringe Ausbeute hat und der molekularbiologische Nachweis mittels Polymerasekettenreaktion (PCR) von der gesetzlichen Krankenversicherung nicht vergütet wird. Für die Therapie ist Metronidazol immer noch Mittel der Wahl, wobei die 7‑tägige Applikation zuverlässiger wirkt als die Einmalgabe. Zunehmend muss mit resistenten Stämmen gerechnet werden, sodass dann als Alternativmaßnahme die lokale Gabe von Desinfektionsmitteln, wie Povidon oder Octenidin, infrage kommt. Da Trichomonas vaginalis oft Mycoplasma hominis als Endosymbiont mit sich trägt, muss mit Doppelinfektionen gerechnet werden. Die Granulozyten spielen die wichtigste Rolle in der Infektabwehr. Da sie zu klein sind, um die Protozoen in toto zu phagozytieren, versuchen sie, mittels Trogozytose die Erreger zu schädigen.

Schlüsselwörter

Sexuell übertragbare Erkrankungen Mycoplasma hominis Phagozytose Polymerasekettenreaktion Octenidin 

Trichomoniasis—an underappreciated infection

Abstract

Trichomoniasis still remains the most prevalent nonviral sexually transmitted disease worldwide. The prevalence in Germany is largely underestimated because the diagnosis by culture from vaginal swabs is often negative and molecular test methods such as polymerase chain reaction (PCR) are not reimbursed by statutory health insurance. Metronidazole still remains the drug of choice for therapy. A treatment schedule over 7 days generates better results than a single dose. One has to keep in mind, however, that resistant strains are emerging. An alternative therapeutic strategy consists of the local application of disinfectants, such as povidone or octenidine. Since Trichomonas vaginalis frequently harbors Mycoplasma hominis as an endosymbiont, one has to be aware of double infections. Granulocytes play the major role in the defense. Since they are too small to phagocytose a complete protozoal organism, they try to damage the pathogen by trogocytosis.

Keywords

Sexually transmitted diseases Mycoplasma hominis Phagocytosis Polymerase chain reaction Octenidine 

Notes

Einhaltung ethischer Richtlinien

Interessenkonflikt

H. Hof gibt an, dass kein Interessenkonflikt besteht.

Dieser Beitrag beinhaltet keine vom Autor durchgeführten Studien an Menschen oder Tieren.

Literatur

  1. 1.
    Hof H, Dörries R (2017) Medizinische Mikrobiologie. Duale Reihe. Thieme, Stuttgart, S 533Google Scholar
  2. 2.
    Kissinger P (2015) Epidemiology and treatment of trichomoniasis. Curr Infect Dis Rep 17:48CrossRefGoogle Scholar
  3. 3.
    Kubiak K, Sielawa H, Chen W, Dzika E (2018) Endosymbiosis and its significance in dermatology. J Eur Acad Dermatol Venereol 32:347–354CrossRefGoogle Scholar
  4. 4.
    Fürnkranz U, Henrich B, Walochnik J (2018) Mycoplasma hominis impacts gene expression in Trichomonas vaginalis. Parasitol Res 117:841–847CrossRefGoogle Scholar
  5. 5.
    Fürnkranz U, Walochnik J, Henrich B (2018) Mycoplasma hominis shows strain-dependent increase of resistance to selected antibiotics after symbiosis with Trichomonas vaginalis. J Glob Antimicrob Resist.  https://doi.org/10.1016/j.jgar.2018.04.003 CrossRefPubMedGoogle Scholar
  6. 6.
    Lustig G, Ryan CM, Secor WE, Johnson PJ (2013) Trichomonas vaginalis contact-dependent cytolysis of epithelial cells. Infect Immun 81:1411–1419CrossRefGoogle Scholar
  7. 7.
    Leitsch D (2016) Recent advances in the Trichomonas vaginalis field. F1000Res.  https://doi.org/10.12688/f1000research.7594.1 CrossRefPubMedPubMedCentralGoogle Scholar
  8. 8.
    Phukan N, Brooks AES, Simoes-Barbosa A (2018) A cell surface aggregation-promoting factor from Lactobacillus gasseri contributes towards inhibition of Trichomonas vaginalis adhesion to human vaginal ectocervical cells. Infect Immun.  https://doi.org/10.1128/IAI.00907-17 CrossRefPubMedGoogle Scholar
  9. 9.
    Mercer F, Ng SH, Brown TM, Boatman G, Johnson PJ (2018) Neutrophils kill the parasite Trichomonas vaginalis using trogocytosis. Plos Biol 16:e2003885CrossRefGoogle Scholar
  10. 10.
    Frobenius W, Bogdan C (2015) Diagnostic value of vaginal discharge, wet mount and vaginal pH—an update on the basis of gynecologic infectiology. Geburtshilfe Frauenheilkd 75:355–366CrossRefGoogle Scholar
  11. 11.
    Van Der Pol B (2016) Clinical and laboratory testing for Trichomonas vaginalis infection. J Clin Microbiol 54:7–12CrossRefGoogle Scholar
  12. 12.
    Herbst de Cortina S, Bristow CC, Davey JD, Klausner JD (2016) A systematic review of point of care testing for Chlamydia trachomatis, Neisseria gonorrhoeae, and Trichomonas vaginalis. Infect Dis Obstet Gynecol 2016:4386127CrossRefGoogle Scholar
  13. 13.
    Upton A, Bissessor L, Lowe P, Wang X, McAuliffe G (2017) Diagnosis of Chlamydia trachomatis, Neisseria gonorrhoeae, Trichomonas vaginalis and Mycoplasma genitalium: an observational study of testing patterns, prevalence and co-infection rates in northern New Zealand. Sex Health.  https://doi.org/10.1071/SH17110 CrossRefGoogle Scholar
  14. 14.
    Nikas I, Hapfelmeier A, Mollenhauer M, Angermeier D, Bettstetter M, Götz R, Schmidmayr M, Seifert-Klauss V, Muckenhuber A, Schenck U, Weirich G (2018) Integrated morphologic and molecular analysis of Trichomonas vaginalis, Mycoplasma hominis, and human papillomavirus using cytologic smear preparations. Parasitol Res 117:1443–1451CrossRefGoogle Scholar
  15. 15.
    Sutton M, Sternberg M, Koumans EH, McQuillan G, Berman S, Markowitz L (2007) The prevalence of Trichomonas vaginalis infection among reproductive-age women in the United States, 2001–2004. Clin Infect Dis 45:1319–1326CrossRefGoogle Scholar
  16. 16.
    Ginocchio CC, Chapin K, Smith JS, Aslanzadeh J, Snook J, Hill CS, Gaydos CA (2012) Prevalence of Trichomonas vaginalis and coinfection with Chlamydia trachomatis and Neisseria gonorrhoeae in the United States as determined by the Aptima Trichomonas vaginalis nucleic acid amplification assay. J Clin Microbiol 50:2601–2608CrossRefGoogle Scholar
  17. 17.
    Newman L, Rowley J, Vander Hoorn S, Wijesooriya NS, Unemo M, Low N, Stevens G, Gottlieb S, Kiarie J, Temmerman M (2015) Global estimates of the prevalence and incidence of four curable sexually transmitted infections in 2012 based on systematic review and global reporting. PLoS ONE 10:e143304CrossRefGoogle Scholar
  18. 18.
    Patel EU, Gaydos CA, Packman ZR, Quinn TC, Tobian AAR (2018) Prevalence and correlates of Trichomonas vaginalis infection among men and women in the United States. Clin Infect Dis.  https://doi.org/10.1093/cid/ciy079 CrossRefPubMedPubMedCentralGoogle Scholar
  19. 19.
    Secor WE, Meites E, Starr MC, Workowski KA (2014) Neglected parasitic infections in the United States: trichomoniasis. Am J Trop Med Hyg 90:800–804CrossRefGoogle Scholar
  20. 20.
    Meites E, Gaydos CA, Hobbs MM, Kissinger P, Nyirjesy P, Schwebke JR, Secor WE, Sobel JD, Workowski KA (2015) A review of evidence-based care of symptomatic trichomoniasis and asymptomatic Trichomonas vaginalis infections. Clin Infect Dis 61(Suppl 8):S837–S848CrossRefGoogle Scholar
  21. 21.
    Yarlett N, Hof H (1987) Comparative activities of metronidazole and niridazole against Trichomonas vaginalis. J Antimicrob Chemother 19:767–770CrossRefGoogle Scholar
  22. 22.
    Leitsch D (2017) Drug susceptibility testing in microaerophilic parasites: Cysteine strongly affects the effectivities of metronidazole and auranofin, a novel and promising antimicrobial. Int J Parasitol Drugs Drug Resist 7:321–327CrossRefGoogle Scholar
  23. 23.
    Ellis JE, Yarlett N, Cole D, Humphreys MJ, Lloyd D (1994) Antioxidant defences in the microaerophilic protozoan Trichomonas vaginalis: comparison of metronidazole-resistant and sensitive strains. Microbiology 140:2489–2494CrossRefGoogle Scholar
  24. 24.
    Howe K, Kissinger PJ (2017) Single-dose compared with multidose metronidazole for the treatment of trichomoniasis in women: a meta-analysis. Sex Transm Dis 44:29–34CrossRefGoogle Scholar
  25. 25.
    Küng E, Pietrzak J, Klaus C, Walochnik J (2016) In vitro effect of octenidine dihydrochloride against Trichomonas vaginalis. Int J Antimicrob Agents 47:232–234CrossRefGoogle Scholar
  26. 26.
    Secor WE (2012) Trichomonas vaginalis: treatment questions and challenges. Expert Rev Anti Infect Ther 10:107–109CrossRefGoogle Scholar

Copyright information

© Springer Medizin Verlag GmbH, ein Teil von Springer Nature 2018

Authors and Affiliations

  1. 1.MVZ Labor Limbach und KollegenHeidelbergDeutschland

Personalised recommendations