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A Coggle Diagram about Introduction (Is a common sexually transmitted disease (STD), Caused by the infection of Trichomonas Vaginalis, The disease is common, but is curable and Infect mostly in women than in men), Epidemiology ( (the disease is under control as it can be treated using an antibiotics), Trichomoniasis

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In 2008, the WHO estimated that the worldwide incidence of trichomoniasis was just over 276 million cases per year. Although most cases occur in resource-poor countries, there are approximately 3 million cases among women of reproductive age in the USA each year. In 2011, approximately 6200 new cases of trichomoniasis were identified in genitourinary medicine clinics in England. Most of these cases (93%) were diagnosed in women while 7% occurred in heterosexual men. it is also co-factor for HIV transmission.

Trichomoniasis can be transmitted through
- perinatally from infected mom to female babies.
-predesposing factors: non use of condoms, smoking and low socioeconomic class.

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Trichomoniasis is caused by the single-celled protozoan parasite, Trichomonas vaginalis. The parasite passes from an infected person to an uninfected person during sex. In women, the most commonly infected part of the body is the lower genital tract (vulva, vagina, cervix, or urethra). In men, the most commonly infected body part is the inside of the penis (urethra). During sex, the parasite usually spreads from a penis to a vagina, or from a vagina to a penis. It can also spread from a vagina to another vagina. It is not common for the parasite to infect other body parts, like the hands, mouth, or anus. It is unclear why some people with the infection get symptoms while others do not. It probably depends on factors like a person’s age and overall health. Infected people without symptoms can still pass the infection on to others.

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Invasion/ entry
T.vaginalis will attach to the surface of the genital tract rather than invade into the cells.
T.vaginalis will encounter the mucous layer of the genital tract as the first host surface. Mucin is the major proteinaceous constitute mucus that will form a lattice structure that act as the physical barrier to microbial invasion.
T.vaginalis can gain access to the underlying epithelium by binding it to the mucin and followed by its proteolytic degradation.
Adhesion
T.vaginalis will bind to the vaginal surfaces and change to amoeboid structure to strengthen the binding to target cell.
The interaction then release cysteine protenases resulting in desquamation of vaginal exracellular surface and also facilitates cytotoxicity toward host cell.These proteinases allow T. vaginalis to traverse the protective mucus barrier of host epithelium. Once the T.vaginalis hosting the target cell (vaginal epithelial cells) they will start to replicate and translation and cause  infection to the host.

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About 70% of infected people do not have any signs or symptoms. When trichomoniasis does cause symptoms, they can range from mild irritation to severe inflammation. Some people with symptoms get them within 5 to 28 days after being infected. Others do not develop symptoms until much later.

Men with trichomoniasis may notice:

Itching or irritation inside the penis;

Burning after urination or ejaculation;

Discharge from the penis.

Women with trichomoniasis may notice:

Itching, burning, redness or soreness of the genitals;

Discomfort with urination;

A change in their vaginal discharge (i.e., thin discharge or increased volume) that can be clear, white, yellowish, or greenish with an unusual fishy smell.

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Genetic Manipulation For Vaccine Development

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Genetic Manipulation For Vaccine Development

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A prime-boost vaccination regime initially using live, whole cell trichomonads in a Freund's Complete Adjuvant (FCA) and followed by Freund's Incomplete Adjuvant (FIA) produced serum IgG and significantly protected mice from infection following intravaginal infection with Tv compared to controls.

Vaginal IgG and IgA were detected in vaccinated mice post-Tv vaginal challenge, but were not detected in control mice post-Tv vaginal challenge. Furthermore, intravaginal infection followed by metronidazole treatment and reinfection did not afford protection by natural immunity. While the efficacy in humans cannot be predicted from this model alone, we suggest that this demonstrates the potential of a vaccine strategy to afford protection not achieved by natural infection.

Vaccination with either Freund's or Alhydrogel was found to significantly reduce incidence of infections on day 7 post-infection (incidence) and significantly improved clearance by day 28 post-infection (resolution) compared to unvaccinated controls

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The most commonly used method of diagnosis is a direct microscopic observation (wet mount) of vaginal secretions and, although both rapid and inexpensive, the sensitivity of this technique is generally 50 to 70%.

Indirect enzyme-linked immunosorbent assay (ELISA) for the detection of Trichomonas vaginalis which is both rapid and sensitive. This assay, which employs affinity-purified rabbit anti-T. vaginalis antibodies in a "sandwich" configuration, is simple to perform and is neither interfered with nor appears to cross-react with other microorganisms which are common inhabitants of the urogenital tract.

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Trichomoniasis can be cured with a single dose of prescription antibiotic medication (either metronidazole or tinidazole), pills which can be taken by mouth. It is safe for pregnant women to take this medication. Some people who drink alcohol within 24 hours after taking this kind of antibiotic can have uncomfortable side effects.

People who have been treated for trichomoniasis can get it again. About 1 in 5 people get infected again within 3 months after treatment.

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Molecular detection for Trichomoniasis vaginalis is using the wet mount and PCR method. PCR demonstrated higher sensitivity of 100% compared to 77% in wet mount.

Both of the techniques exhibit their own negative sides.  The culture technique offers longer turnaround period of 7 days to obtain the result and cross-reaction within trichomonads can also happens. On the other hand, the use of wet mount method will brings a lesser sensitive result for the detection.

PCR method was conducted with the use of 3 different primers and a PCR mixture without DNA samples were used as a negative control for the experiment. In wet mount, 10⁴ organisms per millilitre of vaginal fluids were required to detect a positive sample.  However, the use of tube wet mount method was an alternative to the glass slide, were centrifugation of the specimen’s concentrated sample were being done and thus able to enhance the detection of T.vaginalis.

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How T. vaginalis escaped from host immune response

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How T. vaginalis escaped from host immune response

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molecular mimicry is defined as structural, functional or immunological similarities shared between macromolecules found on pathogens and host tissues. The parasite T. vaginalis can also coat itself with host plasma proteins to avoid being recognized as strange by the host immune system . This parasite adaptation prevents the recognition of the pathogen-associated molecular patterns (PAMPs) and consequently the immune response triggering such as antigen presentation and complement-mediated lysis will not occur.

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Cysteine proteases (CP) plays the main role in the immune response.
CP is secreted by T.vaginalis.
CP will degrade IgG, IgM and IgA. This will allow the organism to survive the antibody response. It also release a high amount of immunogenic soluble antigen.
This antigen may neutralize antibody or cytotoxic T cell. Besides, T. vaginalis can coat itself with host plasma protein. This will made the host immune system cannot recognize it as foreign. Thus, the immune system mechanism such as complement mediated lysis will not occur.
T. vaginalis not only can degrade the antibody, but T. vaginalis also can degrade secretory leukocyte protease inhibitor (SLPI) which SLPI is a factor that protect the mucosal surface of the vagina.  SLPI degraded by T. vaginalis will cause it to be non-functional.
SLPI has the ability to prevent HIV transmission but due to the trichomoad proteinases it causes increasing of risk of HIV in woman with this disease.
A healthy vagina has a range of pH value from 3.8-4.5. It is in acidic range where lactobacilli are responsible to maintain the acidic pH of the vagina. Lactobacilli also consider as protective of normal vaginal flora. Lactobacilli produce hydrogen peroxide to neutralized the CPs. However, increase in vaginal pH and reduction of the flora has been seem to be appeared in patients with this disease. This will cause phagocytosis of lactobacilli which will enable it to survive in a more basic environment, destabilize this host protective effect.