1258 SHORT COMMUNICATION
ActaDV ActaDV
Advances in dermatology and venereology Acta Dermato-Venereologica
Trichomonas vaginalis is Rare Among Women in Iceland
Ingibjorg HILMARSDOTTIR 1, 2, Erna SIGMUNDSDOTTIR 3, Audur EIRIKSDOTTIR 4, Daniel GOLPARIAN 5 and Magnus UNEMO 5
1
Department of Microbiology and 3 Department of Sexually Transmitted Diseases, Landspítali University Hospital, Baronsstigur, 101 Reykjavík,
2
Faculty of Medicine, University of Iceland, 4 The Icelandic Cancer Society, Reykjavík, Iceland, and 5 WHO Collaborating Centre for Gonorrhoea and other Sexually Transmitted Infections, Department of Laboratory Medicine, Faculty of Medicine and Health, Örebro University, Örebro, Sweden. E-mail: ingibjh @ landspitali. is Accepted Jul 5, 2017; Epub ahead of print Jul 6, 2017
Trichomonas vaginalis causes vaginitis in women, urethritis in both sexes and is associated with significant complications, including preterm delivery, low birth-weight and increased risk of HIV infection( 1). Microscopical detection of T. vaginalis in wet-mount preparations of genital fluids may miss up to half of infections, and culture has a highly suboptimal sensitivity compared with modern molecular diagnostic tests( 1). Thus, nucleic acid amplification tests( NAATs), with a sensitivity and specificity of 95 – 100 %( 1), have revolutionized the diagnosis of trichomoniasis and are providing new insights into the epidemiology of the disease. Recent NAAT-based studies on women attending sexually transmitted diseases( STD) clinics have shown unexpectedly high prevalence rates( 14.6 – 27 %) of trichomoniasis in the USA( 2, 3). In contrast, the prevalence in Western European countries and Australia appears to be substantially lower, i. e. 0.6 – 3.6 %( 4, 5). The prevalence of T. vaginalis infection in the Nordic countries in Northern Europe is largely unknown, with the exception of a single NAAT-based study in Sweden, where 1,121 consecutive STD clinic attendees in Örebro demonstrated prevalence rates of 0.16 % in women and 0 % in men, using the APTIMA TV Assay( 6). The aim of the present study was to examine the prevalence of T. vaginalis infection and selected STDs among consecutive Icelandic women attending an STD clinic and a cervical cancer screening programme.
MATERIALS AND METHODS
From 1 February to 16 March 2016, consecutive women were recruited from the Department of Sexually Transmitted Diseases at Landspítali University Hospital( the only STD clinic in Iceland) and the Icelandic Cancer Society, both located in the capital area of Reykjavík, whose population is approximately 214,000 individuals. All consecutive women who were 18 years of age or older at the STD clinic and between 35 and 64 years of age at the Cancer Society were invited to participate, and those who accepted provided written informed consent. Information about age distribution was available for STD clinic attendees only. The STD clinic collected urine specimens in the APTIMA Urine Specimen Transport Tubes( Hologic) from all participants for Chlamydia trachomatis and Neisseria gonorrhoeae APTIMA NAAT on the Tigris instrument( Hologic). High vaginal swabs were also collected from women with genitourinary symptoms( e. g. abnormal vaginal discharge, vulvovaginal itch or burning, dyspareunia, or dysuria), for bacterial vaginosis test and yeast culture that were done by Nugent’ s Gram stain method( 7) and 5-day culture on Sabouraud dextrose agar with chloramphenicol. White, creamy and restricted colonies composed of non-arthroconidial yeast cells were presumptively identified as Candida species. The Cancer Society collected cervical smears into PreservCyt Solution liquid Pap( Cytic Corporation, Marlborough, MA, USA) and 1 ml of the liquid was subsequently transferred into the APTIMA Specimen Transfer Kit( Hologic). Due to lack of appropriate ethical approval, women recruited at the Cancer Society could not be tested for infections other than trichomoniasis. Urine specimens, after C. trachomatis and N. gonorrhoeae testing, and cervical smear liquids were stored at – 80 ° C for 4 months prior to testing for T. vaginalis, which was done by the use of APTIMA TV Assay on the Panther instrument( Hologic). The study was approved by the National Bioethics Committee( permission no. 14-161).
RESULTS
A total of 431 women were included in the study. The 231 STD clinic attendees had a median age of 22 years( interquartile range( IQR) 22 – 26 years; range 18 – 56 years); 23 and 13 women were ≥ 35 years and ≥ 40 years of age, respectively. The 200 women recruited at the Cancer Society had an age ranging from 35 to 64 years. All 431 participants were negative for T. vaginalis. C. trachomatis was detected in 37( 16 %) of the STD clinic attendees and N. gonorrhoeae in none. Eighty-three( 36 %) of the women from the STD clinic were symptomatic and among these 18( 22 %) had C. trachomatis, 28( 34 %) had bacterial vaginosis and 15( 18 %) had positive Candida culture. C. trachomatis was associated with bacterial vaginosis in 7 cases and with Candida in 6 cases.
DISCUSSION
This study, in the Northern European country Iceland, evaluated the prevalence of trichomoniasis in a population at risk for STDs and in women at the age of 35 years and older who, in many studies, have had higher rates of T. vaginalis infection than younger women( 3, 8). No case of trichomoniasis was detected. In contrast, the prevalence of C. trachomatis in the STD attendees was 16 %, which is higher than the rates of 3.8 – 8.6 % reported from studies at STD clinics in Western and Northern Europe, the USA and Australia, where women were tested for both T. vaginalis and C. trachomatis( 2, 4, 6, 9). This is not surprising, as the prevalence of diagnosed C. trachomatis infections in Iceland for the past 20 years has been among the highest in Europe, or up to 739 cases per 100,000 population( http:// www. landlaeknir. is / english / statistics / diseases /). Although this doi: 10.2340 / 00015555-2747 Acta Derm Venereol 2017; 97: 1258 – 1260
This is an open access article under the CC BY-NC license. www. medicaljournals. se / acta Journal Compilation © 2017 Acta Dermato-Venereologica.