Vaginal microbiocenosis in women with trichomoniasis

Cover Page


Background. Trichomoniasis is accompanied by substantial colonization of the genital tract by various opportunistic microorganisms and reduced amount of lactobacilli. Both processes have a negative impact on the reproductive health and fetal development. Today, however, in the treatment of trichomoniasis insufficient attention is paid to the restoration of the normal vaginal microflora. 

Aim. An attempt was made to assess the vaginal microbiocenosis of patients with trichomoniasis using traditional and novel molecular methods.

Matherials and Methods. Archived vaginal samples from 37 women with trichomoniasis were used, which were placed on slides, fixed in the flame and stained according the Gram method and by methylene blue and stored in boxes within last 15 years. The preparations were evaluated using microscopy and the nucleic acid amplification based test Femoflor and tests for the detection of DNA of sexually transmitted agents.

Results. According to the microscopic examination, disorders of the vaginal microbiocenosis were detected in 89.2% of patients with trichomoniasis. C. trachomatis was detected in 8.1% of the samples. Obligate anaerobic microorganisms were determined in all samples, accounting for 8% to 100% of the total bacterialthe majority of the women. Facultative anaerobic microflora was also found in all the patients. Lactobacilli were detected in 8.1% of the women, and mycoplasma – in 37.8%. 

Conclusions. It was shown that in women with trichomoniasis there are often disturbances of the normal vaginal flora, manifested as the presence of a variety of opportunistic bacteria, accompanied by an inflammatory response. Almost half of the preparations showed bacterial vaginosis. Noteworthy, there was high prevalence of Mycoplasma hominis. For the first time, a technique of DNA testing in the materials placed on glass slides after prolonged storage was applied.

Aleksey N. Grigoryev

Author for correspondence.
D. O. Ott Research Institute of Obstetrics and Gynecology, RAMS
Russian Federation

Researcher, Laboratory of microbiology

Elena V. Rybina
D. O. Ott Research Institute of Obstetrics and Gynecology, RAMS
Russian Federation

Bacteriologist, Laboratory of microbiology

Zinaida M. Martikaynen
D. O. Ott Research Institute of Obstetrics and Gynecology, RAMS
Russian Federation

PhD, Senior Researcher, Laboratory of microbiology

Alevtina M. Savicheva
D. O. Ott Research Institute of Obstetrics and Gynecology, RAMS
Russian Federation

MD, Professor, Head of Laboratory of Microbiology

  • Nijhawan AE, DeLong AK, Celentano DD, et al. The association between trichomonas infection and incarceration in HIV-seropositive and at-risk HIV-seronegative women. Sex Transm Dis.2011;38(12):1094-1100. doi: 10.1097/OLQ.0b013e31822ea147.
  • Schwebke JR, Burgess D. Trichomoniasis. Clin Microbiol Rev. 2004;17(4):794-803. doi: 10.1128/CMR.17.4.
  • -803.2004.
  • Zaki MElS, Raafat D, Emshaty WEl, et al. Correlation of Trichomonas vaginalis to bacterial vaginosis: a laboratory-based study. J Infect Dev Ctries. 2010;4 (3):156-163. doi: 10.3855/jidc.434.
  • Rathod SD, Krupp K, Klausner JD, et al. Bacterial vaginosis and risk for Trichomonas vaginalis infection: a longitudinal analysis. Sex Transm Dis. 2011;38(9):882-886. doi: 10.1097/OLQ.0b013e31821f91a1.
  • Street DA, Wells C, Taylor-Robinson D, Ackers JP.
  • Interaction between Trichomonas vaginalis and other pathogenic micro-organisms of the human genital tract.
  • Br J Vener Dis. 1984;60:31-38. doi: 10.1136/sti.60.1.31.
  • Gatski M, Martin DH, Clark RA, et al. Co-occurrence of Trichomonas vaginalis and bacterial vaginosis among HIV-positive women. Sex Transm Dis. 2011;38(3):163-166. doi: 10.1097/OLQ.0b013e3181f22f56.
  • Allsworth JE, Ratner JA, Peipert JF. Trichomoniasis and
  • other sexually transmitted infections: results from the
  • –2004 NHANES surveys. Sex Transm Dis. 2009;
  • (12):738-744. doi: 10.1097/OLQ.0b013e3181b38a4b.
  • Ginocchio CC, Chapin K, Smith JS, et al. 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. 2012;50(8):2601-2608.
  • Conrad MD, Bradic M, Warring SD, et al. Getting trichy: tools and approaches to interrogating Trichomonas vaginalis in a post-genome world. Trends Parasitol. 2013;29(1):17-25. doi: 10.1016/
  • Kissinger P. Trichomonas vaginalis: a review of epidemiologic, clinical and treatment issues. BMC Infect Dis. 2015;15:307. doi: 10.1186/s12879-015-1055-0.
  • Petrin D, Delgaty K, Bhatt R, Garber G. Clinical and microbiological aspects of Trichomonas vaginalis. Clin Microbiol Rev. 1998;11(2):300-317.
  • Hardy PH, Hardy JB, Nell EE, et al. Prevalence of six sexually transmitted disease agents among pregnant inner-city adolescents and pregnancy outcome. Lancet. 1984;2:333-337. doi: 10.1016/S0140-6736(84)92698-9.
  • Cotch MF, Pastorek JG, Nugent RP, et al. Trichomonas vaginalis associated with low birth weight and preterm delivery. The vaginal infections and prematurity study group. Sex Transm Dis. 1997;24:353-360. doi: 10.1097/00007435-199707000-00008.
  • Ness RB, Kip KE, Hillier SL, et al. A cluster analisis of bacterial vaginosis-associated microflora and pelvic inflammatory disease. Am J Epidemiol. 2005;162(6):585-590. doi: 10.1093/aje/kwi243.
  • Martin DH. The microbiota of the vagina and its influence on women’s health and disease. Am J Med Sci. 2012;343(1):2-9. doi: 10.1097/MAJ.
  • b013e31823ea228.
  • McIver CJ, Rismanto N, Smith C, et al. Multiplex PCR testing detection of higher-than-expected rates of cervical Mycoplasma, Ureaplasma, and Trichomonas and viral agent infections in sexually active australian women. J Clin Microbiol. 2009;47(5):1358-1363. doi: 10.1128/JCM.01873-08.
  • McKechnie ML, Hillman R, Couldwell D, et al. Simultaneous identification of 14 genital microorganisms in urine by use of a multiplex PCR-based reverse line blot assay. J Clin Microbiol.2009;47(6):1871-1877. doi: 10.1128/JCM.00120-09.
  • Zhou X, Bent SJ, Schneider MG, et al. Characterization of vaginal microbial communities in adult healthy women using cultivation-independent methods. Microbiology. 2004;150(8):2565-2573. doi: 10.1099/mic.0.26905-0.
  • Bartlett JG, Onderdonk AB, Drude E, et al. Quantitative bacteriology of the vaginal flora. J Infect Dis. 1977;136(2):271-277. doi: 10.1093/infdis/136.2.271.
  • Oakley BB, Fiedler TL, Marrazzo JM, Fredricks DN. Diversity of human vaginal bacterial communities and associations with clinically defined bacterial vaginosis. Appl Environ Microbiol.2008;74(15):4898-4909. doi: 10.1128/AEM.02884-07.
  • Мартикайнен З.М., Григорьев А.Н., Рыжкова О.С., и др. Сравнение лабораторных методов диагностики инфекций, вызываемых Trichomonas vaginalis // Журнал акушерства и женских болезней. — 2014. — Т. LXIII. — № 1 . — С. 5–9. [Martikaynen ZM, Grigoryev AN, Ryzhkova JS, et al. Comparison of laboratory methods for diagnosis of Trichomonas vaginalis. Journal of Obstetrics and Women’s Diseases. 2014; LXIII(1):5-9. (In Russ).]
  • Григорьев А.Н. Современное состояние проблемы лабораторной диагностики урогенитального трихомониаза // Журнал акушерства и женских болезней. — 2013. — Т. LXII. — № 1. — С. 32–41. [Grigoryev AN. Current state of the problem of the laboratory diagnostics of urogenital trichomoniasis. Journal of Obstetrics and Women’s Diseases. 2013; LXII(1):32-41. (In Russ).]
  • Гущин А.Е., Рыжих П.Г., Махлай Н.С. Сравнение пределов обнаружения микроскопии, культурального посева и методов амплификации нуклеиновых кислот, используемых в лабораторной практике для выявления Trichomonas vaginalis // Клиническая дерматология и венерология. — 2012. — № 3. — С. 16–21. [Gushin AE, Ryzhih PG, Makhlaĭ NS. Comparison of detection limits of microscopy, culture, and nucleic acid amplification techniques using in the laboratory practice for the identification of Trichomonas vaginalis. Klinicheskaja dermatologija i venerologija. 2012;3:16-21. (In Russ).]
  • Шипицына Е.В., Золотоверхая Е.А., Григорьев А.Н., и др. Оценка методов амплификации нуклеиновых кислот для диагностики трихомониаза // Журнал акушерства и женских болезней. — 2011. — Т. LX. — № 2. — С. 73–79. [Shipitsyna YeV, Zolotoverhaja YeF, Grigoryev AN, et al. Assessment of methods of amplification of nucleic asids for diagnostics of trichomoniasis. Journal of Obstetrics and Women’s Diseases. 2011; LX(2):73-79. (In Russ).]
  • Pillay A, Radebe F, Fehler G, et al. Comparison of a TaqMan-based real-time polymerase chain reaction with conventional tests for the detection of Trichomonas vaginalis. Sex Transm Infect.2007;83:126-129. doi: 10.1136/sti.2006.022376.
  • Nye MB, Schwebke JR, Body BA. Comparison of APTIMA Trichomonas vaginalis transcription-mediated amplification to wet mount microscopy, culture, and polymerase chain reaction for diagnosis of trichomoniasis in men and women. Am J Obstet Gynecol. 2009;200(2):188.e1-188.e7. doi: 10.1016/j.ajog.2008.10.005.
  • Simpson P, Higgins G, Qiao M, et al. Real-time PCRs for detection of Trichomonas vaginalis beta-tubulin and 18S rRNA genes in female genital specimens. J Med Microbiol. 2007;56: 772-777. doi: 10.1099/jmm.0.47163-0.
  • Schirm J, Bos PA, Roozeboom-Roelfsema IK, et al. Trichomonas vaginalis detection using real-time TaqMan PCR. J Microbiol Methods. 2007;68:243-247. doi: 10.1016/j.mimet.2006.08.002.
  • Nugent RP, Krohn MA, Hillier SL. Reliability of diagnosing bacterial vaginosis in improved by a standardized method of gram stain interpretation. J Clin Microbiol. 1991;29(2):297-301.
  • Рыбина Е.В. Современные методы оценки микробиоценоза влагалища // Журнал акушерства и женских болезней. — 2015. — Т. LXIV. — № 1. — С. 53–66.
  • [Rybina EV. Current methods for evaluation of the vaginal microbiocenosis. Journal of Obstetrics and Women’s Diseases. 2015; LXIV(1):53-66. (In Russ).]
  • Brotman RM, Bradford LL, Conrad M, et al. Association between Trichomonas vaginalis and vaginal bacterial community composition among reproductive-age women. Sex Transm Dis. 2012;39(10):807-812. doi: 10.1097/OLQ.0b013e3182631c79.
  • Brotman RM, Klebanoff MA, Nansel TR, et al. Bacterial vaginosis assessed by gram stain and diminished colonization resistance to incident gonococcal, chlamydial, and trichomonal genital infection. J Infect Dis. 2010;202(12):1907-1915. doi: 10.1086/657320.
  • Balkus JE, Richardson BA, Rabe LK, et al. Bacterial vaginosis and the risk of Trichomonas vaginalis acquisition among HIV-1 negative women. Sex Transm Dis. 2014;41(2):
  • -128. doi: 10.1097/OLQ.0000000000000075.
  • Martin DH, Zozaya M, Lillis RA, et al. Unique vaginal microbiota that includes an unknown Mycoplasma-like organism is associated with Trichomonas vaginalis infection. J Infect Dis.2013;207(12):1922-1931. doi: 10.1093/infdis/jit100.
  • Amsel R, Totten PA, Spiegel CA, et al. Nonspecific vaginitis. Diagnostic criteria and microbial and epidemiological associations. Am J Med. 1983;74:14-22. doi: 10.1016/0002-9343(83)91112-9.
  • Demirezen S, Korkmas E, Beksa MS. Association between trichomoniasis and bacterial vaginosis: examination of 600 cervicovaginal smears. Cent Eur J Pablic Health. 2005;13(2):96-99.
  • Sharma H, Tal R, Clark NA, Segars JH. Microbiota and pelvic inflammatory disease. Semin Reprod Med. 2014;32(1):43-49. doi: 10.1055/s-0033-1361822.
  • Wijgert J, Borgdorff H, Verhelst R, et al. The vaginal microbiota: what have we learned after a decade of molecular characterization? PLoS One. 2014;9(8): e105998. doi: 10.1371/journal.pone.0105998.
  • Fettweis JM, Serrano MG, Huang B, et al. An emerging mycoplasma associated with trichomoniasis, vaginal infection and disease. PLoS One. 2014;9(10): e110943. doi: 10.1371/journal.pone.0110943.
  • Verhelst R, Verstraelen H, Claeys G, et al. Cloning of 16S rRNA genes amplified from normal and disturbed vaginal microflora suggests a strong association between Atopobium vaginae, Gardnerellavaginalis and bacterial vaginosis. BMC Microbiol. 2004;4:16. doi: 10.1186/1471-2180-4-16.
  • Pavlova SI, Kilic AO, Kilic SS, et al. Genetic diversity of vaginal lactobacilli from women in different countries based on 16S rRNA gene sequences. J Appl Microbiol. 2002;92(3):451-459. doi: 10.1046/j.1365-2672.2002.01547.x.


Abstract - 200

PDF (Russian) - 86

Copyright (c) 2016 ECO-vector LLC

Creative Commons License
This work is licensed under a Creative Commons Attribution-ShareAlike 4.0 International License.