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Antimicrobials during Pregnancy
Published in “Bert” Bertis Britt Little, Drugs and Pregnancy, 2022
The two most common forms of vaginitis during pregnancy are fungal and protozoan. Pregnant women with vaginitis secondary to fungi, such as Candida species, can be treated with a variety of antifungal agents that are listed in Box 2.24. Women with trichomoniasis present an unusual therapeutic dilemma. Although there is no scientific evidence that metronidazole is either teratogenic or causes adverse effects in the embryo/fetus, the manufacturer has issued a stern warning regarding its use during the first trimester of pregnancy. Fortunately, many of the patients with trichomoniasis can be treated with antiprotozoal agents until they are past the first trimester and then treated with metronidazole—the only effective treatment for this protozoan infection.
Trichomonas
Published in Vincenzo Berghella, Maternal-Fetal Evidence Based Guidelines, 2022
Trichomoniasis is caused by the protozoan T. vaginalis, which had been previously thought to be a harmless commensal. Trichomonas vaginalis can infect the vagina and the Skene's glands of the urethra along with the urethra itself. Less common sites of infection include the cervix, bladder, and Bartholin's gland. The incubation period for T. vaginalis is 4–7 days on average, but ranges from 2 to 28 days. The mechanism on how trichomoniasis infection causes preterm labor is unknown. Some studies have linked infection to a maternal inflammatory response. This was demonstrated by findings of elevated cervical interleukin-9 and vaginal defensing in pregnant asymptomatic patients which causes a neutrophilic response to release mixed metalloproteinases [5].
Candida and parasitic infection: Helminths, trichomoniasis, lice, scabies, and malaria
Published in Hung N. Winn, Frank A. Chervenak, Roberto Romero, Clinical Maternal-Fetal Medicine Online, 2021
Trichomonas vaginalis is an extracellular flagellated single-cell protozoon that colonizes the female lower urogenital tract and male urethra. Humans are the only host for T. vaginalis and the organisms cannot survive outside their human hosts for very long. T. vaginalis replicates by binary fusion of the trophozoite form. Trichomoniasis is transmitted from person to person, typically via genital contact at the time of sexual intercourse. Although transmission via fomites, such as towels or clothing, has been theorized, non-venereal transmission has not yet been documented.
In Vitro Activation of Macrophages by an MHC Class II-restricted Trichomonas Vaginalis TvZIP8-derived Synthetic Peptide
Published in Immunological Investigations, 2022
Victor Ermilo Arana-Argáez, Emanuel Ceballos-Góngora, María Elizbeth Alvarez-Sánchez, Antonio Euan-Canto, Julio Lara-Riegos, Julio César Torres-Romero
Trichomoniasis, a sexually transmitted infection (STI) caused by the flagellate protist parasite Trichomonas vaginalis, it has become a significant public health concern, with an estimated 276 million new cases each year and prevalence of 187 million of infected individuals, which constitutes over half of the curable STIs worldwide (Menezes et al. 2016; Newman et al. 2015). Chemotherapy with nitroimidazoles, metronidazole or tinidazole, remains as the only strategy that is used for the control of trichomoniasis. However, this limitation on a single drug class for treating the trichomoniasis, can contribute to the treatment failure due to undesirable side effects and/or to the development of nitroimidazoles-resistant strains of T. vaginalis (Bouchemal et al. 2017; Kirkcaldy et al. 2012).
The safety of metronidazole in pregnancy
Published in Health Care for Women International, 2021
Ozioma C. Nwosu, Kathaleen Bloom
The CDC’s 2015 STD guidelines advocate the use of metronidazole as first-line for the treatment of BV and trichomoniasis (Centers for Disease Control, 2015b). A single 2 gram oral dose of metronidazole or 500 mg of metronidazole twice daily for seven days is recommended. The use of metronidazole gel in the treatment of Trichomoniasis is not recommended. It is recommended that all symptomatic women be treated, regardless of gestational age. Metronidazole is transmitted through the placenta and through breast milk. However, no study has linked in-utero exposure to congenital anomalies. A breastfeeding holiday is suggested for lactating women who are taking metronidazole (Centers for Disease Control, 2015b). For women with recurrent or persistent BV stronger doses and longer periods of treatment are recommended. There is much ambiguity regarding the treatment of asymptomatic women who are pregnant. Some studies show that treating asymptomatic pregnant women results in harm, while other studies show no benefits, and still others show benefits (Centers for Disease Control, 2015b). Therefore, the CDC currently has no clear-cut recommendations with regard to the treatment of pregnant women who are asymptomatic.
Inhibition of the β-carbonic anhydrase from the protozoan pathogen Trichomonas vaginalis with sulphonamides
Published in Journal of Enzyme Inhibition and Medicinal Chemistry, 2021
Linda J. Urbański, Andrea Angeli, Vesa P. Hytönen, Anna Di Fiore, Giuseppina De Simone, Seppo Parkkila, Claudiu T. Supuran
Trichomonas vaginalis is a protozoan parasite responsible for trichomoniasis, one of the most frequent non-viral sexually transmitted diseases in humans1,2. Treatment of this disease remains almost exclusively based on just one class of drugs, 5-nitroimidazoles (with two available agents, metronidazole and tinidazole), and resistance to these agents is on the rise worldwide3,4. Trichomoniasis may cause a variety of symptoms, from mild to severe, but a large fraction (10–50%) of infected women show no symptoms, and 5–15% of cases may remain undetectable upon examination1,2. Furthermore, the majority of infected men are totally asymptomatic, making the diagnosis of this disease particularly challenging1,2. T. vaginalis infection may facilitate or worsen other critical pathologies, such as HIV-infection5 or even prostate cancer6. As a consequence, research on novel drug targets for fighting trichomoniasis has seen an increased interest7–11.