Background: Trichomonas vaginalis (T.vaginalis) and Neisseria gonorrhoeae (N.gonorrhoeae) are two most common non-viral sexually transmitted infections in the world. No data are available regarding the epidemiology of genital infections in women of Qom, central Iran. Objective:Epidemiological investigation of sexually transmitted infections in genital specimens of women referred to the referral gynecology hospital in Qom, central Iran.Materials and Methods:Genital swab specimens were collected from women volunteers and used for identification of bacterial and protozoal infections by conventional microbial diagnostics, porA pseudo gene LightCycler® real-time PCR (for N.gonorrhoeae) and ITS-PCR (for T.vaginalis). Results:Of 420 volunteers, 277 (65.9%) had genital signs/symptoms, including 38.3% malodorous discharge, 37.9% dyspareunia, and 54.8% abdominal pain. Totally, 2 isolates of Streptococcus agalactiae were identified. Five specimens (1.2%) in Thayer-Martin culture and 17 (4.1%) in real-time PCR were identified as N.gonorrhoeae. Fifty-four specimens (12.9%) in wet mount, 64 (15.2%) in Dorset’s culture, and 81 (19.3%) in ITS-PCR showed positive results for T.vaginalis. Five mixed infections of T.vaginalis+ N.gonorrhoeae were found. The risk of T.vaginalis infection was increased in women with low-birth-weight (p=0.00; OR=43.29), history of abortion (p=0.00; OR=91.84), and premature rupture of membranes (PROM) (p=0.00; OR=21.75). The probability of finding nuclear leukocytes (p=0.00; OR=43.34) in vaginal smear was higher in T.vaginalis infection.Conclusion:The significant prevalence of trichomoniasis and gonorrhea emphasizes the need for accurate diagnosis and effective surveillance to prevent serious reproductive complications in women.

Introduction: A significant proportion of patients with Sexually Transmitted Infections (STIs) are coinfected with multiple pathogens. We report here development of a multiplex PCR for simultaneous detection of Chlamydia trachomatis (C.trachomatis), Neisseria gonorrhoeae (N.gonorrhoeae) and Trichomonas vaginalis (T.vaginalis) in genital specimens from women. Methodology: After detection of the organisms by routine techniques including PCR, culture and direct smear, multiplex-PCR was optimized to detect ompI gene of CT, parC of NG, ITS ribosomal RNA of TV as target genes. The limit of detection (LOD) was determined using serially diluted genomic DNA from known number of each pathogen. Results: Totally 300 volunteers with mean age of 36.5 ±7.03 years were included and 266 (88.7%) had genitourinary clinical manifestations. Of 300 women, 150 (50.0%) were infected. Of them, 17 (5.7%) had N. gonorrhoeae, 98 (32.7%) T. vaginalis and 35 (11.7%) C. trachomatis. Multiplex-PCR revealed a total of 10 coinfections (3.3%) including 2 specimens of C. trachomatis/ N. gonorrhoeae, 3 specimens of C .trachomatis/ T. vaginalis and 5 specimens of N. gonorrhoeae/T. vaginalis coinfections. The sensitivity and specificity of multiplex-PCR for detecting N. gonorrhoeae were 100% and 98.59% (279 of 283) respectively and, for C. trachomatis and T. vaginalis were 100%. The LOD was 0.1 pg of DNA for C. trachomatis and N. gonorrhoeae, and 1.5 pg for T. vaginalis. Conclusions: The performance of this multiplex-PCR makes it a sensitive, rapid and affordable technique in clinical laboratory for simultaneous detection of STIs.

Background: Trichomoniasis infection is the most common non-viral sexually transmitted disease worldwide. In this study, the frequency of Trichomonas vaginalis infection and the possible risk factors were examined in women attending gynecological clinics in Qom, central Iran.Methods & Materials: A total of 300 women aged 18-50 years were enrolled. Three swab specimens were collected from vaginal discharge of each woman. One swab was used for wet mount preparation and examined for flagellated organism with motility by microscopy; the second swab was used for smear preparation and stained with Giemsa and Gram and examined under the light microscope for cellular/bacterial morphology. The last swab was inoculated into PBS, DNA was extracted by phenol-chloroform method and PCR was set for ITS DNA region. The result of ITS-PCR was confirmed by sequencing of the PCR product.Results: Of total 300 vaginal specimens, 34 samples (11.3%) in wet mount and 96 samples (32%) in ITS-PCR were positive for T. vaginalis (T.V.) infection. The result of sequencing showed the target gene was amplified. Chi-Square and Fisher-Exact tests showed statistically significant difference between T.V. positive and T.V. negative subjects in regard of dysuria (P = 0.001), itching (P = 0.05), history of abortion (P = 0.001), low-birth weight (P = 0.05) and ectopic pregnancy (P = 0.002). There was also a significant increase in epithelial cells and white blood cells (P = 0.000) and Gram+ bacteria (P = 0.001) shedding in vaginal discharge of T.V. positive group. Binary logistic regression analysis showed that the risk of T.V. infection was significantly increased in women with history of abortion (OR = 91.84; 95%CI = 15.50-544.22; P = 0.000), premature birth (OR = 43.29; 95%CI = 2.78-671.98; P = 0.007), and PROM (OR = 21.75; 95%CI = 2.12-222.95; P = 0.009). Conclusion:Awareness should be raised in women with T. vaginalis infection regarding the high risk of reproductive complications such as abortion. Early diagnosis by PCR and accurate treatment of infected people could prevent dissemination of the infection.