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Metronidazole resistance in Trichomonas vaginalis from highland women in Papua New Guinea

Jacqueline A. Upcroft A B F , Linda A. Dunn A B , Tilda Wal C , Sepehr Tabrizi D , Maria G. Delgadillo-Correa E , Patricia J. Johnson E , Suzanne Garland D , Peter Siba C and Peter Upcroft A B

A Queensland Institute of Medical Research, The Bancroft Centre, 300 Herston Road, Brisbane, Qld 4006, Australia.

B Australian Centre for International and Tropical Health, The University of Queensland, Brisbane, Qld 4029, Australia.

C Papua New Guinea Institute of Medical Research, PO Box 60, Goroka, EHP 441, Papua New Guinea.

D The Royal Women’s Hospital, Department of Microbiology, 132 Grattan Street, Carlton, Melbourne, Vic. 3053, Australia.

E Department of Microbiology, Immunology and Molecular Genetics, University of California Los Angeles School of Medicine, 1602 Molecular Sciences Building, 405 Hilgard Avenue, Los Angeles, CA 90095-1489, USA.

F Corresponding author. Email:

Sexual Health 6(4) 334-338
Submitted: 3 February 2009  Accepted: 21 May 2009   Published: 13 November 2009


Background: The prevalence of the sexually transmissible protozoan parasite Trichomonas vaginalis in the highlands of Papua New Guinea (PNG) has been reported to be as high as 46% and although not previously studied in Papua New Guinea, clinical resistance against metronidazole (Mz), the drug most commonly used to treat trichomoniasis, is well documented worldwide. This study was primarily aimed at assessing resistance to Mz in T. vaginalis strains from the Goroka region. Methods: Consenting patients presenting at the Goroka Base Hospital Sexually Transmitted Diseases (STD) Clinic and local women were asked to provide two vaginal swabs: one for culturing of the parasite; and one for polymerase chain reaction detection of T. vaginalis, Chlamydia trachomatis and Neisseria gonorrhoeae. T. vaginalis isolates were assayed for Mz susceptibility and a selection was genotyped. Results: The prevalence of T. vaginalis was determined to be 32.9% by culture and polymerase chain reaction of swabs among 82 local women and patients from the STD clinic. An unexpectedly high level of in vitro Mz resistance was determined with 17.4% of isolates displaying unexpectedly high resistance to Mz. The ability to identify isolates of T. vaginalis by genotyping was confirmed and the results revealed a more homogeneous T. vaginalis population in Papua New Guinea compared with isolates from elsewhere. Conclusion: T. vaginalis is highly prevalent in the Goroka region and in vitro Mz resistance data suggest that clinical resistance may become an issue.

Additional keywords: Chlamydia trachomatis, genotyping, Neisseria gonorrhoeae, polymerase chain reaction, vaginal swab.


[1]  Rein MF , Müller M . Trichomonas vaginalis and trichomoniasis. In: Holmes KK, editor. Sexually Transmitted Diseases. New York: McGraw-Hill; 1990. pp. 481–92.

[2]  Cohen J 2000 HIV transmission. AIDS researchers look to Africa for new insights. Science 287 942 3 doi:10.1126/science.287.5455.942

[3]  Viikki M Pukkala E Nieminen P Hakama M 2000 Gynaecological infections as risk determinants of subsequent cervical neoplasia. Acta Oncol 39 71 5 doi:10.1080/028418600431003

[4]  Upcroft P Upcroft JA 2001 Drug targets and mechanisms of resistance in the anaerobic protozoa. Clin Microbiol Rev 14 150 64 doi:10.1128/CMR.14.1.150-164.2001

[5]  Guenthner PC Secor WE Dezzutti CS 2005 Trichomonas vaginalis-induced epithelial monolayer disruption and human immunodeficiency virus type 1 (HIV-1) replication: implications for the sexual transmission of HIV-1. Infect Immun 73 4155 60 doi:10.1128/IAI.73.7.4155-4160.2005

[6]  Schwebke JR Aira T Jordan N Jolly P Vermund SH 1998 Sexually transmitted diseases in Ulaanbaatar, Mongolia. Int J STD AIDS 9 354 8 doi:10.1258/0956462981922269

[7]  Bowden FJ Paterson BA Mein J Savage J Fairley CK Garland SM et al 1999 Estimating the prevalence of T. vaginalis, C. trachomatis, N. gonorrhoeae, and human papillomavirus infection in indigenous women in northern Australia. Sex Transm Infect 75 431 4

[8]  Mgone CS Lupiwa T Yeka W 2002 High prevalence of Neisseria gonorrhoeae and multiple sexually transmitted diseases among rural women in the Eastern Highlands Province of Papua New Guinea, detected by polymerase reaction. Sex Transm Dis 29 775 9

[9]  Mgone CS Passey ME Anang J Peter W Lupiwa T Russell DM et al 2002 Human immunodeficiency virus and other sexually transmitted infections among female sex workers in two major cities in Papua New Guinea. Sex Transm Dis 29 265 70 doi:10.1097/00007435-200205000-00003

[10]  Tiwara S Passey M Clegg A Mgone C Lupiwa S Suve N et al 1996 High prevalence of trichomonal vaginitis and chlamydial cervicitis among a rural population in the highlands of Papua New Guinea. P N G Med J 39 234 8

[11]  Sorvillo F Kerndt P 1998 Trichomonas vaginalis and amplification of HIV-1 transmission. Lancet 351 213 4

[12]  Crowell AL Sanders-Lewis KA Secor WE 2003 In vitro metronidazole and tinidazole activities against metronidazole-resistant strains of Trichomonas vaginalis. Antimicrob Agents Chemother 47 1407 9 doi:10.1128/AAC.47.4.1407-1409.2003

[13]  Dunne RL Dunn LA Upcroft P O’Donoghue PJ Upcroft JA 2003 Drug resistance in the sexually transmitted protozoan Trichomonas vaginalis. Cell Res 13 239 49 doi:10.1038/

[14]  Upcroft JA Delgadillo-Correa MG Dunne RL Sturm AW Johnson PJ Upcroft P 2006 Genotyping Trichomonas vaginalis. Int J Parasitol 36 821 8 doi:10.1016/j.ijpara.2006.02.018

[15]  Clark CG Diamond LS 2002 Methods for cultivation of luminal parasitic protists of clinical importance. Clin Microbiol Rev 15 329 41 doi:10.1128/CMR.15.3.329-341.2002

[16]  Upcroft JA Upcroft P 2001 Drug susceptibility testing of anaerobic protozoa. Antimicrob Agents Chemother 45 1810 4 doi:10.1128/AAC.45.6.1810-1814.2001

[17]  Knox J Tabrizi SN Miller P Petoumenos K Law M Chen S et al 2002 Evaluation of self-collected samples in contrast to practitioner-collected samples for detection of Chlamydia trachomatis, Neisseria gonorrhoeae, and Trichomonas vaginalis by polymerase chain reaction among women living in remote areas. Sex Transm Dis 29 647 54 doi:10.1097/00007435-200211000-00006

[18]  Voolmann T Boreham P 1993 Metronidazole resistant Trichomonas vaginalis in Brisbane. Med J Aust 159 490

[19]  Passey M Mgone CS Lupiwa S Suve N Tiwara S Lupiwa T et al 1998 Community based study of sexually transmitted diseases in rural women in the highlands of Papua New Guinea: prevalence and risk factors. Sex Transm Infect 74 120 7

[20]  Radonjic IV Dzamic AM Mitrovic SM Arsic Arsenijevic VS Popadic DM Kranjcic Zec IF 2006 Diagnosis of Trichomonas vaginalis infection: The sensitivities and specificities of microscopy, culture and PCR assay. Eur J Obstet Gynecol Reprod Biol 126 116 20 doi:10.1016/j.ejogrb.2005.07.033

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