Metronidazole was once considered to be teratogenic, however 50 years of usage has quelled that concern. However, treatment of Tv during pregnancy did not have the impact of reducing pregnancy complications as hoped. Metronidazole treatment during pregnancy was found to increase preterm labor (relative risk 3.0) compared to placebo (untreated) Tv infections [24] and [25]. A potential conflicting factor of the results from the Klebanoff

study is a nonstandard metronidazole dosage regime. Yet while no evidence of direct causality has been reported, it is speculated that dying Tv learn more or the release of virus contained in some strains of Tv may result in stimulation of innate immune response or changes in bacterial flora that affect the pregnancy outcome, but studies are required to confirm this [25]. The overall data regarding Tv infection and pregnancy strongly suggests the value of screening

and treatment of women seeking to become pregnant, or are at risk of unplanned pregnancies, and their male partners. Reports regarding the increased transmission MK0683 and acquisition of HIV in Tv infected study participants has stimulated recent interest in the parasite. The odds ratio of a female with Tv acquiring HIV has been measured between 1.52 and 2.74 [10], [26] and [27]. A mathematical model of HIV infection based on a 1.8 odds ratio of acquiring HIV when infected with Tv estimates that 2% of all HIV acquired by females in the United States may be attributable to Tv [28]. In regions where mafosfamide Tv is more prevalent such as in Africa, the impact of Tv on HIV transmission could be higher. Guenthner and colleagues [29] investigated the ability of HIV-1 to pass through a polarized monolayer of epithelial cells in conjunction with Tv. They demonstrated p24 gag could be detected in the basolateral supernatant in greater quantities

compared to controls without Tv. Furthermore, differences in amount of epithelial damage based upon the Tv isolate was positively associated with HIV-1 passage through the monolayer. An additional experiment investigated the ability of Tv-stimulated peripheral blood mononuclear cells (PBMC) acutely infected with HIV-1 to induce replication of HIV-1. Activation of the acutely infected PBMC promoted HIV-1 replication. Thus two proposed mechanisms of synergy of Tv and HIV-1 were the pathogenesis of the Tv isolate’s ability to induce damage to epithelial cells and the activation of acutely infected PBMC [29]. The relationship of Tv and HIV is reviewed in more detail elsewhere [30]. Co-infection of Tv and HIV in men and women is positively associated (odds ratio of 1.22 and 1.31, respectively) [31] with further reports identifying more Tv infections in HIV+ than HIV− patients and an odds ratio of 2.12 for HIV+ individuals to acquire Tv [26] and [32]. Lower CD4 counts (40–140 and 150–250 cells/mL) and higher viral loads have been reported to be associated with likelihood of Tv diagnosis [33] and [34].