Extracellular vesicles (EVs) secreted by Trichomonas vaginalis are now recognized as important mediators of host-parasite communication and play crucial roles in the development of trichomoniasis. These membrane-enclosed vesicles, which include exosomes and microvesicles, carry a diverse array of cargo, including proteins, lipids, and nucleic acids, as well as virulence-associated components such as adhesion molecules, proteases, and tRNA-derived small RNAs. Functionally, EVs enhance parasite attachment to vaginal epithelial cells, facilitate colonization, and contribute to host tissue damage. They also influence host immune responses, exhibiting both pro-inflammatory and immunosuppressive activities. Furthermore, the composition of EVs can be modulated by endosymbionts such as Trichomonasvirus, thereby influencing host-pathogen interactions. In addition, EVs mediate parasite-parasite communication, thereby promoting parasite adaptation and survival. This review summarizes current knowledge on the composition and functional roles of T. vaginalis EVs, highlighting their involvement in adhesion, immune modulation, and infection, as well as their potential utility as diagnostic biomarkers and therapeutic targets.
Vaginal trichomoniasis, caused by Trichomonas vaginalis, is the most common sexually transmitted disease. More than 170 million people worldwide are annually infected by this protozoan. In the Republic of Korea, 10.4% of women complaining of vaginal symptoms and signs were found to be infected with T. vaginalis. However, despite its high prevalence, the pathogenesis of T. vaginalis infection has not been clearly characterized although neutrophil infiltration is considered to be primarily responsible for the cytologic changes associated with this infection. We hypothesized that trichomonads in the vagina sometime after an acute infection secrete proteins like excretory-secretory product that have a chemotactic effect on neutrophils, and that these neutrophils are further stimulated by T. vaginalis to produce chemokines like IL-8 and GRO-α, which further promote neutrophil recruitment and chemotaxis. Thus, neutrophil accumulation is believed to maintain or aggravate inflammation. However, enhanced neutrophil apoptosis induced by live T. vaginalis could contribute to resolution of inflammation. Macrophages may constitute an important component of host defense against T. vaginalis infection. For example, mouse macrophages alone and those activated by lymphokines or nitric oxide are known to be involved in the extracellular killing of T. vaginalis. In the host, T. vaginalis uses a capping phenomenon to cleave host immunoglobulins with proteinases and thus escape from host immune responses. Recently, we developed a highly sensitive and specific diagnostic polymerase chain reaction (PCR) technique using primers based on a repetitive sequence cloned from T. vaginalis (TV-E650), and found that the method enables the detection of T. vaginalis at concentrations as low as 1 cell per PCR mixture.
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