Flegr J, Klapilová K, Kaňková S
Department of Philosophy and History of Science, Faculty of Science, Charles University in Prague, CZ-128 44 Prague 2, Czech Republic.
Department of General Anthropology, Faculty of Humanities, University in Prague, CZ-158 00 Prague 13, Czech Republic.
Med Hypotheses. 2014 Sep;83(3):286-9. doi: 10.1016/j.mehy.2014.05.019. Epub 2014 Jun 14.
Toxoplasma gondii infects about 30% of the human population. Common sources of infection are oocysts in cat faeces contaminating drinking water or unwashed vegetables, undercooked meat containing tissue cysts, and organ transplants from infected donors containing tissue cysts. However, very often, it is not possible to identify any potential source of infection in mothers of children with congenital toxoplasmosis. Here we present a hypothesis suggesting that toxoplasmosis is transmitted from infected men to noninfected women during unprotected sexual intercourse, which can result in the most serious form of disease, congenital toxoplasmosis. Arguments for the hypothesis: (1) Toxoplasma tachyzoites are present in the seminal fluid and tissue of the testes of various animals including humans. In some species infection of females by artificial insemination with semen from infected males has been observed. (2) Up to two thirds of Toxoplasma infections in pregnant women cannot be explained by the known risk factors. (3) Prevalence of toxoplasmosis in women in child-bearing age covaries with the incidence of sexually transmitted diseases in particular countries. (4) In some countries, an increased incidence of toxoplasmosis has been reported in women (but not men) aged 25-35 years. This second peak of infection could be associated with women having regular unprotected sex after marriage. (5) Toxoplasmosis triggers schizophrenia in predisposed subjects. Onset of schizophrenia is about 2-3 years earlier in men than in women. However, this difference in the onset can be found only between Toxoplasma-infected patients. The increased onset of schizophrenia in infected women could be associated with the already mentioned second peak of toxoplasmosis incidence. (6) The prevalence of toxoplasmosis decreases in developed countries in last 20 years. This trend could be a result of decrease in promiscuity and increase in safe sex practices, both associated with the AIDS pandemics. (7) In women, probability of being Toxoplasma-infected correlates positively with the amount of unprotected sex with the child's father before the conception. Evidence against the hypothesis: Questionnaire study showed negative association between Toxoplasma infection and the number of earlier partners with whom the woman had unprotected sex. If our hypothesis turns out to be true, then sexual route of transmission, even if rare, could be responsible for a large part of cases of congenital toxoplasmosis. Women should be warned that having unprotected sex with men of positive or unknown toxoplasmosis status should be avoided during pregnancy.
弓形虫感染了约30%的人类。常见的感染源包括猫粪便中的卵囊污染饮用水或未清洗的蔬菜、含有组织包囊的未煮熟肉类,以及来自感染供体且含有组织包囊的器官移植。然而,对于先天性弓形虫病患儿的母亲,往往无法确定任何潜在的感染源。在此,我们提出一个假说,即弓形虫病在无保护的性行为过程中从受感染男性传播至未受感染女性,这可能导致最严重的疾病形式——先天性弓形虫病。该假说的论据如下:(1)在包括人类在内的各种动物的精液和睾丸组织中存在弓形虫速殖子。在某些物种中,已观察到用受感染雄性的精液进行人工授精会使雌性感染。(2)孕妇中高达三分之二的弓形虫感染无法用已知的风险因素来解释。(3)在特定国家,育龄女性中弓形虫病的患病率与性传播疾病的发病率相关。(4)在一些国家,据报道25至35岁的女性(而非男性)弓形虫病发病率增加。这第二个感染高峰可能与女性婚后经常进行无保护性行为有关。(5)弓形虫病会在易感个体中引发精神分裂症。男性精神分裂症的发病时间比女性早约2至3年。然而,这种发病时间的差异仅在受弓形虫感染的患者之间存在。受感染女性精神分裂症发病时间的增加可能与上述提到的弓形虫病发病率的第二个高峰有关。(6)在过去20年中,发达国家弓形虫病的患病率有所下降。这种趋势可能是滥交减少和安全性行为增加的结果,这两者都与艾滋病大流行有关。(7)在女性中,受弓形虫感染的可能性与受孕前与孩子父亲进行无保护性行为的次数呈正相关。该假说的反例:问卷调查研究表明,弓形虫感染与女性之前进行无保护性行为的伴侣数量之间呈负相关。如果我们的假说被证明是正确的,那么即使性传播途径很罕见,它也可能是导致大部分先天性弓形虫病病例的原因。应该警告女性,怀孕期间应避免与弓形虫病检测呈阳性或状况不明的男性进行无保护性行为。