Fifty-six percent of women with T. vaginalis infection in our study were symptomatic and the symptoms occurred independently of the presence of TVV in the protozoon. In vitro studies have shown that TVVs are sensed by the human epithelial cells via Toll-like receptor 3, triggering Interferon Regulating Factor − 3, interferon type I and pro-inflammatory cascades previously implicated in preterm birth and HIV-1 susceptibility . While treatment with metronidazole generally eliminates T. vaginalis, this may aggravate T. vaginalis-associated inflammation caused by the release of TVV by stressed or dying parasites . Additionally, TVVs upregulate levels of phenotypically variable immunogen mRNA P270 of T. vaginalis , while also playing a role in T. vaginalis protein composition and its growth kinetics .