Prevalence and Risk Factors of Vaginal Trichomoniasis in Women: Study at the University Hospital of Pikine in the Suburbs of Dakar, Senegal

Introduction: This study aimed to investigate the epidemiology of genital trichomoniasis in Senegal. It sought to determine the prevalence and risk factors associated with this condition in Senegal. Methodology: The study took place at the university hospital of Pikine in the suburbs of Dakar. For each of the women recruited, socio-demographic data, clinical examination data and the results of direct examination of the vaginal sample were collected in a questionnaire designed for this purpose. Results: A total of 312 women with a mean age of 31.13 (±8.41) years were recruited in this study. The majority of these women (59.94%;95% CI = 54.25 - 65.38), were seen for an infectious diseases assessment. Leucorrhea (58.33%;95% CI = 52.63 - 63.83) and genital discharge on vaginal touch (99.36%;95% CI = 97.45 - 99.89) were the predominant signs on clinical examination. The overall prevalence of vaginal trichomoniasis after direct examination of the specimens was 1.28% (95% CI = 0.41 - 3.47). Only the distribution of this prevalence by occupation was statistically significant (p = 0.0004). Conclusion: The low prevalence of genital trichomoniasis in women and the risk factors associated with it found in this study, which took place about ten years ago, should prompt an update of the data to better define the problem in Senegal.

Kinetics of Serum and Local Leukotriene B₄Response in Experimental Intravaginal Trichomoniasis by <i>T. vaginalis</i>Isolates from Symptomatic and Asymptomatic Women

Trichomoniasis is most common sexually transmitted disease caused by T. vaginalis. The clinical manifestation varies from severe manifestation to asymptomatic condition. However, the exact virulence markers led to varied symptomatology was not well clarified. The role of leukotriene B4 (LTB4) in the pathogenesis of many parasitic diseases has been reported. The present study reports the leukotriene B4 levels on different days post infection (3rd, 7th, 14th, 21st and 28th d.p.i.) in serum and vaginal washes (VWs) and vaginal tissues of mice infected intravaginally with T. vaginalis isolates from 10 symptomatic and 10 asymptomatic women. A significant increase in LTB4 was observed on the 3rd to 28th d.p.i. in serum and VWs of mice infected with T. vaginalis isolates from asymptomatic as compared to symptomatic women. The present study also reports the histopathological changes of the posterior vaginal fornix’s and upper portion of the vagina of mice infected intravaginally with T. vaginalis isolates from 10 symptomatic and 10 asymptomatic women. The results show that there are no significant differences between symptomatic and asymptomatic isolates regarding histopathological changes.

Prevalence and Factors Associated with Trichomoniasis, Bacterial Vaginosis, and Candidiasis among Pregnant Women in a Regional Hospital in Cameroon

Introduction: Several microorganisms cause vaginal infections. Some of them include: Trichomonas vaginalis, Gardneralla vaginalis, Bacteriodes spp., Mobilincus and Candida albicans. In pregnancy, these infections are associated with considerable discomfort and adverse pregnancy outcome including preterm delivery, low birth weight, spontaneous abortions among others. Aims: Bacterial vaginosis, vulvovaginal trichomoniasis and candidiasis in pregnant women are associated with considerable discomfort and adverse pregnancy outcome (preterm delivery and low birth weight). We attempted to determine the prevalence of these conditions in Regional Hospital Bamenda. Methods: A total of 200 vaginal swabs were collected from pregnant women after the administration of a semi-structured questionnaire. The samples were analyzed using wet mount (Trichomonas vaginalis and Candida spp.), and the Gram stain (Gardnerella vaginalis and Candida spp.). Bivariate and multivariate analyses were used to investigate association between vaginal symptoms and their risk factors. Results: The overall prevalence of vaginal infections was 49.5%, with trichomoniasis, bacterial vaginosis, and candidiasis being 2% (4), 27% (54) and 32% (64), respectively. No formal education (AOR = 0.908;95% CI: -20.72 - 35.62;p = 0.001) and practice of douching (16.93: -0.201 - 29.692;p = 0.005) were found to be independent risk factors for trichomoniasis. Malodourous greenish vagina discharges (18.52;2.96 - 60.307;p = 0.005) were associated with trichomoniasis and bacterial vaginosis. White (6.566;17.785 - 21.836;p = 0.004) and yellowish (3.404;20.127 - 23.457;p = 0.004) vaginal discharges were independent risk factors for mycotic vagina infections. Multivariate analysis revealed that the only risk factor significantly associated to VVC in this study was the use of both water cistern and pit toilet (AOR = 3.684;95% CI: 0.388 - 2.649;p = 0.010). Conclusion: There was a high prevalence of vaginal infections. Early treatment will reduce the disease burden and avoid complications associated with it.

Trichomoniasis in Pregnant Sudanese Pregnant Women at Tertiary Obstetric Facility, Khartoum, Sudan

Background: Trichomoniasis is a common Sexually Transmitted Disease (STD) and the most common curable one. Methodology: This was cross sectional, prospective, total coverage hospital based study. It aimed to determine the incidence, risk factors of the Trichomoniasis among the laboring Sudanese women at Omdurman New Hospital Khartoum-Sudan, from September 2012 to April 2013. Data were obtained, entered and analyzed using soft word package program for social science (SPSS) version 17. Results: The prevalence of Trichomoniasis is 6.8%. It was found that the awareness about the infection is very low only 35%. Diabetes and history of sexual transmitted infections are the risks seen among the study cases. Preterm labor was seen significantly. Conclusion: Syndromic management of all women with abnormal vaginal discharge is important since it causes reproductive morbidity.

Comparative analysis of syndromic and PCR-based diagnostic assay reveals misdiagnosis/ overtreatment for trichomoniasis based on subjective judgment in symptomatic patients

Background:Trichomoniasis,a sexually transmitted disease(STD),is caused by Trichomonas vaginalis in both men and women.Screening of trichomoniasis is problematic in resource challenged settings as currently available,inexpensive diagnostic methods are of low sensitivity and/or specificity.In India,National AIDS Control organization(NACO)recommended syndromic case management(SCM)for treatment.The objective of the present study was to compare the utility of the NACO-NACP III Algorithms for STI/RTI treatment used by clinicians with PCR based diagnosis.Methods:Patients visiting Department of Obstetrics&Gynecology,Vardhman Mahavir Medical College and Safdarjung Hospital,New Delhi from January 2011 to June 2014 were enrolled in the study to compare the diagnostic efficiency of PCR-based assays against SCM.Based on SCM,patients(n=820)were treated with antibiotics using pre-packed STI/RTI kits(sexually transmitted infection/reproductive tract infection;procured by National AIDS Control/State AIDS Control Society(NACO/SACS),Ministry of Health and Family Welfare,Govt of India.)under National AIDS Control Programme(NACP III)for syndromic case management(SCM).Ectocervical dry swab samples were also obtained from these patients and out of that 634 samples were tested by PCR.Total genomic DNA was extracted from these samples and used as template for PCR amplification using pfoB,gyrA and orf1 gene specific primers for diagnosis of T.vaginalis(TV),Chlamydia trachomatis(CT)and Neisseria gonorrhoeae(NG)respectively.Results:Out of 6000 patients who visited OPD,820(14%)female patients reported vaginal discharge and were recommended antibiotic treatment for one or more pathogens namely,TV,CT,NG and Candida or for co-infection.On the basis of signs&symptoms and NACO guidelines,the following distribution of various infections was observed:TV(46%),CT(20%),coinfection with TV and CT(12%),coinfection with CT and NG(11%),coinfection with TV,CT and Candida(7%)and coinfection with TV and NG(2%).Others were infected with NG alone(1%),coinfected with TV and Candida(0.4%)and 0.3%were coinfected with CT,NG and Candida.Based on PCR method,110(17%)women tested positive for one or more of these three pathogens while 524(83%)women were negative for any of these three pathogens but could be positive for other STIs not tested in this study.Since all the patients(634)were given antibiotics,we estimate that the over-treatment was 85%while 524(83%)patients were also misdiagnosed by SCM.Conclusions:The over-treatment and inaccurate diagnosis of pathogens due to subjective judgment based on syndromic approach in symptomatic women is a large economic wastage and may also contribute towards increased resistance.The misdiagnosed patients will also serve as a reservoir for transmission of pathogens to their sexual partner.

Trichomonas vaginalis infection in a low-risk women attended in Obstetrics and Gynaecology Clinic, Universiti Kebangsaan Malaysia Medical Centre

Objective: To investigate the presence of trichomoniasis among women attending the Obstetrics and Gynaecology Clinic, Universiti Kebangsaan Malaysia Medical Centre.Methods: A total of 139 high vaginal swabs were taken from the subjects and sent to the laboratory in Amies gel transport media. The specimens were examined for the presence of Trichomonas vaginalis using wet mount, Giemsa staining and cultured in Diamond's medium. Sociodemographic characteristics and gynaecological complaints were obtained in private using structured questionnaire applied by one investigator.Results: The median age was 32 years, with an interquartile interval of 9.96. Most of the subjects were Malays(76.9%) and the remaining were Chinese(15.1%), Indians(2.2%)and other ethnic groups(5.8%). One hundred and thirty eight(99.3%) of the women were married and 98.6% had less than 6 children. More than half(75.5%) of the women's last child birth was less than 6 years ago. Forty seven percent of them were involved in supporting administrative work and 64.7% of the women gave a history of previous or current vaginal discharge.Conclusions: The present study reported zero incidence rate of trichomoniasis. The low incidence rate was postulated due to all women who participated in this study were categorized into a low-risk group.