THE PREVALENCE OF TRICHOMONIASIS AMONG PREGNANT WOMEN ATTENDING ANTENATAL CLINIC IN GOVERNMENT HOSPITAL GBOKO, BENUE STATE, NIGERIA
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Background: The pregnant women infected with Trichomonas vaginalis may be at risk of adverse birth outcomes such as premature rapture of membranes, premature labour, low birth weight, post – abortion or post-hysterectomy infections, as well as neonatal infections. Objectives: To determine the prevalence of trichomoniasis among pregnant women attending antenatal clinic in Government Hospital Gboko, Benue state, Nigeria.
Methodology: The study was a cross sectional survey of one hundred and fifty pregnant women aged between 15 – 60 years. Vaginal swab was collected from each of the subjects, the samples were analysed within one hour of collection. Vaginal swab specimens were also cultivated in prepared OXOID Trichomonas medium and examined for motile Trichomonads. Results: Of the total 150 pregnant women studied, 10 (7.31%) were found to have Trichomonas vaginalis, with the highest prevalence at General Hospital Gboko. The distribution showed that between the ranges of 31 – 40 were more affected, but pregnant women of the age of 21 – 30 are most affected which constitute 4.66% of the total infected cases. There were no significant differences between women of the age range of 15 – 20 and 41 – 50. The infection was more prevalent among the married (2.66%), while 2.66% of women who use pour flush toilet were most infected. Conclusion: The prevalence of Trichomonas vaginalis infection of 7.31% in our community is a public health risk, therefore, clinicians should routinely screen all pregnant women for the infection and appropriate treatment be given early, emphasis must be placed on the youths, those with low educational background and the business women.
TABLE OF CONTENT
Title Page ——————————————————————–i
Approval Page—————————————————————-ii
Declaration ——————————————————————iii
Dedication ——————————————————————-iv
Acknowledgement ———————————————————–v
Abstract ———————————————————————-vi
Table of Content————————————————————-vii
CHAPTER ONE: INTRODUCTION
CHAPTER TWO: LITERATURE REVIEW
2.10.1Molecular Mechanisms of Pathogenesis ——————————————–13
2.11 Hydrolases ——————————————————————————-14
2.12 Cytotoxic Molecules ——————————————————————-15
2.13 Sequencing the Genome ————————————————————16
2.14 Diagnosis —————————————————————————16
2.15 Treatment ————————————————————————–19
2.16 Complications ———————————————————————-21
CHAPTER THREE: METHODS AND MATERIALS
3.1 Study Area ———————————————————–24
3.2 SelectionofStudy Population ————————————————-24
3.3 Materials Used —————————————————————–24
3.4 EthicalConsent —————————————————————-25
3.5 Collection Samples and ExaminationofSamples ————————–25
3.5.1 Parasitological methods ——————————————————25
3.6 Statistical Analysis ————————————————————26
CHAPTER FOUR: RESULTS
4.1 Data Presentation and Analysis———————————————27
CHAPTER FIVE: DISCUSSION, CONCLUSION AND RECOMMENDATIONS
5.1 Discussion ———————————————————–30
5.2 Suggestion for Further Studies—————————————-30
REFERENCE————————————————————-32
CHAPTER ONE
INTRODUCTION
Trichomonas vaginalis is an anaerobic, flagellated protozoan parasite and the causative agent of trichomoniasis. It is the most common pathogenic protozoan infection of humans in industrialized countries. Infection rates between men and women are similar with women being symptomatic, while infections in men are usually asymptomatic. Transmission usually occurs via direct, skin-to-skin contact with an infected individual, most often through sexual intercourse. The WHO has estimated that 160 million cases of infection are acquired annually worldwide. The estimates for North America alone are between 5 and 8 million new infections each year, with an estimated rate of asymptomatic cases as high as 50%. Usually treatment consists of metronidazole and tinidazole.
Sexually transmitted infections (STIs) are infections that are spread primarily through person-to-person sexual contact: anal, vaginal andoral sexual contact. According to the most recent data available of WHO estimates, that 340millionnewcasesofcurableSTIs(Syphilis, Gonorrhea, Chlamydia and Trichomoniasis) occur annually throughout the world in adults aged 15 – 49 years(WHO,2001).Considering Trichomonas Vaginalis world wide infections, 12 million casesoccurannuallywithahighnumberof4 million cases encountered in sub-Saharan Africa. Notably, Trichomonas vaginalis caused infection is believed to increase the risk of HIV transmission. Trichomoniasis is also associated with adverse pregnancy outcomes, infertility, post operative infections, and cervical neoplasia (Soper,2004). Trichomoniasis is the major problem in developing countries, where parental testing and antibiotics use are not adequately available. According to the African Humanitarian Action (AHA)reportofJuly2008,highratesofthe commonly encountered sexually transmitted infections,inKRC,havebeennoticedbythe19 new cases of STIs, including Trichomonas vaginalis(Kiziba RefugeeCampHealthCenter,2008).On the other hand, according to there cent information from CHUK laboratory, a high number of Trichomoniasis cases were observed each month among the patients visiting the health institution.
Inwomen,thediseaseencompassesbroadrangeofsymptoms ranging from a severe inflammation and irritation with frothy malodorous discharge to a relatively asymptomatic carrier state. Butthemainclinicalmanifestationoftrichomoniasis is vaginitis,urethritisandprostatitis.Theoutcomeofinfectionwith Trichomonas may be due to genetic variability of the isolates and thehostimmuneresponse.
The vaginaisthemostcommonsite ofinfection in women andtheurethra (urinecanal) isthemostcommon site of infection in men. The parasite is sexually transmitted through penis-to-vaginaintercourse orvulva to-vulva(thegenital areaoutsidethevagina) contactwith aninfected partner. Women canacquirethediseasefrom infectedmen orwomen, butmenusuallycontract itonly frominfectedwomen. Pregnant womenwith trichomoniasis may have babies who are born early or with low birth weight (low birth weight islessthan 5.5 pounds).
Trichomonas vaginalisis an obligate parasite in that it lacks the ability to synthesize many macromolecules denovo, particularly purines, pyrimidines and many lipids. These nutrients are acquired from the vaginal secretions or through phagocytosis of host and bacterial cells. Culture media for Trichomonas vaginalistherefore need to include all the essential macro molecules, vitamins andminerals. In particular, serum is essential for the growth of trichomonads, since it provides lipids, fatty acids, amino acids and trace metals. Invitro, it grows optimallyatapHof6.0-6.3, although it canalsogrow through a wide range of pHs, especially in the changing environment of the vagina. The presence of Trichomonas vaginalis in the vagina increases predispositions to mv sero conversion. The genital inflammation caused by trichomoniasis can increase a woman’s susceptibility to HIV infection if exposed to the virus. Having trichomoniasis may increase the chance that an HIV-infected woman passes HIV to her sex partner(s).
Recent literature documents that women infected duringpregnancy arepredisposed topremature ruptureofmembranes, premature labor and low-birth-weight infants.Further,itmayamplifyHIVtransmission.The organism typically elicits an aggressive local cellular immune response, withheavyinfiltration ofleucocytes, eveninsymptom-free patients. Inaddition, inabout50% of infectedwomen, punctatehemorrhages can be observed.InanHIV-negative person, therearetarget cellsavailable,as alsoaccesstobloodstream.
Inanmvpositive person, allthismayexpandtheportalofexitfor thevirus and increase shedding ofHIV-l inthe genital area.Thus,trichomoniasis may amplify HIV-l transmission by increasingsusceptibility in an HIV-l negative person and the infectiousness of an HIV-1- positive patient.
Few studies have beenpublished on Trichomonas vaginalis.
Buve etal., (1975)confirmed thattheriskofTrichomonasvaginalis is higher inwomen reporting agreater lifetime number of sexual partners inthosewithpoorer education levels and inwomen withalcohol dependency while McClelland et al.reported thattheinfection wasalsomore common in women with concomitant cervicitis or bacterial vaginosis. Ontheotherhand,theuseof condoms and progesterone-only contraceptivemethods(depot medroxyprogestrone acetate orNorplant) wasfoundtobe associated withalowerrisk ofinfection inamultivariate analysismodel.
Prevention oftrichomoniasis hasnotbeen apriority due to lack of understanding of its public health implications and lackofresources.For long ithas been considereda‘minor’ STD.Ithasbeen seenthat womeninfectedduringpregnancy are predisposed topremature ruptureofmembranes, premature laborandlowbirth-weight infants. Further,itmayamplifymv transmission.The naturalhistory of thisorganism, includingits oftensymptomless natureandprotracted carriage,playan importantrolein HIVtransmission dynamics, especiallywhereheterosexualbehavioursand a high prevalence ofmvobtain. The pregnant women infected with this parasite may be at risk of an adverse birth out comes such as premature rapture of membranes, premature labour, low birth weight, and post– abortion or post-hysterectomy infection, as well as infertility and enhanced predisposition to neoplastic transformation in cervical tissues. As withother sexually transmitted infections, the TrichomonasinfectioncanincreasetheriskoftransmissionofHIV infection.
TransmissionofTrichomonasVaginalistoneonatesduring passagethroughaninfectedbirthcanalisalsopossible.In thefoetusandtheneonates,complicationssuchasabnormalities of the major organ systems as well as infections in form of pneumonia and conjunctivitis may also occur. Neonatal infection is infrequently reported, but has been noted to cause urinarytractinfectionandvaginitisininfants.Inaddition, iinfants withTrichomonas vaginalis cultured from nasopharyngeal secretions have been reported to present with significantrespiratorydistress.
Trichomonas vaginalis can be isolated in vaginal, prostatic or urethralsecretions,semenandurineofinfectedindividuals.The mostcommonly employeddiagnosticmethodsare direct microscopic examinations of wet mount preparations (with a sensitivity of 38% – 82%), and culture techniques. Combination of both wetmountexaminationand culture has been recommended as being more effective inestablishing diagnosis than either one alone. Direct examination of wet mount preparation of clinical specimen is the most rapid and least expensive technique for identifying Trichomonas vaginalis, hence the most commonly used. This method has however been reported insensitive for the diagnosis of the disease, particularly in male patients. Other methods include antigen detection methods, plastic envelope method ,in-pouch system, cell culture, staining techniques, serological and DNA techniques.
InNigeria, thereare some documented reports onthe prevalenceofTrichomonasinfectionsamongwomen,students, Commercial sex workers and in pregnant women, but no similar study on pregnant women have been done in our region (northeastern Nigeria) and possiblyonlyoneinthenorthernpartofNigeria.
1.1 Objectives of Studies
1.2 Purpose of Study
This study was aimed to determine the prevalence of the Trichomonas vaginalis among pregnant women attending antenatal clinic in general hospital Gboko.
1.3 Statement of the Problem
Trichomonas vaginalis has neither been the focus of intensive study none of active control program and the negligent is likely a function for relatively mind of the disease.
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