THE OCCURRENCE OF TRICHOMONAS VAGINALIS AMONG WOMEN IN THE CHILD BEARING AGE IN THE BUEA REGIONAL HOSPITAL.

Abstract

Background: Trichomonas Vaginalis commonly known as “sugar sugar” is among the most common curable Sexually Transmitted Infection worldwide. Though very neglected but the repercussions are enormous. It is associated with adverse birth outcomes and HIV virus acquisition and transmission.

Objective: Trichomoniasis has been on increase in the world which led to this study to find the prevalence of Trichomoniasis among women in the child bearing age (18-35 years) in the Buea Regional Hospital.

Methods: This study was a cross-sectional study involving 105 women aged between 18-35 years. Structured questionnaires were used to obtain data. Vaginal swabs were used to collect samples from the vagina. The prevalence of Trichomonasvaginalis was determined by wet mount preparation. Only women who accepted to participate were included in the study. Information collected from the participants were age, marital status, level of education, occupation, risk factors and the clinical manifestations of Trichomoniasis. The data was analyzed using SPSS (20.0) software for windows.

Results: Almost half of the participants 44(41.9%) were aged between 18-25 years. About half 52(49.5%) of the participants were in the university. The overall prevalence of Trichomoniasis was 1.9%. The positive cases emerged from participants aged between 18-30 years who were single based on their marital status while based on the risk factor, a history of Trichomonasvaginalis with 3.5%, sexually transmitted infection with 5.3%, had unprotected sex 4.7%, and douched (washing inside the vagina) were 2.6% respectively. More than half (54) of the participants had heard of Trichomonasvaginalis.

Conclusion: In conclusion, having a past History of Trichomoniasis, having a past history of sexually transmitted infections, having unprotected sex, having multiple sexual partners and douching do not necessarily affect the prevalence of Trichomoniasis. Nevertheless, these participants are likely to have Trichomoniasis in the future

CHAPTER ONE

INTRODUCTION

1.1 Introduction

Trichomonas vaginalis, aerobic parasitic flagellated protozoa is a causative agent of trichomoniasis (Mairiga et al., 2011).

Trichomonas vaginalis infection is a commonly transmitted protozoa infection and is associated with several adverse health outcomes such as preterm birth, delivery of low-birth weight infant, and facilitation of sexual transmission of human immune deficiency virus (Madeline et al., 2007).

Trichomoniasis is an infection caused by parasitic trichomonads, chiefly affecting the urinary tract, vagina and digestive system. Trichomoniasis is among the most common sexually transmitted infections; its risk factors include multiple sexual partners and not using condoms during sex.

TV has been recognized as a cosmopolitan parasite of male and female genital tract (Jatau et al.,2006). Globally, an estimated 180 million people are infected yearly (Bowden and Garnett, 2000; WHO 2004).

Most cases of TV remain undiagnosed as it is currently not a target of sexually transmitted infections control and besides because of its asymptomatic nature in about half of infected men and women (Fouts and Kraus et al., 1980). This disease has been reported as a major cause of pathology in obstetrics and gynecology (Hook., 1999; Hobbs et al.,2006). It has also been reported to cause discomfort and psychological distress in infected patients (Jatau et al., 2006).

Complications of TV that have been reported among women and non-pregnant patients may include premature rupture of membrane, premature labor, low weight, post abortion infections pelvic inflammatory disease, urinary tract infections and bronchitis, pneumonia and oral lesions (Soper., 2004; Gookin et al., 2005).

Although the disease has been seen as a risk factor for other sexually transmitted agents such as Chlamydia trachomatis and Neisseria gonorrhea (Perrin et al., 1998),it has also been linked to one of the most predisposing factors of HIV infection, Acquired Immune Deficiency Syndrome (AIDS), and cervical cancer (Soper, 2004).

It symptoms are commonly observed in women than in men (Smith and Ramos et al., 2010). The symptoms in women may include frothy greenish foul smelling vaginal discharge accompanied with vulvo vaginal irritation, post-coital bleeding, and frequency in micturition, dysuria and lower abdominal pain.

Untreated infections can persist for up to 5years (Klausner et al., 1999). Neonatal Trichomoniasis can be acquired during passage through an infected birth canal. It’s estimated that 2 to 17% of female babies acquired Trichomonaisis through direct vulvo-vaginal contamination. The incidence of Trichomoniasis depends on the population screened and examined.

The disease encompasses a vast range of symptoms ranging from a set of severe inflammation, itches and irritation with a frothy malodorous discharge to an asymptomatic carrier state. This parasite has the characteristic of motility because it has the flagella and undulating membrane. Under favorable growth conditions, T vaginalis can round up and internalize the flagella. The main energy of T vaginalis comes from fermentative carbohydrates metabolism under both aerobic and anaerobic conditions. Typically it spreads through contact with a penis and a vagina.

1.2 Background of Study

Trichomoniasis which is caused by the protest Trichomonasvaginalisis one of the most common non-viral sexually transmitted infections worldwide (Shira and Franket al., 2006).The high prevalence of TV infection worldwide has made Trichomoniasis a compelling public health concern. Notably, research has shown that Trichomonias infection can increase the risk of transmission of HIV infection in both men and women (Frona et al., 2003; Wang et al., 2001).

Humans are the only known host with the trophozoite transmitted principally via vaginal sexual intercourse and rarely via fomites (meaning inanimate objects capable of carrying infection agents like sex toys) (Wilkerson., 2011). During infection, the parasite binds to the vaginal epithelial cells, eliciting and aggressive, local cellular immune response and causing inflammations in addition to laminating itself into the host cell. T vaginalis has been seen to release a lytic factor that destroys nucleated cells and erythrocytes. Most men are asymptomatic, whereas only about half of women are asymptomatic. (trichomoniasis.org). symptomatic men suffer from urethral discharge, pruritus and dysuria.

Symptomatic women suffer from severe inflammation and irritation with frothy malodorous discharge to relatively asymptomatic carrier state (Perrin et a.,1998). But the main clinical manifestation of TV is vaginitis and prostatitis. The outcome of infection with Trichomoniasis may be due to genetic variability of the isolates and the host immune response (Iman et al., 2006).

Complications for men and women are prostatitis and vaginitis, respectively. Trichomonas infection is generally curable with metronidazole or sometimes tinidazole. Worldwide, there hasbeen varying prevalence of this pathogen, grossly due to differences in participants characteristics and socio-demographic/socioeconomic factors. Trichomoniasis is likely the most common non-viral sexually transmitted infection (STD) in the word. While not a reportable disease, the World Health Organization estimated that there were 276.4 million cases in 2008 and nearly 90% of those infections occurred among people living in resource-limited settings (World Health Organization, 2001). The global prevalence of TV has been estimated at 8.1% for women and 1.0% for men (World Health Organization, 2001).

In Cameroon, there have been a few reports about the prevalence and frequency of this health condition. It is known, however, to vary greatly by population and geography. WHO estimates that 173 million of new cases occur annually (World health organization, 2001; Geneva.,2001; Switzerland., 2001). The frequency of Trichomonas infection is not monitored in most countries nor do control programs exist.

A better understanding of the epidemiology of this infection in women is needed to foster disease control programs in population at risks for reproductive health complications. Although Trichomoniasis is diffused worldwide, its prevalence greatly varies among different populations. One of the reasons for the high prevalence of Trichomoniasis in Africa is the lack of STI screening programs and limited control measures and nearly 90% of these infections occurred among people living in resource limited settings (World Health Organization, 2001).

It is however known to vary greatly by population and geography, WHO estimates that 173 million of new cases occur annually (World Health Organization., 2001; Geneva., 2001; Switzerland., 2001). The prevalence of Trichomoniasis in Yaounde, Cameroon was 17.6% in adult aged 15-49 (Buv et al., 2001).

1.3 Statement of Problem

Trichomoniasisinfection is among the most widespread infectious diseases and has remain the most important cause of premature labor, low birth rate, weight, post-abortion or post-hysterectomy infections, adverse birth outcomes such as premature ruptures of membranes, as well as neonatal infections and infertility (Johnson et al., 2011).

T vaginalis infection is also strongly associated with the presence of other STIs including gonorrhea, Chlamydia, and sexually transmitted viruses. T vaginalis infection has even been shown to increase a patient’s susceptibility to sexually transmitted viruses including herpes simplex virus, human papillomavirus, and HIV. Persons with Trichomoniasis were twice likely to develop HIV infection as the general population (Darvin et al.,).

One potential explanation for this is that T vaginalis disrupts the epithelial monolayer, leading to increased passage of the HIV virus. Another posits that T vaginalis induces immune activation, specifically lymphocyte activation and replication and cytokine production, leading to increased viral replication in HIV-infected cells.Theknowledge or awareness of patients/people concerning Trichomaniasis is limited.

The fact that people don’t know about Trichomoniasis is a problem since there is limited data about this infection.Data obtained from this study shall also provide substantial information to Public Health officials as simultaneous combat against this infection is very crucial to improve health of the affected communities.

1.4 Rational of Study

Epidermiology data show that Trichomoniasis is more common than some better known diseases which led to the observation that Trichomoniasis is a disease which is highly neglected (Stacey Butterfield, 2012), but the repercussions are enormous and most women have the notion that “sugar sugar” is normal and they tend to endure the discomfort with the belief that it will be over with time. This therefore is a motivation to carry out this work to assess the prevalence of Trichomoniasis infection among women in the Buea Regional Hospital.

1.5 Research Questions

1.5.1 General research questions

What is the prevalence of Trichomoniasis among women in the child bearing age in the Buea Regional Hospital?

1.5.2 Specific research questions

1. What is the prevalence of TV among women in the child bearing age in the Buea Regional Hospital?
2. What are the Risk factors of TV?
3. What are the clinical manifestations of TV?