Trichomonas Vaginalis infection among women in Ikwuano Abia State Nigeria

A study on Trichomoniasis was conducted to determine the prevalence, symptoms and factors that promote the transmission of Trichomonas vaginalis among women of Ikwuano in Abia State using high vaginal swab and urine samples. A total of 600 women aged between 14-60years were examined and 112 (18.67%) were infected with Trichomoniasis. The highest prevalence of Trichomonas vaginalis infection (20.57%) was observed among the age group of 21-30 years, the least (7.8%) was observed among those of 41-50years while 51-60 age group had no infection at all. Occupational related prevalence revealed that traders had the highest (30%) followed by students (19.78%), civil servants (15.66%) and house wives had the least (8.33%). In relation to marital status, single women had the highest (19.72%). While widows had the least (9.09%). Symptomatic individuals had characteristic symptoms such as itching/rashes (3.83%), Genital sores (2.88%), Hot feeling sensation (4.50%), Greenish yellow discharge (6.00%), while very few had no symptom at all. Lack of hygiene, ignorance poverty, promiscuity and factors influencing the transmission. Trichomonas vaginalis is a common sexually transmitted disease among women in Ikwuano Abia State. Proper sex education especially for the adolescent and youths should be intensified so as to ensure a population fully aware of the medical implications of STD and hence reduce the spread and other health complications as a result of the infection. ©JASEM http://dx.doi.org/10.4314/jasem.v17i3.7 Trichomonas vaginalis is a parasitic protozoan that causes trichomoniasis, a sexually transmitted disease (STD) of worldwide importance and one of the most prevalent causes of non-viral sexual transmitted disease (Schwebke, 2002). Trichomoniasis occurs in females (Males rarely exhibit any symptoms) if the normal acidity of the vagina is shifted from semiacidic PH (3.8-4.2) to a much more base form (5.06.0) that is conducive to T. vaginalis growth (Swygard et al./2004). The disease is characterized in female patients by frothy-greenish yellow foul smelling vaginal discharge accompanied with vulvovaginal irritation, dysuria and lower abdominal pains (Workowski et al., 2006). Moodley et al., (2002) reported that Trichomonas vaginalis is also associated with a condition known as strawberry cervix, an inflammatory reaction that mimics the cervical tenderness associated with pelvic inflaminatory disease (PID). Complications of Trichomonas vaginalis reported in pregnant women include: premature rupture of membrane, premature labour, slow labour, low birth weight and post abortion infectors (Soper 2004). According to Sobel (2005), trichomoniasis is also linked to increased mortality as well as predisposing factor to HIV infections and cervical cancers. Cervicitis due to trichomonasis is characterized by purulent discharges in the endocervical canal and induces early endocervical bleeding (Workowski 2006). Studies reveal that T. vaginalis induces immune activation specifically Lymphocytes activation, replication and cytokine production leading to increased viral replication in HIV infection cells (Smith and Ramos 2010). Symptomatic trichomoniasis is more common in women than in men but when parasitic organism is found in the anterior urethrea, external genitalia, prostrate, epididymis causes infertility in men (Smith et al., 2010). Factors such as poor personal hygiene, multiple sex partners, low socio economic status and under development are documented to be associated with high incidence of infection (Crosby et al., 2002). Over 180million people are infected annually worldwide and 5million in America (Bowden and Garnett 2000. WHO, 2004). In Nigeria cases of Trichomonas vaginalis has variously been reported by Nmorsi et al., (2001), konye et al (1991) Okonofua (1995), Wokem, G.N. (2006). The aim of this study is to investigate the status of trichomoniasis in Ikwuano Abia State, provide a base line data and create awareness on its public health implication. MATERIALS AND METHODS A total of 600 urine specimens and vaginal swabs were collected from women of different age groups, socioeconomic status and students from a tertiary institution using sterile bijou bottles and Evapon swab sticks respectively. Questionnaires were administered to collect data on their age, marital status, occupation, available toilet facilities. Volunteers were adequately educated on how to complete the questionnaire and the illiterate ones Trichomonas Vaginalis infection 390 AMADI, A.N.C; NWAGBO, A.K were assisted to complete theirs on collection of their specimen. These samples were labeled and transported immediately to the laboratory to minimize contamination and were examined for the presence of Trichomonas vaginalis using the methods of Ogbonna et al, (1991) and Njoku et al, (2000). The urine specimens were spun at 3,500.pm for 5 minutes using electrically powered centrifuge. The supernatant fluid was decanted and the deposits of each sample was examined microscopically using both low power (x10) and dry high power (x40) objectives Njoku, A.J. et al., Two drops of Normal saline were introduced to each container of the vaginal swab mixed by shaking properly a drop of the mixture of each sample was placed on clean glass slide, covered with cover slip and examined under a light microscope using low power (x10) and dry high power (x40) magnifications respectively. Stained smear of the vaginal swab were made using safranin and papanicolaou and examined for Trichomonas vaginalis using oil immersion objective (x100). Results obtained from laboratory findings and questionnaires were recorded and analyzed statistically using chi-square RESULTS AND DISCUSSION Of the 600 women examined, 112 (18.67%) were infected with Trichomonas vaginalis. Out of the 112 infected women 21(3.50%) respondent had Trichomonas vaginalis in urine and none in their vaginal swab. 40(6.67%) had infection vaginal swabs with no infection in urine samples while 51(9.17%) had Trichomonas vaginalis in both urine samples and vaginal swabs Analysis of the data showed that there is significant difference between urine samples and vaginal swabs P<0.05. The highest prevalence of infection 58 (20.57%) was observed among women aged between 21-30years, followed by those aged 3140 years 23(19.45%). The least prevalence of infection 3(7.89%) was recorded amongst the age group of 41-50years while those between 51-60years 12(0.00%) had no infection at all (table 1). Occupational related prevalence T. vaginalis, it was observed that traders had the highest infection rate (23. 07%) followed by students (20.63%), civil servants (15. 66%) while house wives had the least (8. 33%) (Table 2). In the marital status prevalence of Trichomonas vaginalis infection (table 3) showed that single women had a highly prevalence (20.53%) than married women (16.27%). While some women were found be asymptomatic 9 (1.50%), most of the infected women experienced symptoms like itches/ rashes 23 (3.83%) genital/sore 17 (2. 88%) hot feeling sensation 27 (4.50%) and greenish yellow discharge 36 (6.00%) (Table 4). Microscopic examination of direct wet smear of the urine deposit and vaginal swabs showed 112 (18.67%) respondents were infected with trichomoniasis while stained smear using Papanicolaou staining technique showed that 84 (14.00%) respondents were infected. 28 smear showing presence of Trichomonas vaginalis in direct wet smear did not show presence of Trichomonas vaginalis in stained smear. Table 1 Age related prevalence of Trichomonas vaginalis among woman in Ikwuano Age No No Effected Prevalence of infection according to specimen (%) (Years) Examined (%) urine HVS both urine only only & HVS 14 – 20 150 28(18.67) 7(4.67) 9(6.00) 12(8.00) 21-30 282 58(20.57) 10(3.55) 20(7.04) 28(9.93) 31-40 118 23(19.45) 3(2.54) 7(7.63) 11(9.32) 41-50 38 3(7.89) 1(2.23) 2(4.00) 0(0.00) 51-60 12 0(0.00) 0(0.00) 0(0.00) 0(0.00) 600 112(18.67) 21(3.50) 40(6.67) 51(9.17) Table 2 Occupational related prevalence of Trichomanas vaginalis among women of Ikwuano No No Occupation Examined Infected % Infected Civil Servant 102 18 15.66 Traders 65 15 23.07 Students 349 72 20.63 House wives 84 7 8.33