November 02, 2021
OWSD Nigeria National Chapter University of PortHarcourt Branch series of scientific communications: Helen O. Imafidor on TRICHOMONIASIS IN WOMEN
TRICHOMONIASIS IN WOMEN
Prof. Helen O. Imafidor
Animal and Environmental Biology Department,
Faculty of Science, University of PortHarcourt
Trichomonas vaginalis has been described as the most prevalent non-viral sexually transmitted infection. Globally, the World Health Organisation estimates that its prevalence ranges from 170 million to 190 million cases worldwide each year (Barbara, 2007). The disease Trichomoniasis was once thought to be a nuisance sexually transmitted infection, but it is now being recognized as an important source of reproductive morbidity and a facilitator of both HIV transmission and acquisition (Patricia, 2015) .Trichomoniasis is an unpleasant disease that can go undiagnosed for years and it is often transmitted via asymptomatic carriers (CDC, 2006).
The parasite Trichomonas vaginalis is known to alter the pH balance of the vagina. This it achieves by reducing the acidity of the vagina from between a pH of 3.8 - 4.2 to a more basic pH of 5.0- 6.0. The normal habitat of the parasite is the human vagina, prostrate and urinary tract of both males and female. It lives on the mucosa and feeds on bacteria and leukocytes (Arora, 2005). T. vaginalis is a pathogen of men and women (WHO, 2001). Trichomoniasis is often asymptomatic in men however in more than half of the infected women manifests vaginitis, cervicitis, urethritis and irritation with frothy malodorous discharge. The parasite Trichomonas vaginalis can lead to urogenital tract infection. The parasite may also cause nongonococcal urethritis, prostratis and perhaps other lower genitourinary tract syndrome in infected men (Abdurehman et al., 2013). Trichomonas vaginalis is rather commonly responsible for mild vagina inflammation associated with a copious, foul-smelling discharge (Olorode et al., 2014).
History of Trichomonas vaginalis
T. vaginalis infection was first described as a veneral disease in the mid-20th century before Chlamydia trachomatis infection was recognized as such. The flagellate was originally considered to be a commensal organism until the 1950’s when the understanding of its role as a sexually transmitted disease began to evolve (Barbara, 2007).
Morphology of Trichomonas vaginalis
Trichomonas vaginalis is a flagellated parasite with humans as its natural host. The parasite could be described as a pear-shaped, flagellated protozoan possessing five flagella, four of which are located at its anterior portion, the fifth flagellum is incorporated within the undulating membrane of the parasite and is supported by a slender non-contractile Costa (Samiksha, 2013).
Diagnosis of T. vaginalis
Trichomoniasis is diagnosed by visually observing the Trichomonads via a microscope. In women, the doctor collects the specimen during a pelvic examination by inserting a speculum into the vagina and then using a cotton-tipped applicator to collect the sample. The sample is then placed onto a microscope slide and sent to a laboratory to be analyzed. The examination may also reveal small red ulcerations on the vaginal wall or cervix. 10% of those infected will present a strawberry cervix or vaginal on examination. Currently, the most common method of diagnosis is via overnight culture with a sensitivity range of 75-95%. Newer methods such as Rapid antigen testing and transcription-mediated amplification have even greater sensitivity but are not in widespread use. The presence of Trichomonas vaginalis can also be diagnosed by polymerase chain reaction
Epidemiology of T. Vaginalis
Worldwide, Trichomoniasis caused by T. vaginalis is one of the most common non-viral sexually transmitted diseases with an estimated 170 million cases occurring annually (PHAC, 2011). Trichomonas vaginalis is not a reportable disease. Information regarding its prevalence is scarce because the infection receives only limited public health attention; although previous research has shown that T. vaginalis causes 180 million new infections per year worldwide (Weinstock et al., 2000). The incidence of vaginal Trichomoniasis has noticeably risen in populations with High-risk sexual behavior, Prisoners, and HIV positive or Human bacterial vaginosis positive infected people (WHO, 2001). The parasite T. vaginalis is cosmopolitan in distribution and has been identified in all racial groups and socioeconomic strata; however, it has been encountered in every continent and climate with no seasonal variability (Abdurehman et al., 2013). The percentage prevalence of T. vaginalis in some African states and countries revealed that South Africa has a prevalence rate of 49.2%; Kenya, 34%; Tanzania, 24.7%; Zaria, Nigeria 18.7%; Port Harcourt, Nigeria 4.5% and Niger Delta Region 10% (Abah, 2017). In Nigeria, reported studies on the prevalence of Trichomoniasis show that the infection is still endemic (Adetokunbo and Giles 1990; Ogbonna et al., 1991; Sam-Wobo et al., 2012).
Transmission of Trichomonas vaginalis
Women acquire the infection from infected men or women, but men acquire it only from infected women during sexual intercourse (WHO, 2001). Non-sexual transmission of the infection can also occur through contaminated means such as towels, douche nozzles, medical practitioner spatula, swimming pool water, and toilet seats. Trichomoniasis is believed to be transmitted usually through unprotected sexual intercourse. However, some infections probably are acquired through Fomites such as towels, toilet seats, and Sauna benches which serve as reservoir hosts (Etuketu et al., 2015).
Pathogenesis and Symptomology of Trichomonas vaginalis .
The parasite is usually site-specific and survives only in the urogenital tract of humans. During infection, the vaginal pH becomes elevated, vaginal walls become tender and prone to bacterial infection. The parasite is anaerobic and adheres to epithelial cells of the Urogenital tract. Trichomoniasis is often asymptomatic in men, however in more than half of the infected women manifests vaginitis, cervicitis, urethritis. Urethral infection in males causes dysuria, frequency of urination, dirty-white discharge containing leukocytes, epithelial cells, and Trichomonads. The disease is often characterized by a burning sensation, itching of the penis/vagina, abdominal pain, erythrema, vulvovaginal soreness and/or irritation, dysuria, and dyspareunia. Some may exhibit haemorrhagic spots on the genital mucosa referred to as Colpitis macularis or strawberry cervix (Cudmore et al., 2004). Vaginal discharge can be yellowish or greenish with an unusual fishy smell (Dahab et al.,2012). Adverse effects include Low birth weight, unpleasant sexual intercourse, cervical and prostate cancers, and premature delivery.
Treatment of Trichomoniasis
Treatment of Trichomoniasis helps to reduce signs and symptoms of Trichomonas vaginalis infection and might reduce transmission, the likelihood of adverse outcomes in women with HIV.
The Nitroimidazoles are the only class of antimicrobial medication known to be effective against T. vaginalis infection. Of these drugs, metronidazole and Tinidazole have been cleared by the Food and Drugs Administration (FDA) for the oral or parenteral treatment of Trichomoniasis.
Risk Factors of Trichomonas vaginalis
Risk factors of T. vaginalis includes:
Multiple Sex partners. Chemotherapy. Sexual activity and history of Gonorrhoea and other STDs. Age. Socioeconomic status includes such factors as poverty level and education. Use of antibiotics, alcohol, or douche during pregnancy. Feminine hygiene practices such as douching, use of feminine powder. Co-infection with other Sexually transmitted diseases. Use of contraceptives.
Preventive Measures of Trichomonas vaginalis
These are practices that help reduce the occurrence of this infection and help prevent the further spread of the disease.
- Abstinence from all forms of sexual practices
- Being in a faithful monogamous relationship helps to reduce the risk encountered by having multiple sexual relationships.
- Safe sex practice includes the correct and consistent use of latex condoms and female condoms.
- Cleanliness of clothes, good personal hygiene, and avoidance of shared personal items.
- Concurrent treatment of all partners whether symptomatic or not will further limit possible transmission
- Public Health Education: Trichomoniasis should be stressed during awareness campaigns of other STIs, during antenatal as well as secondary and tertiary educational levels.
- Avoid the use of douche because it changes the delicate balance of the normal vaginal flora thereby serving to promote infection.
- Keeping the vaginal area dry especially after showering.
- Use of vaccine strategy to reduce vaginal infection
In recent years, many advances have been made in the epidemiology, diagnosis, and treatment of T. vaginalis. The focus of these efforts, however, has largely been on women. With enhanced awareness, availability, and application of modern diagnostic tests, better detection and treatment of Trichomoniasis in women and in their sexual partners can be achieved.
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