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PREVALENCE OF TRICHOMONA VAGINALIS AMONG ADULTS

ABSTRACT

The prevalence of Trichomonas Vaginalis among adult in “Osumenyi” in Nnewi south local government Area of Anambra state was carried out. This was done using a stotal of one hundred adults from there different clinics viz ;- Health center, family planning and Antenatal Clinic in Osumenyi; in Nnewi South L.G.A of Anambra State. the general prevalence was 37 (37%) positive cases out of the 100 samples used. The highest number of positive cases were seen in Health centre Clinics, Osumenyi with (20%) positive cases, followed by family planning clinic, Osumenyi with (14%) positive cases and the least in Antenatal clinic in Osumenyi with (4% positive cases. The parasitic organism was confirmed using wet mount preparation of urine and genital secretions. The organism trichomonas vaginalis was identified by its Jerky swaying motion or jumpy movement. It was observed that the prevalence was highest in adults in the age range 31-45 years with 19 cases (19%) positive, followed by the age range 16-30 years with 10 cases (10%). Next was in aga-range 46-60 years with 5 cases (5%) and least in age-range 61-75 years with 3 cases (3%).

CHAPTER ONE

INTRODUCTION

Donne first discovered and named Trichomonas Virginalis in 1836.He found the orgnaism in genital secretions 7 women and men, but it was initially regarded as non-pathogenic (Donne, 1936). Trichomonas vaginalis is a pear-shaped, flagellaatic, motile protogoa, with an undulating membrance. It is about 10-20 Hm wide, and oxide. The organism is propelled by four anterior flagella with a flagellium attached to an undulating membrance (Heine, 1993). I. Vaginalis is a eukaryrote, anaeobic and does not contain mitochoria in its cytop[lasm but instead contains specialized granules called hydrogenosomes throguh out the region of the cytoplasm with a slender posteriorly protruding regid rod called axostyle (Nester, est el, 2001 and Rultyle, 1983). I. Vaginalis exist only as a trophozoile and do not take o a cyst from (Lossick, 1990). Due to the organism’s unique energy metabolism,s the organism bears a strong resemblance to anaerobic bacteria (Petriu, 1998). In wet mount preparation of vaginal secretions, the live organism can often be recognised by its unmistakably swaying motion (Nester et al, 2001). I. Vaginalis grows best under anearobic conditions and at elevated PH levels. Masimum growth and metabolic functions are greatest at PH of 6.0 (Spence, 1992) In accord with its anaerobic state, sthese interesting cytoplasmic double –bounded organelles (hydrogenosomes) remove the carboxyl group (CooH) from pyruvate and trasnfer electrons to hydrogen gas (Nester et al, 2001). I. Vaginalis derives its glucose into oseccinate, acelate, malate, and hydrogen. In addition it produces some carbondioxide but nost via the kreb cycle pathway (Dyall and Johnson, 2000).

I. vaginalis causes sexually transmitted inecxtion (STI) called Trichomoniasis. This infection is the most common nonviral sexually transmistted disease in the world. Trichomoniasis, sometimes referred to as “Trich” is primarily an infection of the urogenital tract,. Which infects both men and women. The urethra is the most common site for I. Vaginalis infection in men. The organism can aslo be detected in the epididymis, semen and urine (Krieger, 1981). I. Vaginalis was first located in prostatie secretions from husbands of infected women (Drummond, 1936). In women, vagina is the most, common site of the infection the organism may be isolated from the cervix, vagina, bartholins glands, bladder and occasionally. The upper sreproductive / urinary tract (Reing, 1990). Over 95% of infections have been isolated from vagina and only 5% from the urinaryu tract of adult women (Grys, 1964) the urethra and skene’s glands are infected in 90% of cases. There have also been instances where organisms were isolated from bladder urine (Thoniason, 1989). Infected men are usually asymsptomatic carriers of the organisms (Krieger, 1995) which most symptomatic I.Vaginalis infection occur in women (Wolner- Hanssen, 1989). It ranks third after bacterial vaginosis and candidiasis among the diseases that commonly cause vaginal symptoms (Nester, et al, 2001). According to World Health Organisation’s annual, estimates, There are an estimated 7.4 million trichomoniasis cases each year in the united states, with over 180 million cases reported world wide (Weinstock et al, 2004). WHO in 1999 states that the infection rates have been reported by some researchers to be as high as 67% in Monogolia in 1988 (Schwebke, et al, of 40 – 60% in Africa and 40% in indigenous Australians. Trichomoniasis rates are also high in inner city populations in the united states. I . vaginal is was originally considered a commensal until in the 1950s when the understanding of its role as a sexually transmitted infection began to involve (Swygard, et al, 2004). Trichomoniasis often leads to vaginitis, an acute inflammatrory disease of genital mucosa.

This infection is associated with preterm delivery, low birth weight and increase in infant mortality. It also pre-disposes individuas to HIV/AIDS and cervical cancer (Cohen, 2000 and Upcroft and Upcroft, 2001). Among both women and men, I. Vaginalis is emerging as one o the most important factors in transmission and acquisition of HIV infection (Sorvillo, 1998). In women, the health complications include increased risks for the following, infertility, development of a typical pelvic inflammatory disease (PID), infection following gynecologic suggery and cervical inflammatory neoplasia. There have also been high rates of correlation between trichonioniasis and pregnancy complication in women (Cotch, 1997). In men, I vaginals has been linked to main factor in infertility and as a common cause of non-gonococcal urethritis (NGU) in men (Sch webke 2002, and soper, 2004). Minkoff, et al (1984) identified a strong association between I vaginalis infection and prefern rupture of membrane. Several studies have showns I. Vaginalis to be a rish factor for tubal infertility (El-Shazly, 2001). Sorvillo (1998) states that I.Vaginalis may amplify HIV – I transmission by increasing subceptibity in an HIV-1 negative person and the infectiousness in an HIV-1positive patient. He further stats that I. Vafinalis is emerging as one of the most important cofactor in amplifying HIV transmission particularly in African American Communities in the united state (Sorvillo, 2001). The association of trichomoniasis with HIV amplification is seen among men as well (Hobbs, 1999). I. Vaginalis has a significantly increased incidence of HIV transmission (Jackson, et al, 1998). I vaginalis elicits an aggressive local cellular immune response with a heavy influx of target cells in HIV. This response may increase a seronegative individual. Conversely in an HIV-seropisitive individual, punctuate haemorrhages, That are frequently associated wit I vaginalis infection, increased shedding and subsequent transmission of the virus (Cohen, et al, 1997).

In women, the infection is often characterised by vaginal i.e a thin foamy yellow – green, frothy vaginal discharge, vaginal odour, sometimes macodoros, pains with sexual intercourse, pain with urination and vulvovaginal sorness (Itching) (Rein, 1990, and Nester et al, 2001). (Common clinical signs include vulva erythema, inflammation excess of white blood cells seen on a wet mount preparation of vaginal discharge, numerous polymorphonuclear nuetrophils (Similar in size with Trichomonads) and occasional red blood cell (Rein, 1980), motile trichomonads in the wet mount preparation and a vaginal PH above 5.0, most of which overlap with Baterial vaginosis (Rein, 1984, and Wolner-Hassen, 1989). The wall of the vagina and vulvu are diffusely red and slightly swollen (Nester et al, 2001). I vaginalis infection is a persistant disease of genitourinary tract, characterised with foul odour, serve cases, puncstuate or scattered pinpoint haemorrhagos are present. It may also cause preumonies bronchitis (public Health Agency of Canada. (PHAC) 2001, and MC Laren, et al, 1983). These symptoms usually appear within four to twenty days of exposure. In men, the infection is more difficult to detect as the majority of infections remain a symptomatic and readily available diagnotic techniques are inadequate this is problematic since long tewrm carriage of I vaginalis in a symptomatic men have been documented up to 4 months (Kreiger, 1993). Most men seeking treatment do so because of htier infected partners (Hager, 1994). Up to 50% males are usally a symptomatic with the organism persisting in their prostate gland or seminal vesicles (Krieger, 1995). Symptoms in men typically include Urethral discharge, dysuria, mild prurities licting burning after intercourse (Kreiger 1995, and Latif, 1987). These may casue Urethritis, prostatis, reversible sterility and semen PH is 78.1 – 8.0 (Gopalkrishnan, 1990). This changes have been attributed to the mechanical trauma by the moving protozoa, but toxins or exotoxins have not be ruled out by the organism. The frothy discharge is probably due to gas produced by the organism (Nester, et al, 2001).

The life cycle of I. Vaginalis is still poorly understood. The trophozoite lives in close association with the epithelia of the urogenital tract (Latif et al, 1987) and reproduces by longitudinal binary fission (Nester et al. 2001). I vaginalis is distributed world wide as a human parasite and has no other reserviors (Nester et al, 2001) the mode of transmission is by intimate or direct copntact with vaginal and urethral discharges of infected persons during sexual intercourse rarely occurs by intimate contact with contaminated articles. The highest rate of infection with multiple sex partners and congenital infection is possible (That is from infected mother to infant at child birth althought infrequent). New born girls can acquire the infection from their infected mothers through birth canal. In such cases, the infection tends to remain a symptomatic unstil puberty (Nester et al, 2001, Bradley, et al, 1993 and public Health Agency Canada (PHAC) 2001). The organism can survive for hours on moist objects such as damp towels clothes and bathtubs of infected women (Lossick, 1989 and Nester et al, 2001). Nonsexual transmission is extremely rare sine i. Vaginalis infection is generally rstricted to a specific sites namely the urogenital tract Ithomason (1989). The only known nonviral form of transmission is through perinatal acquisition. Approximately 5% of female babies born of infected mothers contract the infection (Bramley, 1976). Nevetheless, I. Vaginalis infection in children should at least raise the question of sexual abuse and p[ossible exposure to other sexually transmitted diseases (Nester et al, 2001). Evidence for sexual transmission of I. Vainalis is very strong as prevalence is highest among patients with increased sexual acitivity and mul;tiple partners. Approximately 14-65% of male partners of infected females are also infected (Krieger, 1995, and Sena, 2003). The incubation period before symptoms arise is 4-28 days and years for persistat infection (PHAC, 2001). There is high percentage of a sympstomatic carriers especially among men and this fosters tranmission of the disease (Nester et al, 2001). Asymptomatic infected individuals factors in trichomoniasis transmission. Many studies have shown that treatment of the male partner (s) of infected women improves bsoth cure rates and recurrence rates (Hager, 1980 and lyng, 1981).

AIM AND OBJECTIVES OF THE STUDY

1. To determine the prevalence of I. Vaginalis among adults in”Osumenji” in Nnewi South Local Government Area of Anambra state.

2. To determine the age level which are msore susceptible to the infection

3. To determine the sex with higher prevalence of the infection

HYPOTHESIS

Ho: The prevalence of I. Vaginalis is higher in women than in men.

Hi: The prevalence of I vaginalis is not higher in women than in men