Prevalence, Clinical Criteria and Sociodemographic Predictors of Trichomonas vaginalis Infection in Suspected Egyptian Women, Using Direct Diagnostic Techniques
AbstractBackground: The present study aimed to determine the prevalence and associated risk factors of vaginal trichomoniasis in women referred to gynecologic clinic in Benha University Hospital, Egypt.Methods: Two hundred female patients enrolled in the study. Vaginal samples were obtained from them and examined for T. vaginalis by wet mount, Giemsa stain, Acridine orange (AO) stain and culture on modified Diamond’s medium. For analysis of accuracy of the methods used, the receiver operating characteristic (ROC) curve concept with culture as a gold standard was applied.Results: Out of 200 patients, T. vaginalis was found in 22 (11%) patients by any of the diagnostic methods used. The accuracy of AO staining comes next to Diamond’s culture (AUC 0.909, sensitivity 81.8%, specificity 100%, CI 0.81-1.0) followed by Giemsa staining (AUC 0.835, sensitivity 68.2%, specificity 98.9%, CI 0.72-0.95). The wet mount was the least accurate method (AUC 0.795, sensitivity 59.1%, specificity 100%, CI 0.67-0.92). There was no significant association between potentially supposed risk factors and trichomoniasis except patients complaining of either dysuria and dyspareunia or back pain and abdominal pain.Conclusion: Trichomoniasis is a common disease in our community. Sociodemographic factors do not seem to affect the prevalence among different Egyptian population. For accurate diagnosis, laboratory investigation is essential. A positive wet smear is diagnostic, but negative samples should be examined by methods that are more sensitive.
Sherrard J, Donders G, White D, Jensen JS. European (IUSTI/WHO) guideline on the management of vaginal discharge, 2011. Int J STD AIDS. 2011; 22:421–429.
Cotch MF, Pastorek JG, Nugent RP, Hillier SL, Gibbs RS, Martin DH, Eschenbach DA, Edel-man R, Carey JC, Regan JA, Krohn MA, Klebanoff MA, Rao AV, Rhoads GG. Trichomonas vaginalis associated with low birth weight and preterm delivery. Sex Transm Dis. 1997; 24:353-360.
WHO. Global incidence and prevalence of selected curable sexually transmitted infections – 2008. WHO press, Geneva, Switzerland; 2012. p. 1. Available from: http://www. who.int/reproductivehealth/publica-tions/rtis/2008_STI_estimates.pdf
Secor WE, Meites E, Starr MC, Workowski KA. Neglected Parasitic Infections in the Unit-ed States: Trichomoniasis. Am J Trop Med Hyg. 2014; 90(5):800–804.
El-Moamly AM, Rashad SM. T. vaginalis anti-gens in vaginal and urine specimens by immu-nochromatography, compared to culture and microscopy. J Egypt Soc Parasitol. 2008; 38(2):573-84.
Hegazy MM, Makhlouf LM, Elbahey MA, El-Hamshary EM, Dawoud HA, El-Gayar EK. Polymerase chain reaction versus conventional methods in the diagnosis of vaginal trichomo-niasis. J Egypt Soc Parasitol. 2009; 39(1):11-21.
Madhivanan P, Bartman M, Pasutti L, Krupp K, Arun A, Reingold A, Klausner J. Prevalence of Trichomonas vaginalis infection among young reproductive age women in India: implications
Hussein et al.: Prevalence, Clinical Criteria and Sociodemographic Predictors of Trichomonas vaginalis…
Available at: http://ijpa.tums.ac.ir 439
for treatment and prevention. Sex Health. 2009; 6(4): 339–344.
Eshete A, Mekonnen Z, Zeynudin A. Trichomo-nas vaginalis Infection among Pregnant Women in Jimma University Specialized Hospital, Southwest Ethiopia. ISRN Infectious Diseases. 2013; 2013:1-5.
Dahab MM, Koko WS, Osman EE, Hilali AH. Prevalence and transmission of Trichomonas vaginalis infection among women in Khartoum State, Sudan. J Public Health Epidemiol. 2012; 4(2):34-38.
Miranda AE, Pinto VM, Gaydos CA. Trichomo-nas vaginalis infection among young pregnant women in Brazil. BJID. 2014; 18(6):669–67.
Huppert J, Mortensen J, Reed J, Kahn J, Miller W, Hobbs M. Comparison of diagnostic meth-ods for Trichomonas vaginalis. J Adolescent Health. 2007; 40(2): S8.
Harp DF, Chowdhury I. Trichomoniasis: eval-uation to execution. Eur J Obstet Gyn Reprod Biol. 2011; 157:3–9.
Chalamilla G, Mbwana J, Mhalu F, Mmari E, Majigo M, Swai A, Urassa W, Sandstrom E. Patterns of sexually transmitted infections in adolescents and youth in Dares Salaam, Tanza-nia. BMC Infect. Dis. 2006; 6: 22.
Darani HY, Ahmadi F, Zabardast N, Yousefi HA, Shirzad H. Development of a latex agglu-tination test as a simple and rapid method for diagnosis of Trichomonas vaginalis infection. Avi-cenna J Med Biotechnol. 2010; 2:63–66.
Sibau L, Bebb D, Proctor EM, Bowie WR. Enzyme-linked immunosorbent assay for the diagnosis of trichomoniasis in women. Sex Transm Dis. 1987; 14:216–220.
Patel SR, Weise W, Patel SC, Ohl C, Byrd JC, Estrada CA. System review of diagnostic tests for T. vaginalis. Infect Dis Obstet Gynecol. 2000; 8:248-57.
Mason PR, Super H, Fripp PJ. Comparison of four techniques for the routine diagnosis of Trichomonas vaginalis infection. J Clin Pathol. 1976; 29:154-7.
Radonjic IV, Dzamic AM, Mitrovic SM, Ar-senijevic A, Popadic DM, Kranjcic Z. Diagno-sis of T. vaginalis infection: The sensitivities and specificities of microscopy, culture and PCR assay. Eur J Obstet Gyn Reprod Biol. 2006; 126(1):116-20.
Diamond LS, Clark CG, Cunnick CC. YI-S, a casein-free medium for axenic cultivation of Entamoebahistolitica, related Entamoeba, Giardia in-testinalis and T. vaginalis. J Eukaryot Microbiol. 1995; 42(3):277-78.
Zaki MM, Moussa H, Hassanin OM. Evalua-tion of the OSOM Trichomonas Rapid Test for Detection of Trichomoniasis. PUJ. 2011; 4(2):177-184.
Gabr NS, Kamal AM, Mohamed RT, Abdel Wahab SF. Sensitivity and specificity of wet mount, culture and PCR in diagnosing T. vaginalis infection in females attending the gyne-cology clinic of Minia University Hospital. Minia Med Bull. 2006; 17: 1.
Elsherif RH and Youssef MA.Real-time PCR improves detection of T. vaginalis compared to conventional techniques. Comp Clin Pathol. 2013; 22(2):295-300.
Negm AY, Abd El-Haleem DA. Detection of trichomoniasis in vaginal specimens by both conventional and modern molecular tools. J Egypt Soc Parasitol. 2004; 34: 589-600.
Valadkhani Z, AssmarMB, Esfandiari B, Amirkhani A, Hassan N, Lotfi M, Ghobadi-rad S. Trichomoniasis in asymptomatic patients. Iran J Public Health. 2008; 37(3):113-117.
Javanbakht M, Stirland A, Stahlman Sh, Smith LV, Chien M, Torres R, Guerry S. Prevalence and Factors Associated with Trichomonas vaginal-is Infection among High-risk Women in Los Angeles. Sex Transm Dis. 2013; 40(10):804–807.
Fernando SD, Herath S, Rodrigo C, Rajapakse L. Clinical features and sociodemographic fac-tors affecting T. vaginalis infection in women at-tending a central sexually transmitted diseases clinic in Sri Lanka. Indian J Sex Transm Dis. 2012; 33(1): 25–31.
Silva L, Miranda A, Batalha R, Montea R, Talhari S. Trichomonas vaginalis and associated factors among women living with HIV/AIDS in Amazonas, Brazil. Braz J Infect Dis. 2013; 17(6):701–703.
Krashin JW, Koumans EH, Bradshaw-Sydnor AC, Braxton JR, Secor WE, Sawyer MK, Mar-kowitz LE. T. vaginalis prevalence, incidence, risk factors and antibiotic-resistance in an ado-lescent population. Sex Transm Dis. 2010; 37: 440-444.
Iran J Parasitol: Vol. 10, No. 3, Jul -Sep 2015, pp.432-440
Available at: http://ijpa.tums.ac.ir
Hollman D, Coupey SM, Fox AS, Herold BC. Screening for Trichomonas vaginalis in High-risk Adolescent Females with a New Transcription-mediated Nucleic Acid Amplification Test (NAAT): Associations with Ethnicity, Symp-toms, and Prior and Current STIs. J Pediatr Adolesc Gynecol. 2010; 23:312-316.
Bachmann L, Hobbs M, Sena A, Sobel J, Schwebke J, Krieger J, McClelland R, Workow-ski K. Trichomonas vaginalis Genital Infections: Progress and Challenges. Clin Infect Dis. 2011; 53(Suppl 3):S160-72.
Gavgani AM, Namaz A, Ghazanchaei A, Alizadeh S, Sehhati F, Rostamzadeh S, Dolatkhah A. Prevalence and risk factors of trichomoniasis among women in Tabriz. Iran J Clin Infect Dis. 2008; 3(2):67-71.
Patil MJ, Nagamoti JM, Metqud SC. Diagnosis of T. vaginalis from vaginal specimens by wet mount microscopy, In Pouch TV culture sys-tem and PCR. J Glob Infect Dis. 2012; 4(1):22-25.
Zaki M, Raafat D, El Emshaty W, Azab MS, Hossam H. Correlation of T. vaginalis to bacte-rial vaginosis: a laboratory-based study. J Infect Dev Ctries.2010; 4(3):156-163.
Ojuromi OT, Oyibo WA, Tayo AO, Ibidapo AI, Fagbenro-Beyioku AF, Oladosu OO, Ola-Gbadamosi IO, Okposugbo ER, Balogun AO. Reliance on microscopy in T. vaginalis diagnosis and its prevalence in females presenting with vaginal discharge in Lagos, Nigeria. J Infect Dev Ctries. 2007; 1(2):210- 213.