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ORIGINAL ARTICLE
Year : 2017  |  Volume : 20  |  Issue : 2  |  Page : 67-71

Prevalence of trichomoniasis among pregnant women in Benin City


1 Department of Medical Laboratory Science, School of Basic Medical Sciences, University of Benin, Benin City, Nigeria
2 Department of Obstetrics and Gynaecology, University of Benin Teaching Hospital, Benin City, Nigeria

Date of Web Publication18-Sep-2017

Correspondence Address:
Frederick Olusegun Akinbo
Department of Medical Laboratory Science, School of Basic Medical Sciences, University of Benin, Benin City
Nigeria
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DOI: 10.4103/1118-8561.215037

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  Abstract 

Background: Trichomonas vaginalis has been recognized as a cosmopolitan parasite of male and female genital tract. This study was conducted to determine the prevalence of asymptomatic trichomoniasis among pregnant women in Benin City, Edo State. Materials and Methods: A total of 300 patients and subjects consisting of 250 pregnant women attending antenatal clinics and 50 non-pregnant apparently healthy subjects who served as controls were recruited in this study. The age ranged from 20 to 40 years. High vaginal swab was collected from each participant and T. vaginalis was diagnosed by microscopy. Results: An overall prevalence of 2.8% of trichomoniasis was observed among pregnant women. Gestational age and educational status of pregnant women were significantly associated with the prevalence of trichomoniasis. Conclusion: Asymptomatic T. vaginalis infection is common in pregnancy. We recommend routine screening for this infection in order to reduce the potential adverse pregnancy outcomes.

Keywords: Pregnant women, routine screening, trichomoniasis


How to cite this article:
Akinbo FO, Mokobia CN, Ande AB. Prevalence of trichomoniasis among pregnant women in Benin City. Sahel Med J 2017;20:67-71

How to cite this URL:
Akinbo FO, Mokobia CN, Ande AB. Prevalence of trichomoniasis among pregnant women in Benin City. Sahel Med J [serial online] 2017 [cited 2019 Oct 15];20:67-71. Available from: http://www.smjonline.org/text.asp?2017/20/2/67/215037


  Introduction Top


Trichomonas vaginalis has been recognized as a cosmopolitan parasite of male and female genital tract.[1] Globally, an estimated 180 million people are infected yearly.[2],[3],[4]T. vaginalis is mainly transmitted through sexual contact but may also be transmitted through sharing of towels and underwears with infected individual.[5] Most cases of T. vaginalis 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.[6] The disease is reported as a major cause of pathology in obstetrics and gynecology.[7],[8] It has also been reported that the disease causes discomfort and psychosocial distress in infected patients.[1] Complications of T. vaginalis that have been reported among pregnant women and nonpregnant patients may include premature rupture of membranes, premature labor, low birth weight, postabortion infections, pelvic inflammatory disease, urinary tract infection and bronchitis, pneumonia and oral lesions,[9] and infertility.[10],[11] Although the disease has been seen as a risk factor for other sexually transmitted agents such as Chlamydia trachomatis and Neisseria gonorrhoeae,[12] it has also been linked to one of the predisposing factors to HIV infection, acquired immune deficiency syndrome, and cervical cancers.[9],[13],[14],[15] Its symptoms are commonly observed in women than in men.[16] The symptoms in women may include frothy-greenish foul-smelling vaginal discharge accompanied with vulvovaginal irritation, postcoital bleeding, frequency in micturition, dysuria, and lower abdominal pains;[17] preterm rupture of membranes, preterm delivery, low birth weight infants, and neonatal morbidity and mortality are symptoms associated with pregnancy.[18]

Factors such as poor personal hygiene, multiple sexual partners, low socioeconomic status, and under development have been reported to be associated with high incidence of infection.[19]

In Nigeria, there has been increasing prevalence of trichomoniasis in many states of the federation,[1],[20],[21],[22],[23] and based on the public health importance of T. vaginalis infection, this study was conducted to determine the prevalence of trichomoniasis among pregnant women in Benin City, Edo State.


  Materials and Methods Top


Study area

This study was carried out at the University of Benin Teaching Hospital, Benin City, Edo State, Nigeria. The hospital is a tertiary health institution saddled with the responsibility of providing health-care services for the inhabitants of Edo and neighboring states.

Study population

A total of 300 patients and subjects were recruited for this study. The study population consisted of 250 pregnant women attending antenatal clinics and 50 nonpregnant apparently healthy subjects served as controls.

The age ranged from 20 to 40 years. Informed consent was sought from the participants before specimen collection. Serial sampling was employed, and the patients who did not return their consent form were excluded from the study. The protocol for this study was approved by the Ethics and Research Committee of the University of Benin Teaching Hospital, Benin City, Edo State. A structured questionnaire was administered to obtain demographic characteristics (such as age, marital status, level of education, occupation, parity, and gestational age) from each participant.

Specimen collection and processing

High vaginal swab was collected from each participant using a previously described method.[24] Briefly, exudate from the vagina was collected using a sterile swab stick aided with sterile speculum. To the exudate collected, a drop of normal saline was added and mixed. A drop of the emulsified vaginal exudate was placed on a grease-free slide and a coverslip mounted. The preparation was immediately examined microscopically using ×10 and ×40 objective lenses. Using its characteristic morphology and darting motility, T. vaginalis was identified.

Statistical analysis

Statistical analyses for the data obtained were carried out using the Chi-square for comparing the frequency data and odds ratio (OR) for the potential risk factors. The software InStat (GraphPad Software Inc., La Jolla, CA, USA) was used in all analyses.


  Results Top


An overall prevalence of 2.8% of trichomoniasis was observed among pregnant women Age (P = 0.4448), marital status (OR = 40.333, 95% CI = 2.245, 724.61; P = 0.0560), and type of toilet (OR = 0.1004, 95% CI = 0.00970, 1.039; P = 0.3242) [Table 1]. Gestational age significantly associated with the prevalence of trichomoniasis, with pregnant women in their first trimester having the highest prevalence of 28.57% when compared with other trimesters (P< 0.0001). Educational status of the pregnant women strongly related to the prevalence of T. vaginalis (P< 0.0001) [Table 1].
Table 1: Effects of some sociodemographic and clinical characteristics on the frequency of Trichomonas vaginalis infection

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  Discussion Top


Trichomoniasis is an unpleasant parasitic infection that can go undiagnosed for years and is mainly transmitted by asymptomatic carriers.[17] The high incidence of T. vaginalis infection, co-infection with other sexually transmitted infections and attendant high risk of adverse pregnancy outcomes,[25] pelvic inflammatory diseases, and tubal infertility makes trichomoniasis an infection of compelling public health concern.[26],[27]

Cameron and Padian [28] observed that T. vaginalis infection prevalence ranges from 5% to 10% in healthy women populations while it could be as high as 50% in prostitutes and female prisoners. The prevalence of 2.8% of T. vaginalis infection observed in this study could be considered to be within the normal range in a healthy women population. The prevalence observed in our study is similar to that of Jombo et al.[29] that reported 2.7% in Jos, Uneke et al.[30] that observed 2.8% in Abakaliki, and 3.3% reported in Lagos by Adeoye and Akande.[31] However, this observation is lower than the 4.7% in Ilorin,[32] 13.3% in Umunze [33] 15.0% in Ekwulumili and Benin City, respectively,[23],[34] 17.7% in Uyo,[21] 18.7% in Zaria,[1] 20.0% in Abeokuta,[22] 21.5% in Nnewi,[20] all in Nigeria, 24.7% in Tanzania,[35] 34.0% in Nairobi, Kenya,[36] and 49.2% in South Africa. There is a general understanding that the prevalence of T. vaginalis varies markedly based on settings [2] and locations. This may explain the difference in our study and that of other authors.

Trichomoniasis is known to occur in females when the normal acidity of the vagina shifts from a semi-acidic pH (3.8–4.2) to a much more basic one (5.0–6.0) that is conducive to T. vaginalis growth.[37] Host factors that increase vaginal pH such as pregnancy, menses, and coincident anaerobic infections in the vaginal wall appear to encourage the growth of T. vaginalis.[38],[39] Surprisingly, pregnancy did not affect significantly the prevalence of trichomoniasis in this study. The finding in this study may have been due to the health education given at every antenatal clinic day where good personal hygiene is encouraged.

It has been reported that the incidence of trichomoniasis depends on sexual activities.[28] It is a general consensus that the incidence of sexually transmitted diseases including trichomoniasis is the highest among the 15–30 years age group.[40] This age group has been associated with high sexual activity and that incidence of trichomoniasis decreases with age.[41] Rising age of the participants was not statistically significant with a prevalence of T. vaginalis infection in our study as the 36–40 years age group had the highest prevalence of 6.25% while the 20–25 years age group presented with the least prevalence (1.70%). This finding is at variance with that of other workers.[13],[23],[42] The reason for this finding is unclear.

Single women are believed to be unattached, thus free to indulge in more sexual activities probably involving multiple sexual partners.[41] Pregnant women who are single were observed to have a 2- to724-fold increase risk of acquiring trichomoniasis in this study. However, this was not statistically significant. Single pregnant women were found to be more infected (50.0%) with T. vaginalis than their married counterpart. The finding in this study is in tandem with that of Okpara et al.[21] and Usanga et al.[41]

Usanga et al.[41] documented that the frequency of sexual intercourse decreases as pregnancy advances. Gestational age was observed to have a significant influence on the prevalence of trichomoniasis with those in the first trimester presenting with the highest prevalence (28.57%), followed by the second trimester (19.23%) while the third trimester recorded no incidence of T. vaginalis infection. The finding in this study agrees with the previous observation made by Obiajuru and Ogbulie [43] and Usanga et al.[41]

An increased risk of T. vaginalis infection has been demonstrated in persons with poor personal hygiene and low socioeconomic status.[44] Elsewhere, educational status had been linked with the occurrence of T. vaginalis infection.[21],[29],[30],[32] Educational status significantly affected the prevalence of trichomoniasis among pregnant women. This finding is consistent with previous reports.[21],[29],[30],[32]

Pregnant women who use pit latrine had the highest prevalence (20.0%) of trichomoniasis. However, the type of toilet did not significantly affect the prevalence of trichomoniasis among pregnant women.


  Conclusion Top


An overall prevalence of 2.8% of trichomoniasis was observed among pregnant women. Gestational age and educational status significantly affected the prevalence of trichomoniasis among pregnant women. Routine screening for T. vaginalis infection could be of benefit to pregnant women to reduce the adverse pregnancy outcomes.

Financial support and sponsorship

Nil.

Conflicts of interest

There are no conflicts of interest.

 
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