T.A. Ajani1, C.J. Elikwu1, S.A. Fayemiwo2, 5, V. Nwadike1, B. Tayo1, C.G. Anaedobe3, O. Shonekan1 , C.C. Okangba1, A.M. Akanji4, A. Omeonu1, B. Faluyi1, A.O. Asini1, E.V. Ajayi1, O.O. Adeyoola1, F.B. Atalabi1, E.B. Nwanane1
- Department of Medical Microbiology and Parasitology, University College Hospital, Ibadan, Oyo State, Nigeria.
- Department of Medical Microbiology, College of Medicine, University of Ibadan, Ibadan.
- Department of Medical Microbiology, University of Abuja, Federal Capital Territory, Abuja.
- Department of Histopathology, Babcock University Teaching Hospital, Ilishan-Remo, Ogun State, Nigeria.
- Division of Infection, Immunity and Respiratory Medicine, School of Biological Sciences, University of Manchester, Manchester, M13 9PL, UK.
Background: Trichomonas vaginalis is one of the common non- viral sexually transmitted infections that infect both men and women worldwide. It is largely asymptomatic and its association with the risk of HIV transmission has made it a compelling public health concern. Therefore, this study aims to determine the prevalence and the risk factors associated with T. vaginalis among asymptomatic undergraduate students at Babcock University, Ilisan-Remo, Ogun state, Nigeria.
Materials and Methods: This is a descriptive cross-sectional study involving 246 asymptomatic students of Babcock University between February 2019 to April 2020. Information on socio-demographic and associated risk factors was obtained by structured-questionnaire in an interview-based manner. First-void urine was collected from each participant for the detection of T. vaginalis using the traditional wet prep method and TV in-pouch. The data were analyzed by SPSS Version 23.
Result: The overall prevalence of T. vaginalis among the participants was 12.2%(30/246). The use of wet-preparation showed 8.5% (21/246) while the use of TV inpouch yielded 12. 2% (30/246) prevalence of positive results. The results of the wet prep in comparison to the in-pouch technique was statistically significant among the study population. (P < 0.001). Sexual intercourse, use of hormonal contraceptives and practice of internet-based sex seeking behaviour were factors that had increase likelihood of T. vaginalis infection on multivariate analysis.
Conclusion: The occurrence of T. vaginalis and, its associated risk factors among the asymptomatic population in this study is very high. We advocate for the screening of young people.
Keywords: Trichomonas vaginalis, TV In-pouch, Asymptomatic, Undergraduate
Dr. S.A. Fayemiwo
Department of Medical Micro,
College of Medicine,
University of Ibadan, Ibadan.
Date of Acceptance: 31st Dec.
Trichomonas vaginalis, the commonest pathogen of nonviral sexually transmitted infection (STI)was estimated to 156 million incident cases worldwide in the year 2016.1, 2 The epidemiology of Trichomonas vaginalis is not well understood since no concrete surveillance system and methods of diagnosis has been in place.3 The prevalence, however, varies by geographical location.3 It ranges from 5.0% among high-risk women to 3.0% among high-risk men.4, 5 A review of STI in Papua New Guinea revealed the prevalence of T. vaginalis to be 39.3%.6
Though not a reportable infection, the high prevalence of Trichomonas vaginalis and its association with the risk of HIV transmission in both men and women has made it a compelling public health concern.7-10 T. vaginalis is a flagellated parasite that infects the urethra and prostate gland of males causing urethritis prostatitis, balanoposthitis, and epididymitis.11 In females, it infects the urethra and the vaginal mucosa causing vaginitis and urethritis.12 However, trichomoniasis is largely asymptomatic in 85% of infected women, and 77% of the men.9,13 If the asymptomatic individuals are left untreated, it could lead to sequelae such as ectopic pregnancy, low birth weight, preterm birth, pelvic inûammatory disease (PID), male infertility, female infertility and increased risk of HIV acquisition.14-15 Recent studies have associated T.vaginalis to cervical cancer in women and prostate cancer in men.16-17
Nearly 90% of T. vaginalis infections was reported to occur in resource-limited countries.2 Individuals of African origin have increased rates of T. vaginalis, and this is proven by higher rates reported in the literature from Sub-Saharan Africa. 9,18-19 In Nigeria, the prevalence of T. vaginalis ranges from 0% to 18.6% across a variety of populations.20-26 Increased age, concomitance STI, intravenous drug use, cigarette smoking are risk factors of Trichomonas vaginalis.5, 27. High rates of T.vaginalis infection have been reported among African adolescents of which majority of them are students in higher institutions of learnings.27-30 A study in Nigeria reported that 53% of those infected with T. vaginalis among the study population were university undergraduates.31
The most widely used diagnostic test for T. vaginalis is the direct microscopic examination of the vaginal fluid.12 However, the culture of the parasite using specimens from the vagina is the current “gold standard.8-9 Nevertheless, urine specimen can be used because it’s been proven that the organisms colonizing the urethral epithelium, are present in urine in adequate quantities to be relevant diagnostically.32 The in-Pouch system is a method that combines a wet preparation, and a culture method to detect T. Vaginalis.33-34 It can detect T. vaginalis from male or female urine samples. This makes TV in-Pouch system an appropriate diagnostic method for this study. Although Nucleic acid amplification tests (NAATS) is more sensitive, however, this option is not often used because it is not cost-effective in resource limited countries.35
In Babcock University, a previous study on the prevalence of T. vaginalis among the undergraduate was carried out among the female population only, and majority of them were symptomatic. 36 Considering that T. vaginalis can infect males and females, majority of those infected are usually asymptomatic, additional population-based data will be helpful in understanding the burden of its infection. Thus, this research work aimed to determine the prevalence of Trichomonas vaginalis among asymptomatic male and female undergraduate students of Babcock University as well as to evaluate the associated risk factors.