Annals of Tropical Medicine and Public Health

ORIGINAL ARTICLE
Year
: 2012  |  Volume : 5  |  Issue : 5  |  Page : 498--501

The frequency study of trichomoniasis in women referred to gynecology clinic of Ayatollah Rohani Hospital, Babol, Iran, in 2010


Narges Kalantari1, Salman Ghaffari2, Sedigheh Esmaeilzadeh2,  
1 Cellular and Molecular Research Center, Babol, Iran
2 Fatamta-al-Zahra Infertility and Reproductive Health Research Center, Babol University of Medical Sciences, Babol, Iran

Correspondence Address:
Salman Ghaffari
Fatamta-al-Zahra Infertility and Reproductive Health Research Center, Babol University of Medical Sciences, Babol
Iran

Abstract

Background and Objectives: Trichomonas vaginalis is a flagellate protozoan parasite commonly found in the human genitourinary tract. The main aim of this study was to study of T. vaginalis infection among symptomatic women and to compare the clinical findings with laboratory results. Materials and Methods: In this study, a total of 76 nonpregnant women participated. All of them were interviewed and examined physically. Two swabs of vaginal discharge were obtained to perform wet-mount and Giemsa staining methods. Results: The mean age of the studied population was 31.69 years. The overall frequency of trichomoniasis was 1 out of 76 (1.3%) as obtained with both laboratory methods. The infected case was 28 years old. Her clinical findings were abdominal pain and simple discharge. Conclusions: The frequency of trichomoniasis was low in the current work. This study suggests that multilaboratory diagnostic methods should be carried out before clinical decision and treatment.



How to cite this article:
Kalantari N, Ghaffari S, Esmaeilzadeh S. The frequency study of trichomoniasis in women referred to gynecology clinic of Ayatollah Rohani Hospital, Babol, Iran, in 2010.Ann Trop Med Public Health 2012;5:498-501


How to cite this URL:
Kalantari N, Ghaffari S, Esmaeilzadeh S. The frequency study of trichomoniasis in women referred to gynecology clinic of Ayatollah Rohani Hospital, Babol, Iran, in 2010. Ann Trop Med Public Health [serial online] 2012 [cited 2020 Apr 6 ];5:498-501
Available from: http://www.atmph.org/text.asp?2012/5/5/498/105143


Full Text

 Introduction



Trichomonas vaginalis is a flagellated protozoan parasite, which causes trichomoniasis in females and males. This is the most common nonviral sexually transmitted disease (STD) in the world. [1] It is estimated that 173 million new cases occur annually worldwide. [2] The infection is asymptomatic in approximately 50% of the infected women, but about 30% of these will develop symptoms within 6 months. [3] In mild trichomoniasis, symptoms generally are pruritus, dyspareunia, and vaginal discharge besides vaginitis and vulvitis in more severe infections. [3] Trichomoniasis is associated with spontaneous abortion, [4] early premature preterm rupture of membranes, [5] and low birth weight [6] in pregnant women. Furthermore, it is related with increased human immunodeficiency virus transmission, infertility, [7],[8],[9] and cervical neoplasia. [10]

Moreover, race, [3] age, [11] and socioeconomic factors such as lower level of education, [12] and contraceptive methods [13] appear to be associated with prevalence rate of the infection.

On the other hand, T. vaginalis infection frequency rate varies depending on different societies [14] and diverse diagnostic methods same as parasitologic techniques and clinical findings. [15],[16]

In Iran, the frequency rate of trichomoniasis is varied among different populations and areas. It is reported that the rate of infections is about 4%-40% using different methods. [17] For example, a study which was performed in the Babol city showed that 28 out of 150 (18.67%) suspicious patients to trichomoniasis were concurrently diagnosed with wet-mount, Pap smear, and culture. This study demonstrated that 38 (25.3%) cases were positive with Pap smear alone and 122 (80%) cases had clinical symptoms and signs. [16]

Given the evidence in most areas of Iran, the diagnosis and treatment of trichomoniasis is performed based on clinical observations. Therefore, this study was aimed to find the frequency of T. vaginalis infection among symptomatic individuals and to compare the presentation of clinical findings with laboratory methods, such as wet-mount and Giemsa staining in the diagnosis of trichomoniasis in women.

 Materials and Methods



Study population

All nonpregnant women with clinical symptoms who visited the outpatient gynecology clinic of Ayatollah Rohani Hospital, Babol, Iran, were enrolled in this cross-sectional study from October 2010 to February 2011. Pelvic examination was performed, using sterile speculum, on all the participants at the clinical department. Genital specimens were collected and proceed based on standard methods. [18] In total, 76 women enrolled in the current study. The number of samples was based on Moshfe and Hosseini's study. [19]

Data collection

All women had 2 vaginal swabs. One swab was transferred to a tube containing 2 mL normal saline and other transferred to a tube containing 2 mL polyvinyl alcohol (PVA). [20]

All women participated in a standard questionnaire inquiring in detail about demographic, medical, and behavioral factors during the visit. The questionnaire forms and the vaginal samples were sent to parasitology laboratory as soon as they were collected. All samples were initially screened by microscopy using wet-mount followed by Giemsa staining. In wet-mount, smears were prepared from the vaginal secretion in normal saline. Slides were then mounted with a coverslip and examined with 100× and 400× magnification. T. vaginalis trophozoites appear with the rotation movement or the parasite features, such as undulating membrane, flagellum, nuclear shape, and size about 7-30μ. [20]

In Giemsa staining, smears were prepared from the vaginal secretion in PVA. The preparation were fixed with methanol for at least 30 s, and then stained with Giemsa stain (1:10 dilution). [21] In this method, the parasite appears with blue cytoplasm, reddish purple or red nucleus, red flagellum, and axostyle.

Data analysis and ethical considerations

The data were analyzed using SPSS software (Statistical Package for Social Sciences, version 18.0). The study was approved by the letter No.30/5798 of Ethical Committee of the Research Council of Babol University of Medical Sciences, Babol, Iran.

 Results



Demographic findings

All 76 women participated in this study were married. The mean age was 31.69, which ranged from 18 to 63 years. Fifty-two out of 73 women had 1-3 children and 21 did not have a child. For contraception, 27 (35.5%), 15 (19.7%), and 10 (13.2%) women used natural method (interrupt/withdrawal and safe period), condoms, and tubectomy, respectively. Nine women (11.8%) used any of the contraceptive methods for about 1 year. The rest of the participants used other methods, such as withdrawal with pill consumption, intrauterine devices, and their husband vasectomy. Nobody used the safe period alone. The positive case had 2 children and used the injection method.

Among the participants, 16 (21.1%) had abortion history (range 1-3, median 1) and the frequency of reproductive-organ morbidity, such as infertility, was low. Three participants (3.9%) reported primary infertility history and one case (1.3%) had secondary infertility background. The positive case had no abortion or infertility history.

Laboratory findings

The overall frequency of T. vaginalis infection was one out of 76 (1.3%) as obtained with both methods (wet-mount and Giemsa staining). Number of parasites per microscopic field with 400× magnification was one.

Symptoms and signs

The infected woman was 28 years old. Her clinical symptoms and signs were lower abdominal pain and simple discharge; 10 (13.2%), 7 (9.2%), and 7 (9.2%) out of 76 women had simple vaginal discharge, infectious discharge, and nonspecific discharge.

The 2 most common complaints were smelling discharge [11 (14.5%)] and lower abdominal pain [8 (10.5%)]. Furthermore, some women had two symptoms together, for example, smelling discharge with lower abdominal pain [5 (6.6%)] or itching with smelling discharge [4 (5.3%)]. Also, a relationship between age under 35 years and over 35 years groups and clinical findings are shown in [Table 1]. The most common clinical findings was nonspecific discharge (34.7%) followed by vaginitis in women younger than 35 years (16.6%).{Table 1}

 Discussion



Seventy-six nonpregnant women with clinical manifestations attended this study.

The frequency of T. vaginalis obtained in the current study, with both wet-mount and Giemsa staining methods, was 1 (1.3%) among women complaining of some gynecologic problems.

The frequency of our study by microscopy was similar to results obtained from other studies, which performed in several areas of Iran [22],[23],[24] and Turkey. [25] But this is in contrast with other studies that indicate a higher frequency rate of infection. [16],[19],[26],[27] Difference between the results of the present study and other investigations should be related to various factors, such as specimen collection, laboratory methods, and techniques of examination and host-dependent factors. [3] The laboratory techniques used in the current study have some limitations, for example, losing typical morphologic characters during fixation and staining or misdiagnosis with polymorphonuclear leukocytes. [3],[21],[28]

Another objective of this study was to compare clinical symptoms and signs with laboratory methods in diagnosis of trichomoniasis. Unfortunately, the current study was not able to gain this objective because only one case was detected by the laboratory methods. She had simple symptoms, including lower abdominal pain and simple discharge. Furthermore, the women who attended to this study expressed various complications and symptoms. Also, the physicians found different clinical signs in physical examination. However, these results showed that the highest rate of various clinical findings was demonstrated in women younger than 35 years. This group has higher risk for genital infection because of their more sexual intercourses. Moreover, the semen fluid causes an increase in pH and gives rise to produce vaginal symptoms, such as discharge, which may be due to other infectious agents with the exception of T. vaginalis.[26]

 Conclusion



The current study had several limitations, such as laboratory methods and excluding the pregnant women, which may have decreased the power to identify the real frequency of trichomoniasis. However, our study, similar to other studies, demonstrated major differences between clinical findings and laboratory results. [16],[25],[27] Therefore, diagnosis and treatment cannot be readily made based on the clinical presentations alone. It also suggests that more forthcoming studies should be performed with more sensitive methods, such as cultures and polymerase chain reaction to estimate T. vaginalis infection precisely among symptomatic cases. [18],[21],[27],[29]

 Acknowledgments



We thank Ms. Asieh Shaabani Faramarzi and Mrs. Maryam Sadat Shafiee, Babol University of Medical Sciences, for their help and samples collection.

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