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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

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

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Date of Web Publication27-Dec-2012


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.

Keywords: Sexually transmitted disease, Trichomonas vaginalis, Trichomoniasis

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 2021 Apr 11];5:498-501. Available from:

   Introduction Top

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 More Details, 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 Top

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 Top

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: Association between age groups and clinical findings of women referred to gynecology clinic of Ayatollah Rohani Hospital, Babol, Iran, in 2010

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   Discussion Top

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 Top

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 Top

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

   References Top

1.Cudmore SL, Garber GE. Prevention or treatment: The benefits of Trichomonas vaginalis vaccine. J Infect Public Health 2010;3:47-53.  Back to cited text no. 1
2.World Health Organization. Global prevalence and incidence of selected curable sexually transmitted diseases: Overview and estimates. Geneva, Switzerland: WHO; 2001.  Back to cited text no. 2
3.Petrin D, Delgaty K, Bhatt R, Garber G. Clinical and microbiological aspects of Trichomonas vaginalis. Clin Microbiol Rev 1998;11:300-17.  Back to cited text no. 3
4.Romero R, Espinoza J, Mazor M. Can endometrial infection/inflammation explain implantation failure, spontaneous abortion, and preterm birth after in vitro fertilization? Fertil Steril 2004;82:799-804.  Back to cited text no. 4
5.Simhan HN, Caritis SN, Krohn MA, Hillier SL. The vaginal inflammatory milieu and the risk of early premature preterm rupture of membranes. Am J Obstet Gynecol 2005;192:213-8.  Back to cited text no. 5
6.Hardy PH, Hardy JB, Nell EE, Graham DA, Spence MR, Rosenbaum RC. Prevalence of six sexually transmitted disease agents among pregnant inner-city adolescents and pregnancy outcome. Lancet 1984;324:333-7.  Back to cited text no. 6
7.Fichorova RN. Impact of T. vaginalis infection on innate immune responses and reproductive outcome. J Reprod Immunol 2009;83:185-9.  Back to cited text no. 7
8.Soper D. Trichomoniasis: under control or undercontrolled? Am J Obstet Gynecol 2004;190:281-90.  Back to cited text no. 8
9.Risser WL, Bortot AT, Benjamins LJ, Feldmann JM, Barratt MS, Eissa MA, et al. The Epidemiology of Sexually Transmitted Infections in Adolescents. Semin Pediatr Infect Dis 2005;16:160-7.  Back to cited text no. 9
10.Gram IT, Macaluso M, Churchill J, Stalsberg H. Trichomonas vaginalis (TV) and human papillomavirus (HPV) infection and the incidence of cervical intraepithelial neoplasia (CIN) grade III. Cancer Causes Control 1992;3:231-6.  Back to cited text no. 10
11.Sutton M, Sternberg M, Koumans EH, McQuillan G, Berman S, Markowitz L.The prevalence of Trichomonas vaginalis infection among reproductive-age women in the United States, 2001-2004. Clin Infect Dis. 2007;45:1319-26.  Back to cited text no. 11
12.Andrews WW, Goldenberg RL, Hauth JC, Cliver SP, Conner M, Goepfert AR. Endometrial microbial colonization and plasma cell endometritis after spontaneous or indicated preterm versus term delivery. Am J Obstet Gynecol 2005;193:739-45.  Back to cited text no. 12
13.Berberian DA, Coulston F, Slighter RG. Laboratory evaluation of a new contraceptive gel with trichomonadicidal and moniliastatic properties. Toxicol Appl Pharmacol 1959;1:366-76.  Back to cited text no. 13
14.Buvé A, Weiss HA, Laga M, Van Dyck E, Musonda R, Zekeng L, et al. The epidemiology of trichomoniasis in women in four African cities. AIDS 2001;15 Suppl 4:S89-96.  Back to cited text no. 14
15.Karaman U, Karadag N, Atambay M, Arserim Kaya NB, Daldal NU. [A comparison of cytological and parasitological methods in the diagnosis of Trichomonas vaginalis]. Turkiye Parazitol Derg 2008;32:309-12.  Back to cited text no. 15
16.Sharbat Daran M, Shefaei Sh, Samiei H, Haji-Ahmadi M, Ramezanpour R, Mersadi N, Behrad A. Comparison of clinical presentations, wet smear, Papanicolaou smear with Dorset's culture for diagnosis of Trichomonas vaginalis in doubtful women to Trichomoniasis. J Babol Univ Med Sci 2005;7:46-9.  Back to cited text no. 16
17.Ghaffari S, Farid Moayer H, Shaadzee S. Determination of sensitivity and specificity of wet-mount in comparison with culture as standard method of Trichomoniasis diagnosis. Teb va Tazkiyeh 1999;34:18-23.  Back to cited text no. 17
18.Bennett JR, Barnes WG, Coffman S. The emergency department diagnosis of Trichomonas vaginitis. Ann Emerg Med 1989;18:564-6.  Back to cited text no. 18
19.Moshfe AA, Hosseini S. Comparison of clinical and microscopic diagnosis of Trichomoniasis referred to the Yasuj women clinic. Armaghane-danesh. J Yasuj Univ Med Sci 2004;9:71-82.  Back to cited text no. 19
20.Available from: [Last accessed on 2011 Mar 14].  Back to cited text no. 20
21.Radonjic IV, Dzamic AM, Mitrovic SM, Arsic Arsenijevic VS, Popadic DM, Kranjcic Zec IF. Diagnosis of Trichomonas vaginalis infection: The sensitivities and specificities of microscopy, culture and PCR assay. Eur J Obstet Gynecol Reprod Biol 2006;126:116-20.  Back to cited text no. 21
22.Ziaee H, Rezaeian M. Study of Trichomoniasis in women referring to gynecology centers of Sari and comparison of laboratory diagnostic methods. J Mazand Univ Med Sci 1998;8:34-40.  Back to cited text no. 22
23.Habiby Pour R, Amirkhani A, Matinnia N. Contamination rate of Trichomonas vaginalis in females referring to Taamin Ejtemayi hospitals in Hamedan in 2005. Tabib-e-shargh. Zahedan J Res Med Sci 2007;8:245-51.  Back to cited text no. 23
24.Baghaei M, Meamarzadeh Z. Prevalence of Trichomoniasis in women: Isfahan, 1995. J Res Med Sci 2001;6:108-12.  Back to cited text no. 24
25.Culha G, Hakverdi AU, Zeteroglu S, Duran N. Investigation of the prevalence of Trichomonas vaginalis in women with complaints of vaginal discharge and itching. Turkiye Parazitol Derg 2006;30:16-8.  Back to cited text no. 25
26.Bakhtiari A, Hajian-Tilaki K, Pasha H. Genital infection by Trichomonas vaginalis in women referring to Babol health centers: Prevalence and risk factors. I RCMJ 2008;10:16-21.  Back to cited text no. 26
27.Loo SK, Tang WY, Lo KK. Clinical significance of Trichomonas vaginalis detected in Papanicolaou smear: a survey in female Social Hygiene Clinic. Hong Kong Med J 2009;15:90-3.  Back to cited text no. 27
28.Krieger JN, Tam MR, Stevens CE, Nielsen IO, Hale J, Kiviat NB, et al. Diagnosis of trichomoniasis. Comparison of conventional wet-mount examination with cytologic studies, cultures, and monoclonal antibody staining of direct specimens. JAMA 1988;259:1223-7.  Back to cited text no. 28
29.Nye MB, Schwebke JR, Body BA. Comparison of APTIMA Trichomonas vaginalis transcription-mediated amplification to wet mount microscopy, culture, and polymerase chain reaction for diagnosis of trichomoniasis in men and women. Am J Obstet Gynecol 2009;200:188.e1-.e7.  Back to cited text no. 29

Correspondence Address:
Salman Ghaffari
Fatamta-al-Zahra Infertility and Reproductive Health Research Center, Babol University of Medical Sciences, Babol
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Source of Support: This research was supported by project No. 882779 from the Research Council of Babol University of Medical Sciences, Conflict of Interest: None

DOI: 10.4103/1755-6783.105143

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