Genital infection by Trichomonas Vaginalis in women referring to Babol health centers: prevalence and risk factors
Subgroup: Volume 10, Issue 1
Date: January 2008
Type: Original Article
Start Page: 16
End Page: 21
- A Bakhtiari Midwifery Lecturer, Department of Midwifery, Babol University of Medical Sciences, Babol, Mazandaran, Iran
- K Hajian-Tilaki Department of Midwifery, Babol University of Medical Sciences, Babol, Mazandaran, Iran
- H Pasha Department of Community Medicine, Babol University of Medical Sciences, Babol, Mazandaran, Iran
City, Province: Babol, Mazandaran
Background: There is little information about the prevalence and risk markers of Trichomonas Vaginalis (TV) in Islamic Republic of Iran. This study aimed to determine the prevalence of TV and to examine the factors associated with this infection.
Methods: A sample of 550 sexually active women aged less than 45 years living in Babol were enrolled using systematic sampling technique. They were interviewed using a questionnaire, and all the subjects underwent pelvic examination and a discharge ectocervix sample was collected for the diagnosis of TV using wet smear.
Results: The prevalence of TV was 4%, there being a significant association between TV and the sociodemographic variables such as the husband’s education, and woman’s age (20-30 years). The behavioral markers significantly associated with the infection were, not using condom, having ever heard of lack of information about STD/HIV (Sexual Transmitted Disease), and protected last sexual contact in that month and cigarette smoking by husbands. The signs significantly associated with the infection were vaginal discharge, mucopurulent cervicitis, and redness of vulvovaginal. Syndromic diagnosis revealed a moderate sensitivity of 55% and poor positive predictive value for infection.
Conclusion: The prevalence of positive TV is low in the studied women. Therefore, a net diagnosis using laboratory tests is necessary before the initiation of treatment.
Keywords: Trichomonas Vaginalis; Risk factors; High-Risk behaviors
Trichomonas Vaginalis (TV) is a sexual disease. Symptoms in acute vaginitis TV are usually vaginal discharge, vulvae itching/burning, dysuria and dysparunia.1 Transmission is often by coitus specifically through infectious and asymptomatic men.2,3 This disease is common worldwide but its prevalence is varied. The prevalence of infection has been reported up to 20%. In the female prisoners and in women communities with low health the prevalence is reported up to 50-75%.3 In Iran, the rate of TV has been reported to be 26%).4-7 In other countries, it varies from 3% to 7%.8-12 TV is associated with infertility, abortion, ectopic pregnancy, preterm labor, Low Birth Weight (LBW) and cervix cancer. In men, it may cause, uretheritis and prostatit.13,14 In our community, diagnosis is frequently made without laboratory tests, only on the basis of clinical grounds. However, due to drug side effects/resistance, it should be treated after laboratory diagnosis. With regards to the importance of this disease, the necessity of detection and treatment of infectious individuals this study was designed to assess the prevalence of TV and its causal factors in Babol, northern Iran.
Materials and Methods
This Study was carried out among women referring to the health centers of Babol University of Medical Sciences, Babol, Iran. 550 women (P=0.10 and D= 0.025) who attended six health therapeutic centers of Babol were prospectively enrolled by an expert midwife in each health center. The Medical Ethical committee of the university approved the study and informed consent was provided from all participants.
Our inclusion criteria were: women aged 15-45 years who were sexually active and had referred to gynecology units in these centers. They could be either symptomatic (vaginal discharge, genital ulcer and lower abdominal pain) or asymptomatic (routine examination). The exclusion criteria were: antibiotic intake within the past 4 weeks, pregnancy, or uterine bleeding.
A standardized questionnaire was administered and all the subjects were followed by pelvic examination. The data were collected using a questionnaire including the following information: 1) Socio-demographic data including age, educational and professional status, marital status, and income, 2) Behavioral variables including age of the onset of sexual activity, extramarital sex, marriage, marital status of the women, perception of the husband having extramarital sex in the previous 3 months, history of sexual abuse, addiction, cigarette smoking, alcohol, current type of contraception, use of condom, lack of information on STD and HIV, history of STD and PID (Pelvic Inflammatory Disease) and their frequency, 3) Clinical variables studied were reasons of presentation to the clinic, chief complaint, data recorded by physical examination, number of pregnancies, abortions, and infertility. The questionnaires were delivered to one of the authors in order to ensure confidentiality.
The discharged ectocervix samples were delivered to a single laboratory where all the tests were performed. A vaginal discharge sample was taken for Trichomonas Vaginalis diagnosis using wet smear as follows: briefly, the samples were placed into a tube containing 0/5 ml of normal saline and delivered to bacteriology department of laboratory immediately. Direct wet mount was formed from this specimen and examined for the presence of TV under low and high power field (440X and 200 X) of light microscope. The statistical analysis was performed using SPSS package version 11. Comparison of the results was performed by Chi-square test analysis and Fisher’s exact two-tailed test where appropriate. All the tests were two-sided and the level of significance was 0.05. The simple logistic regression model was used to estimate the odd ratio (OR) and 95% confidence interval (95% CI). The diagnostic performance was evaluated using the following indices: sensitivity, specificity, positive and negative predictive values.
The mean age of women with positive TV was 29.8 years; about half of these women (54.5%) and 36.4% of their husbands had primary education. 18.2% of the women and their husbands had diploma degrees, and only 7.5% of them and 12.4% of their husbands had a university degree. The majority were housewives, and 54.5% of their husbands were selfemployed. Regarding the economic status, only 21.3% of the study subjects could save money.
The mean age for the first sexual intercourse was 18 years. There was no history of having sex with more than one partner, extramarital sex, or history of sexual abuse. Most of the women (95%) were not aware of their husbands’ extramarital sex relationships. 9.1% and 50% of their husbands were addicts and smokers, respectively. The most common contraceptive methods used were OCP and then withdrawal (22.7% and 18.2%, respectively), and only 18.2% of the participants had always used condom.
The mean gravidity and abortion were 2.45 and 0.55, respectively; 22.7% of the women had a history of pelvic inflammatory disease and 4.5% history of infertility. All the women denied having a past history of sexually transmitted infections and they did not know their symptoms, or they thought they were not important, or were ashamed to visit the health centers. In fact, 93.5% of them had not heard about STD, while 95.5% heard of HIV. STI services are not free of charge and 86.2% mentioned stigma/social barriers against seeking STD services, and the mean (±SD) time taken to reach the STI services was 12.3 ± 8.2 minutes.
The prevalence of Trichomonas Vaginalis was 4%. The main reasons for presentation at the gynecology clinics in positive TV were urogenital complaints (59.1%), the most frequent ones being vaginal discharge (6.8%), dysparoeunia (6.6%) and genital itching (5.9%) in positive TV. The most frequent signs were redness of vulvevaginal (11.3 %%), MPC (13.8%) and leucorrhea (9.5%). Dysparoeunia, MPC and lekureahe were risk factors for TV. Totally 59.1% of the women with positive TV had symptoms and 50% had signs; 18.2% of the individuals with TV in examination were positive by laboratory test. Association of urogenital manifestations with T vaginalis infection is shown in Table 1. Analysis of demographic markers showed that a significant association was present between the women's age (20-30years) with TV infection. In fact the age group 20-30 years was associated with a significantly higher risk of TV infection. Also the husbands’ low education was significantly associated with TV positive (P
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