Trichomonas Vaginalis and HIV in Asymptomatic Pregnant Women

Trichomonas Vaginalis and human immunodeficiency virus in Asymptomatic Pregnant WomenPREVALENCE OF TRICHOMONAS VAGINALIS AND HIV CO-INFECTION AMONG ASYMPTOMATIC PREGNANT WOMEN IN ZARIA, NORTHERN NIGERIAABSTRACTBackground Trichomonas vaginalis is the most prevalent curable sexually familial transmittal worldwide. Serious adverse reproductive health outcomes including pregnancy complications, pelvic inflammatory disease, and an increased risk of HIV science have been linked to Trichomonas vaginalis infection.Objective To determine the prevalence of Trichomonas vaginalis in asymptomatic pregnant women and their HIV status in Ahmadu Bello University Teaching hospital Zaria, Northern Nigeria. methodology A prospective cross-sectional descriptive study, using a proforma to fetch demographic and reproductive health information from consenting pregnant women attending antenatal clinic. Vaginal swab and blood samples was taken and analysed for Trichomonas vaginalis and HIV respective ly. Data was analysed using SPSS V17 with p value of significance was set at 0.05.Results The overall prevalence of Trichomonas vaginalis was 19.2%.There was an opponent relationship among the level of instruction and encyclopaedism of Trichomonas vaginalis infection in pregnancy women having no formal grooming had a higher prevalence of the Trichomonas vaginalis infection (7.5%) as against those who had tertiary education (1.7%). The 26- 30 years get on with classify had the highest prevalence of both HIV infection (5.0%) and Trichomonas vaginalis infection (5.8%) strongly suggesting the possibility of co-infection amongst the two eldnts. There was a statistically significant association amidst Trichomonas vaginalis infection and HIV infection with a P value of 0.0003. The relative risk of acquiring HIV in the presence of Trichomonas vaginalis infection was 4. (RR 4.193 confidence Interval 1.756-10.01).Conclusion Improvement of the socioeconomic status and education of wo men especially sexual health will reduce the prevalence of Trichomonas vaginalis and HIV co-infection.Keywords Pregnancy, Trichomonas vaginalis, HIV infectionINTRODUCTIONTrichomonas vaginalis has continued to cause serious adverse reproductive health outcomes including pregnancy complications, pelvic inflammatory disease, and an increased risk of HIV erudition1 The magnitude of social and economic consequences of sexually transmitted infections (STIs) in developing countries has made it a major general health problem. 2, 3 STIs are too engraft in pregnant women and the prevalence is higher in Africa causing significant maternal and perinatal morbidity. 3-5Trichomonas vaginalis is a unicellular flagellate protozoan organisms that cause STI.6 Many STIs including those due to Trichomonas, can be transmitted to the fetus via transplacental spread or by release through the birth canal and via lactation to the neonate. 6 Sexually Transmitted Infections (STIs) and other Reproductive T ract Infections (RTIs) have been associated with a number of adverse pregnancy outcomes which includes abortion, stillbirth, preterm delivery, low birth freight, postpartum sepsis, neonatal pneumonia, neonatal blindness congenital infection. 2-5, 7 Recent research has shown that having one untreated STI increases the risk of contracting some other potentially more dangerous one, equal Human Immunodeficiency Virus (HIV) infection if there is exposure. 8, 9Trichomoniasis in pregnancy has been reported to impacts adversely on birth outcomes and is also a co-factor in Human Immunodeficiency Virus (HIV) transmittal and acquisition. 10, 11Clinical infection with Trichomonas vaginalis in the neonate is an unusual occurrence and has been reported in a two weeks old girl child presenting with vaginal discharge with complete resolution to metronidazole treatment.12 Due to high frequency of the infection during pregnancy and the discipline of metronidazole-resistant isolates, therapeutic alternatives to 5-nitroimidazole are being searched like Triterpenes which are natural products presenting several biological activities such as anti-protozoal activity.13The prevalence of Trichomonas vaginalis infections are typically underestimated due to silly sensitivity of diagnostic tests.6 However, the arena Health Organization (WHO) quoted the overall prevalence as 3.1%.6, 14 In Nigeria the prevalence observed in an Enugu study was 6.9% 15 4.7% was seen in Ilorin16 and 29.8% in Lagos.17In the sub-Saharan Africa, including Nigeria, Trichomoniasis has neither been the focus of intensive study nor of active control programs, and this neglect is likely a function of the comparatively mild nature of the disease. 18 This study explored the rate of Trichomonas infection in pregnancy as well as the level of co-infection with HIV with a scene to adding to the growing body of literature and suggests control measures.METHODOLOGYThis was a cross sectional study which was conducted o ver a three month period. Questionnaires were used to obtain the socio-demographic and reproductive profile from consenting clients who were attending antenatal clinic for the first time in their current pregnancy at the Ahmadu Bello University Teaching Hospital, Zaria, Northern Nigeria. High vaginal swabs and blood specimens for both Trichomonas vaginalis and HIV were obtained and analysed. The data obtained was analyzed using Statistical Package for Social Science (SPSS) Version 17.0 for windows. The level of significance was considered to be p-value Trichomonas vaginalis and HIV infection was determined using the Epi-Info software.RESULTSA total of 120 women consented for the study. The socio-demographic and obstetric characteristics of the patients are as shown in Table 1.0. The mean age was 28.5 + 2.3years, mean gravidation was 3.5 and 20 weeks was the average gestational age at booking.The overall prevalence of Trichomonas vaginalis was 19.2%. The 26-30 years age groups havin g a value of 5.8% which was closely followed by age group 21-25years with 5.0%. The lowest prevalence was implant at age group 36-40years.Low level of education is shown to have a positive impact on the acquisition of vaginal Trichomonas vaginalis. Clients having low level of education had a higher prevalence of the Trichomonas vaginalis 7.5% was seen in those with Koranic (non-formal) education. The prevalence was however lowest in those who had tertiary education 1.7%.-The highest prevalence was seen in clients who were housewives (10.5%) students and civil servants had the lowest prevalence of 1.7% and 2.5% respectively.Mutigravidae are more likely than primigravidae to have Trichomonas vaginalis infection (15.0% vs. 4.1%). The prevalence was observed to be highest in the s trimester (10.8%) as compared to the first and third trimester which were 5.0% and 3.3% respectively.The frequency distribution of HIV status in the study population among the consenting client is shown in T able 2.0. cardinal out of 98 were positive for HIV giving a prevalence of 16.3%. Figure 1.0 shows the percentage distribution of HIV by clients age group. It was observed that HIV was more prevalent in age group 26-30years (5.0%) and was least prevalent in the older age group of 36-40years (0.8%). The relationship between the occurrence of Trichomonas vaginalis and HIV infection is shown in a two by two table (Table 2.0).DISCUSSIONThe prevalence of Trichomonas vaginalis found in this study was 19.2%. The World Health Organization quoted a prevalence of between 3.0- 3.1%6, 14, 19, but added that there was under reporting of the infection. Prevalence rates as high as 29.8% was found in Lagos, Nigeria 17 16.0% was seen in Mwanza, Tanzania20 and a lower rate of 4.7% and 6.9% were found in Ilorin, Nigeria 16 and Enugu, Nigeria15 respectively. A prevalence of 3.7% was seen in a study in Togo.21 Our result compares with that of Tanzania.In the age related prevalence, the study showed a st eady increase in prevalence between ages of 16 to 30years, with the highest rate of 5.8% occurring in the age group 26-30years. This may suggest an increasing sexual activities along the age line considering the fact that Trichomonas vaginalis is sexually transmitted. This can also probably explain the blood in prevalence in the older age group with lowest rate of 0.8% at age group 35-40years. There is however a frail variation with the Enugu study which found the highest age related prevalence of 3.7% among the age group 20-25years.There was an inverse relationship between the level of education and acquisition of Trichomonas vaginalis infection in pregnancy women having no formal education had a higher prevalence of the Trichomonas vaginalis infection (7.5%) as against those who had tertiary education (1.7%). This was consistent with findings in Enugu and Ilorin where low level of education was associated with Trichomonas vaginalis infection. Formal education is associated with improvement in personal hygiene and sexual behavior.The prevalence of Trichomonas vaginalis was highest among housewives and least among students this was unlike the Enugu study that found the highest prevalence to be among the business group. The sociocultural backgrounds of the two environment relatively differs and the lack formal education among housewives in our environment can be a predisposing factor to the acquisition of Trichomonas vaginalis infection.There appears to be a relationship between parity, trimester of pregnancy and infection with Trichomonas vaginalis. Previous pregnancies was recorded in the literature to be a risk factor.10 This study showed a higher prevalence rate among the multigravidae as compared to primigravidae. The prevalence was highest in the uphold trimester of pregnancy as compared to other trimesters. This findings was similar that of Cotch et al4 in their study of vaginal infections and prematurity where Trichomonas vaginalis infection was comm onest in mid gestation. The mean age at booking was 20 weeks showing that most women were seen in the second trimester when Trichomonas vaginalis infection was more likely to be present.The prevalence of HIV infection in this study was 16.8% which was higher than the national average of 3.4% and Kaduna state average of 9.2%. 22 This may be explained by the fact that most of the clients were in their reproductive years and the Ahmadu Bello University Teaching Hospital, Zaria was a major referral center for the Prevention of Mother To pincer Transmission (PMTCT) of HIV in Northern Nigeria.Both HIV and Trichomonas vaginalis infection were highest in the age group 26-30 years this was strongly suggestive of the possibility of co-infection between the two agents. There was a statistically significant association between Trichomonas vaginalis infection and HIV infection with a P value of 0.0003. There was a four times relative risk of acquiring HIV in the presence of Trichomonas vaginali s infection (RR 4.193 confidence Interval 1.756-10.01).CONCLUSION AND RECOMMENDATIONSRoutine screening for STIs like Trichomonas vaginalis during antenatal period should be the standard of care because of its proven benefits on the outcome of pregnancy. Metronidazole which is the treatment option when found, is a cheap, readily available and golosh in pregnancy. Additionally, screening for HIV co-infection will add value to healthcare services in the antenatal clinic.Improvement of the socioeconomic status and formal education in women especially sexual health and lifestyle modification is likely to reduce the prevalence of Trichomonas vaginalis and HIV co infection.REFERENCEColeman JS, Gaydos CA, Witter F. Trichomonas vaginalis Vaginitis in Obstetrics and gynecology Practice New Concepts and Controversies. Obstet Gynecol Surv. 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