Trichomonas Vaginalis and HIV in Asymptomatic Pregnant Women

Trichomonas Vaginalis and human immunodeficiency virus in Asymptomatic Pregnant WomenPREVALENCE OF TRICHOMONAS VAGINALIS AND human immunodeficiency virus CO-INFECTION AMONG ASYMPTOMATIC PREGNANT WOMEN IN ZARIA, NORTHERN NIGERIAABSTRACTBackground Trichomonas vaginalis is the around common curable intimately catching contagious disease worldwide. Serious unfavourable productive health outcomes including motherliness complications, pelvic inflammatory disease, and an increased put on the line of human immunodeficiency virus scholarship have been linked to Trichomonas vaginalis contagious disease.Objective To determine the preponderance of Trichomonas vaginalis in asymptomatic pregnant women and their human immunodeficiency virus status in Ahmadu Bello University article of belief Hospital Zaria, Northern Nigeria.Methodology A prospective cross-sectional descriptive arena, utilise a proforma to obtain demographic and reproductive health nurture from consenting pregnant wome n attending prenatal clinic. Vaginal swab and declivity samples was taken and analysed for Trichomonas vaginalis and human immunodeficiency virus respectively. Data was analysed using SPSS V17 with p value of importee was set at 0.05.Results The overall prevalence of Trichomonas vaginalis was 19.2%.thither was an inverse relationship amidst the direct of education and acquisition of Trichomonas vaginalis infection in pregnancy women having no formal education had a blueer prevalence of the Trichomonas vaginalis infection (7.5%) as against those who had ordinal education (1.7%). The 26- 30 years suppu rove radical had the highest prevalence of both human immunodeficiency virus infection (5.0%) and Trichomonas vaginalis infection (5.8%) strongly suggesting the possibility of co-infection in the midst of the two agents. There was a statistically significant association surrounded by Trichomonas vaginalis infection and human immunodeficiency virus infection with a P value of 0.0003. The comparative risk of acquiring human immunodeficiency virus in the presence of Trichomonas vaginalis infection was 4. (RR 4.193 bureau Interval 1.756-10.01).Conclusion receipts of the socioeconomic status and education of women peculiarly internal health go forth 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 acquisition1 The magnitude of social and economic consequences of sexually contagious infections (STIs) in growing countries has made it a major universal health problem. 2, 3 STIs ar to a fault plant in pregnant women and the prevalence is higher(prenominal) in Africa causing significant maternal and perinatal morbidity. 3-5Trichomonas vaginalis is a unicellular trounce protozoan org anisms that cause STI.6 Many STIs including those due to Trichomonas, can be transmitted to the fetus via transplacental spread or by passage by the birth canal and via lactation to the neonate. 6 bring upually Transmitted Infections (STIs) and otherwise Reproductive Tract Infections (RTIs) have been associated with a number of adverse pregnancy outcomes which includes abortion, stillbirth, preterm delivery, junior-grade birth encumbrance, postpartum sepsis, neonatal pneumonia, neonatal blindness inbred infection. 2-5, 7 Recent research has shown that having one untreated STI increases the risk of catching another potentially much dangerous one, like Human Immunodeficiency computer 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) infection and acquisition. 10, 11Clinical infection with Trichomonas vaginalis in the neonate is an u nusual natural event and has been reported in a two weeks old girl claw presenting with vaginal discharge with complete resolution to metronidazole treatment.12 Due to high frequency of the infection during pregnancy and the development of metronidazole-resistant isolates, therapeutic alternatives to 5-nitroimidazole are beingness searched like Triterpenes which are natural products presenting several biological activities such as anti-protozoal activity.13The prevalence of Trichomonas vaginalis infections are typically chthonicestimated due to poor sensitivity of diagnostic tests.6 However, the World health Organization (WHO) quoted the overall prevalence as 3.1%.6, 14 In Nigeria the prevalence observed in an Enugu sketch 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 potential a function of the comparative ly 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 view to adding to the growing body of literary productions and suggests control measures.METHODOLOGYThis was a cross sectional study which was conducted over a three calendar month period. Questionnaires were used to obtain the socio-demographic and reproductive profile from consenting invitees who were attending antenatal clinic for the first time in their current pregnancy at the Ahmadu Bello University training Hospital, Zaria, Northern Nigeria. High vaginal swabs and blood specimens for both Trichomonas vaginalis and HIV were obtained and analysed. The entropy obtained was analyzed using Statistical Package for Social Science (SPSS) chance variable 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 gravidity was 3.5 and 20 weeks was the mean(a) gestational age at booking.The overall prevalence of Trichomonas vaginalis was 19.2%. The 26-30 years age groups having a value of 5.8% which was closely followed by age group 21-25years with 5.0%. The lowest prevalence was put 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 pr imigravidae to have Trichomonas vaginalis infection (15.0% vs. 4.1%). The prevalence was observed to be highest in the second trimester (10.8%) as compared to the first and third trimester which were 5.0% and 3.3% respectively.The frequency statistical distribution of HIV status in the study population among the consenting client is shown in Table 2.0. Sixteen 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 senior age group of 36-40years (0.8%). The relationship mingled with the occurrence of Trichomonas vaginalis and HIV infection is shown in a two by two dining table (Table 2.0).DISCUSSIONThe prevalence of Trichomonas vaginalis fix in this study was 19.2%. The World wellness Organization quoted a prevalence of between 3.0- 3.1%6, 14, 19, but added that there was under reporting of the i nfection. prevalence rates as high as 29.8% was bring 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 steady 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 decline in prevalence in the older age group with lowest rate of 0.8% at age group 35-40years. There is however a slight 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 Trichomon as 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 face-to-face 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 comparatively 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 lite rature 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 second 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 commonest 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 statement Hospital, Zaria was a major referral center for the Prevention of Mother To Child transmittance (PMTCT) of HIV in Northern Nigeria.Both HIV and Trichomonas vagin alis 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 vaginalis infection (RR 4.193 confidence Interval 1.756-10.01).CONCLUSION AND RECOMMENDATIONS part screening for STIs like Trichomonas vaginalis during antenatal period should be the standard of oversee because of its proven benefits on the outcome of pregnancy. Metronidazole which is the treatment option when found, is a cheap, readily available and safe 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 prevale nce of Trichomonas vaginalis and HIV co infection.REFERENCEColeman JS, Gaydos CA, Witter F. Trichomonas vaginalis Vaginitis in Obstetrics and Gynecology Practice spic-and-span Concepts and Controversies. Obstet Gynecol Surv. Jan 2013 68(1) 4350. doi 10.1097/OGX.0b013e318279fb7dBegum A, Nilufar S, Akther K, Rahman A, Khatun F, Rahman M. Prevalence of selected reproductive tract infections among pregnant women attending an urban maternal and childcare unit in Dhaka, Bangladesh. J wellness Popul Nutr 2003 21 112-6.Muelen J, Mgaya HN, Chang-Claude J, et al. Risk factors for HIV infection in gynaecological inpatients in Dar Es Salaam, Tanzania, 1988-1990. East Afr Med J 1992 69 688-92.Cotch MF, Pastorek JG, Nugent RP Trichomonas vaginalis associated with low birth weight and preterm delivery.The Vaginal Infections and Prematurity Study Group. Sex Transm Dis 1997 Jul 24(6) 353-60Shuter J, Bell D, Graham D, Holbrook KA, Bellin EY. judge of and risk factors for trichomoniasis among pregn ant inmates in New York City. Sex Transm Dis 1998 25 303-7.Richard aristocracy Wilkerson, et al. Trichomoniasis via http/e music emergency medicineinfectious disease. Accessed March 20 2008, 1430hrs.Sebitloane HM, Moodley J, Esterhuizen TM. Pathogenic lower genital tract organisms in HIV-infected and uninfected women, and their association with postpartum infectious morbidity. S Afr Med J. 2011 Jun 27 101(7)466-9.Ament, L. A. and E. Whalen (1996). Sexually transmitted diseases in pregnancy diagnosis, impact, and intervention. J Obstet Gynecol Neonatal Nurs 25(8) 657-66.Borchardt, K. A. (1994). Trichomoniasis its clinical significance and diagnostic challenges. Am Clin Lab 13(9) 20-1.Laga M, Manoka A, Kivuvu M, et al. Non- ulcerative sexually transmitted diseases as risk factors for HIV-1 transmission in women results from a cohort study. aid 1993 7 95-102.Sorvillo F, Smith L., Kerndt P, et al. Trichomonas vaginalis, HIV and African-Americans. Emerg Infect Dis 2001 7927-32 (Medline ).Irving S D, pile M S et al Neonatal T. Vaginalis infection. Journal of Emergency Medicine vol 13 issue 1 Jan Feb 1995. 51-54Innocente AM, Vieira PB, Frasson AP, Casanova BB, Gosmann G, Gnoatto SC, Tasca T. Anti-Trichomonas vaginalis activity from triterpenoid derivatives. Parasitol Res. 2014 Aug 113(8)2933-40. doi 10.1007/s00436-014-3955-0.Madeline S et al Trichomoniasis highly prevalent in US black women clin infec dis 2007 451319-1325Chigozie J. U, Cletus D. C. U., Ali, Mirian A. Trichomonas vaginalis infection in pregnant women in South Eastern Nigeria a public health importance. The internet Journal of obstetrics and gynecology accessed 20th April 2008.Aboyeji AP, Nwabuisi C. Prevalence of sexually transmitted diseases among pregnant women in Ilorin, Nigeria. J Obstet Gynaecol 2003 23 637-9.Oladele TO et al, assurance on microscopy in T. Vaginalis Diagnosis and prevalence in female presenting with vaginal discharge in Lagos Nigeria.eMedicine on pubmed accessed 20 August 20 08 2100HrsOgunjobi BO, Osola AO Trichomonal Vagintis in Nigerian Women Tropical Geographic Medicine 1984 36(1) 67-70.WHO Trichomoniasis. Available at http//www.who.int.Mayaud P, Uledi E, Cornelissen J, et al. Risk heaps to detect cervical infections in urban antenatal clinic attenders in Mwanza, Tanzania. Sex Transm Infect 1998 74 Suppl 1 S139-46.Tchelougou DI, Karou DS, Kpotsra A, Balaka A, Assih M, Bamoke M, Katawa G, Anani K, Simpore J, de Souza C. Vaginal infections in pregnant women at the Regional Hospital of Sokode (Togo) in 2010 and 2011. Med Sante Trop. 2013 Jan-Mar23 (1)49-54. doi 10.1684/mst.2013.0142.Federal Ministry of wellness Nigeria (2013). National HIV AIDS and Reproductive Health Survey, 2012 (NARHS Plus). Federal Ministry of Health Abuja, Nigeria. Pp 40-42.1