CHAPTER ONE

1. INTRODUCTION

1.1Background to the Study

Trichomoniasis is a common sexually transmitted parasitic disease (STPD) in Nigeria, caused by Trichomonas vaginalis. It was reported by Krieger (2012) that Trichomoniasis is a “curable sexually transmitted disease (STD) that infects the urogenital tract of sexually active men and women inducing substantial vaginal and cervical ulceration”.

Among the diseases that commonly cause vaginal symptoms, trichomoniasis infection comes after bacterial vaginosis and candidiasis (McClelland et al., 2017). The causative organism known to as Trichomonas vaginalis, is located inside genitourinary structures (such as the urethra, ureter, bladder, genital organs, including the uterus). It has been reported that annually, an estimate of 2.5 to 3 million Americans get infection and about one billion people suffer trichomoniasis worldwide while in Nigeria approximately 25% of students and 20% of pregnant women are infected (Toth, 2013).

The infection is typically acquired via direct (sexual) and indirect (rarely through contact with formites or surfaces contaminated with fluids from infected individuals) contact (Nester et al., 2011). Women particularly those with multiple sex partners contract trichomoniasis infection via sexual contact with infected men or via vulva to vulva contact also, through non venereal mode of transmission due to the open biological nature of women, while seated on lavatory seat (the seat containing infected urine that is passed within thirty to forty five minutes) while men contact the infection only when they involve themselves in a sexual contact with infected women. Men serve as vectors, they are infestors rather than been infected while the women as reservoirs.

It has been reported by Swygard et al. (2014) that more than 180 million women globally might be infected, with prevalence varying between studied populations and ranges from 5-29 % in men and 5-74 % in women. Prevalence is lesser in males when compared to females; this is due to the fact that the infection in men is mostly asymptomatic and they do not seek evaluation until their partners are confirmed. However, when symptoms do manifests they can include; irritation inside the penis, mild discharge and slight burning sensation following urination or ejaculation. The symptoms in women appear within 5-28days of exposure. The symptoms include greenish-yellow frothy discharge, painful urination, vaginal itching and discomfort during intercourse in 50 % of cases to pruritus or dysuria and pelvic inflammatory disease (PID) (Krieger, 2012).

Trichomoniasis causes genital inflammation which also increases a woman’s risk of HIV infection if exposed to HIV / shedding HIV if the woman is already a carrier, increasing the chances of transmission. Most of the women that are asymptomatic and usually avoid diagnosis turn out to be positive of trichomoniasis infection. The observation is affirmed by a case study in Zimbabwe where 75% of women denied symptoms on direct questioning out of which 16% tested positive after screening (Rathore et al., 2017). The infection of trichomoniasis is often confusing for example, in a case study where 200 Nigerian  women  with  discharge  about  74%  of  them  were  infected with Trichomonas while out of a hundred and forty-nine (149) Nigerian women with discharge, none were infected (Swygard et al., 2014). As was reported by Rathore et al. (2017), trichomoniasis are often asymptomatic in both men and women at a ratio of 50-70 % which contribute majorly to the source of transmissions of the infection. Pregnancy in women can be affected due to the asymptomatic nature of most of the infections in females leading to preterm birth, low birth weight in infants that usually develop congenital health problems which degenerate later in life. Infants become infected as a

result of rape and possibly through exposure to other STDs. So also, it was reported that “the disease can be contracted congenitally during birth by the newborn babies” (Lawing et al., 2010).

The vaginal discharge is the common sample collected mostly for the diagnosis of trichomoniasis in women while urine is sample mostly used for diagnosis in men. The pH paper is used in order to differentiate T. vaginalis from yeast rapidly in women, it is also used for the evaluation of pH. As was reported by Gary and Garber (2015), that pH level of the vagina which normally is 4.5, rises to 6 and above with Trichomoniasis but is not altered during yeast infestation. This simply means that T. vaginalis infection raises the hydrogen ion concentration (pH) of the vagina.

A single oral dose of 2 g metronidazole or tinidazole can treat T. vaginalis infection. It is always better for the sex partners to be treated at the same time as re-infection occurs often, in every five people treated, one gets re-infected within 3 months of treatment and it is advisable for them to avoid intercourse until every symptom disappear (Anorlu et al., 2012). The investigation of the prevalence of trichomoniasis among patients attending Umaru Sanda Ndayako General Hospital in Bida is due to the lack of baseline data in many parts of the state especially in the study area and the asymptomatic nature of the infection.

1.2Statement of the Research Problem

Trichomoniasis affects more than two million people annually (Centre for Disease Control (CDC), 2021) and prevalence of the infection is often associated with significant public health problems. Infection in the majority of the men and women are often asymptomatic thereby escaping diagnosis and treatment. As a result of this, frequent spread and transmissions of the disease (trichomoniasis). Trichomoniasis in

females adversely affects pregnancies resulting in premature birth of mostly low birth weight infants that usually develop congenital health problems later in life. Schwebke (2012) and Soper (2014) reported that T. vaginalis is a major cause of infertility and a common cause of non-gonococcal urethritis (NGU) in men.

1.3Aim and Objectives of the Study

This study was aimed at determining the prevalence of Trichomoniasis among pregnant women attending antenatal in general hospital.

The objectives of the study were to

1. isolate and identify Trichomonas vaginalis from infected individual

1. determine the prevalence of T. vaginalis among patients attending Umaru Sanda General Hospital
2. determine the socio-demographic factors (age group, sex, status) associated with prevalence of the infection.

1.4Justification for the Study

Early diagnosis of the infection with trichomoniasis is important to avoid obvious adverse effects to the infected individual, their sex partners and the unborn babies. Knowing the prevalence of trichomoniasis infection will help health professionals and individuals to be conscious of the parasite and forestall its further spread. Also establishing the socio-demographic factors associated with this infection will also aid in the control measure.