ABSTRACT
The prevalence of Trichomonas Vaginalis among adult in “Osumenyi” in Nnewi south local government Area of Anambra state was carried out. This was done using a stotal of one hundred adults from there different clinics viz ;- Health center, family planning and Antenatal Clinic in Osumenyi; in Nnewi South L.G.A of Anambra State. the general prevalence was 37 (37%) positive cases out of the 100 samples used. The highest number of positive cases were seen in Health centre Clinics, Osumenyi with (20%) positive cases, followed by family planning clinic, Osumenyi with (14%) positive cases and the least in Antenatal clinic in Osumenyi with (4% positive cases. The parasitic organism was confirmed using wet mount preparation of urine and genital secretions. The organism trichomonas vaginalis was identified by its Jerky swaying motion or jumpy movement. It was observed that the prevalence was highest in adults in the age range 31-45 years with 19 cases (19%) positive, followed by the age range 16-30 years with 10 cases (10%). Next was in aga-range 46-60 years with 5 cases (5%) and least in age-range 61-75 years with 3 cases (3%)
TABLE OF CONTENTS
CHAPTER ONE
1.0 Introduction
1.1 Aim and objective
1.2 Hypothesis
1.3 Limitation/scope of the study
1.1 Limitation in the study
1.2 Statement of problem
1.3 Justification of the study
CHAPTER TWO
2.0 LITERATURE REVIEW
CHAPTER THREE
3.0 Materials and method
3.1 Materials
3.2 Method
3.2.1 Sterilization
3.2.2 Population sampled
3.2.3 Collection of samples
3.2.4 Laboratory examination
CHAPTER FOUR
4.0 RESULTS
CHAPTER FIVE
5.0 DISCUSSION
CHAPTER SIX
6.0 Conclusion and recommendations
6.1 Conclusion
6.2 Recommendations
References
Appendix
LIST OF TABLES
TABLE I: Colour Clarity and odour of urine sample collected from both sexes of adult………………………………………….
TABLE II: Colour and odour of ggental secretion collected from both sexes of adult examine……………………………………..
TABLE
III: Age distribution, numbering of possitive cases and negative cases
of both sexes from health center, Osumenyi in Nnewi south L.G.A of
Anambra State……………………………………………..
TABLE IV: Age distribution, number
of positive and negative cases of both sexes from family planning
clinic, Osumenyi in Nnewi south L.G.A of Anambra State……………………………………………
TABLE
V: Age distribution, number of positive and negative cases of both
sexes from Antenatal clinic, Osumenyi in Nnewi south of Anambra State.
TABLE VI : Age distribution of positive and negative case and their percentages from all the three clinics……………….
CHAPTER ONE
INTRODUCTION
Donne
first discovered and named Trichomonas Virginalis in 1836.He found the
orgnaism in genital secretions 7 women and men, but it was initially
regarded as non-pathogenic (Donne, 1936). Trichomonas vaginalis is a
pear-shaped, flagellaatic, motile protogoa, with an undulating
membrance. It is about 10-20 Hm wide, and oxide. The organism is
propelled by four anterior flagella with a flagellium attached to an
undulating membrance (Heine, 1993). I. Vaginalis is a eukaryrote,
anaeobic and does not contain mitochoria in its cytop[lasm but instead
contains specialized granules called hydrogenosomes throguh out the
region of the cytoplasm with a slender posteriorly protruding regid rod
called axostyle (Nester, est el, 2001 and Rultyle, 1983). I. Vaginalis
exist only as a trophozoile and do not take o a cyst from (Lossick,
1990). Due to the organism’s unique energy metabolism,s the organism
bears a strong resemblance to anaerobic bacteria (Petriu, 1998). In wet
mount preparation of vaginal secretions, the live organism can often be
recognised by its unmistakably swaying motion (Nester et al, 2001). I.
Vaginalis grows best under anearobic conditions and at elevated PH
levels. Masimum growth and metabolic functions are greatest at PH of
6.0 (Spence, 1992) In accord with its anaerobic state, sthese
interesting cytoplasmic double –bounded organelles (hydrogenosomes)
remove the carboxyl group (CooH) from pyruvate and trasnfer electrons to
hydrogen gas (Nester et al, 2001). I. Vaginalis derives its glucose
into oseccinate, acelate, malate, and hydrogen. In addition it produces
some carbondioxide but nost via the kreb cycle pathway (Dyall and
Johnson, 2000).
I. vaginalis causes sexually transmitted
inecxtion (STI) called Trichomoniasis. This infection is the most
common nonviral sexually transmistted disease in the world.
Trichomoniasis, sometimes referred to as “Trich” is primarily an
infection of the urogenital tract,. Which infects both men and women.
The urethra is the most common site for I. Vaginalis infection in men.
The organism can aslo be detected in the epididymis, semen and urine
(Krieger, 1981). I. Vaginalis was first located in prostatie secretions
from husbands of infected women (Drummond, 1936). In women, vagina is
the most, common site of the infection the organism may be isolated from
the cervix, vagina, bartholins glands, bladder and occasionally. The
upper sreproductive / urinary tract (Reing, 1990). Over 95% of
infections have been isolated from vagina and only 5% from the urinaryu
tract of adult women (Grys, 1964) the urethra and skene’s glands are
infected in 90% of cases. There have also been instances where
organisms were isolated from bladder urine (Thoniason, 1989). Infected
men are usually asymsptomatic carriers of the organisms (Krieger, 1995)
which most symptomatic I.Vaginalis infection occur in women (Wolner-
Hanssen, 1989). It ranks third after bacterial vaginosis and
candidiasis among the diseases that commonly cause vaginal symptoms
(Nester, et al, 2001). According to World Health Organisation’s annual,
estimates, There are an estimated 7.4 million trichomoniasis cases each
year in the united states, with over 180 million cases reported world
wide (Weinstock et al, 2004). WHO in 1999 states that the infection
rates have been reported by some researchers to be as high as 67% in
Monogolia in 1988 (Schwebke, et al, of 40 – 60% in Africa and 40% in
indigenous Australians. Trichomoniasis rates are also high in inner
city populations in the united states. I . vaginal is was originally
considered a commensal until in the 1950s when the understanding of its
role as a sexually transmitted infection began to involve (Swygard, et
al, 2004). Trichomoniasis often leads to vaginitis, an acute
inflammatrory disease of genital mucosa.
This infection
is associated with preterm delivery, low birth weight and increase in
infant mortality. It also pre-disposes individuas to HIV/AIDS and
cervical cancer (Cohen, 2000 and Upcroft and Upcroft, 2001). Among both
women and men, I. Vaginalis is emerging as one o the most important
factors in transmission and acquisition of HIV infection (Sorvillo,
1998). In women, the health complications include increased risks for
the following, infertility, development of a typical pelvic inflammatory
disease (PID), infection following gynecologic suggery and cervical
inflammatory neoplasia. There have also been high rates of correlation
between trichonioniasis and pregnancy complication in women (Cotch,
1997). In men, I vaginals has been linked to main factor in infertility
and as a common cause of non-gonococcal urethritis (NGU) in men (Sch
webke 2002, and soper, 2004). Minkoff, et al (1984) identified a strong
association between I vaginalis infection and prefern rupture of
membrane. Several studies have showns I. Vaginalis to be a rish factor
for tubal infertility (El-Shazly, 2001). Sorvillo (1998) states that
I.Vaginalis may amplify HIV – I transmission by increasing subceptibity
in an HIV-1 negative person and the infectiousness in an HIV-1positive
patient. He further stats that I. Vafinalis is emerging as one of the
most important cofactor in amplifying HIV transmission particularly in
African American Communities in the united state (Sorvillo, 2001). The
association of trichomoniasis with HIV amplification is seen among men
as well (Hobbs, 1999). I. Vaginalis has a significantly increased
incidence of HIV transmission (Jackson, et al, 1998). I vaginalis
elicits an aggressive local cellular immune response with a heavy influx
of target cells in HIV. This response may increase a seronegative
individual. Conversely in an HIV-seropisitive individual, punctuate
haemorrhages, That are frequently associated wit I vaginalis infection,
increased shedding and subsequent transmission of the virus (Cohen, et
al, 1997).
In women, the infection is often characterised
by vaginal i.e a thin foamy yellow – green, frothy vaginal discharge,
vaginal odour, sometimes macodoros, pains with sexual intercourse, pain
with urination and vulvovaginal sorness (Itching) (Rein, 1990, and
Nester et al, 2001). (Common clinical signs include vulva erythema,
inflammation excess of white blood cells seen on a wet mount preparation
of vaginal discharge, numerous polymorphonuclear nuetrophils (Similar
in size with Trichomonads) and occasional red blood cell (Rein, 1980),
motile trichomonads in the wet mount preparation and a vaginal PH above
5.0, most of which overlap with Baterial vaginosis (Rein, 1984, and
Wolner-Hassen, 1989). The wall of the vagina and vulvu are diffusely
red and slightly swollen (Nester et al, 2001). I vaginalis infection is a
persistant disease of genitourinary tract, characterised with foul
odour, serve cases, puncstuate or scattered pinpoint haemorrhagos are
present. It may also cause preumonies bronchitis (public Health Agency
of Canada. (PHAC) 2001, and MC Laren, et al, 1983). These symptoms
usually appear within four to twenty days of exposure. In men, the
infection is more difficult to detect as the majority of infections
remain a symptomatic and readily available diagnotic techniques are
inadequate this is problematic since long tewrm carriage of I vaginalis
in a symptomatic men have been documented up to 4 months (Kreiger,
1993). Most men seeking treatment do so because of htier infected
partners (Hager, 1994). Up to 50% males are usally a symptomatic with
the organism persisting in their prostate gland or seminal vesicles
(Krieger, 1995). Symptoms in men typically include Urethral discharge,
dysuria, mild prurities licting burning after intercourse (Kreiger 1995,
and Latif, 1987). These may casue Urethritis, prostatis, reversible
sterility and semen PH is 78.1 – 8.0 (Gopalkrishnan, 1990). This
changes have been attributed to the mechanical trauma by the moving
protozoa, but toxins or exotoxins have not be ruled out by the
organism. The frothy discharge is probably due to gas produced by the
organism (Nester, et al, 2001).
The life cycle of I.
Vaginalis is still poorly understood. The trophozoite lives in close
association with the epithelia of the urogenital tract (Latif et al,
1987) and reproduces by longitudinal binary fission (Nester et al.
2001). I vaginalis is distributed world wide as a human parasite and has
no other reserviors (Nester et al, 2001) the mode of transmission is by
intimate or direct copntact with vaginal and urethral discharges of
infected persons during sexual intercourse rarely occurs by intimate
contact with contaminated articles. The highest rate of infection with
multiple sex partners and congenital infection is possible (That is from
infected mother to infant at child birth althought infrequent). New
born girls can acquire the infection from their infected mothers through
birth canal. In such cases, the infection tends to remain a
symptomatic unstil puberty (Nester et al, 2001, Bradley, et al, 1993 and
public Health Agency Canada (PHAC) 2001). The organism can survive for
hours on moist objects such as damp towels clothes and bathtubs of
infected women (Lossick, 1989 and Nester et al, 2001). Nonsexual
transmission is extremely rare sine i. Vaginalis infection is generally
rstricted to a specific sites namely the urogenital tract Ithomason
(1989). The only known nonviral form of transmission is through
perinatal acquisition. Approximately 5% of female babies born of
infected mothers contract the infection (Bramley, 1976). Nevetheless,
I. Vaginalis infection in children should at least raise the question of
sexual abuse and p[ossible exposure to other sexually transmitted
diseases (Nester et al, 2001). Evidence for sexual transmission of I.
Vainalis is very strong as prevalence is highest among patients with
increased sexual acitivity and mul;tiple partners. Approximately 14-65%
of male partners of infected females are also infected (Krieger, 1995,
and Sena, 2003). The incubation period before symptoms arise is 4-28
days and years for persistat infection (PHAC, 2001). There is high
percentage of a sympstomatic carriers especially among men and this
fosters tranmission of the disease (Nester et al, 2001). Asymptomatic
infected individuals factors in trichomoniasis transmission. Many
studies have shown that treatment of the male partner (s) of infected
women improves bsoth cure rates and recurrence rates (Hager, 1980 and
lyng, 1981).
AIM AND OBJECTIVES OF THE STUDY
1.
To determine the prevalence of I. Vaginalis among adults in”Osumenji” in
Nnewi South Local Government Area of Anambra state.
2. To determine the age level which are msore susceptible to the infection
3. To determine the sex with higher prevalence of the infection
1.2 HYPOTHESIS
Ho - The prevalence of I. Vaginalis is higher in women than in men.
Hi - The prevalence of I vaginalis is not higher in women than in men
H2 - The prevalence of I vaginalis occurs more in young adults than in older people.
1.3 LIMITATION/SCOPE OF THE STUDY
This study is limited to adults in “Osumenyi” in Nnewi south local Government Area of Anambra state.
1.4 STATEMENT OF PROBLEM
Trichomoniasis
is a prevalent sexually transmitted disease (STB) pathogen that will
not go away because we ignore it (Bowden and Garneth, 1999). Moreover,
according to Duboucher (2003), data collected suggest that trichomonads
are overlooked parastites and may be mplicated in various pathologies.
Therefore it I pertinent to determine the prevalence of I. Vaginalis
among adults.
1.5 JUSTIFICATION OF THE STUDY
The
ressults project research revealed high prevalence of I. Vaginalis among
adults, therefore, there is need for screening of the adult population
from time to time. This is done either individually or by Government
policy so as to promote the health of the populace.
