Abstract:
Sexually transmitted infections (STIs) continue to be a significant public health problem with
an increased burden on women of reproductive age. These infections can be transmitted
between humans by means of sexual activity including vaginal intercourse, oral sex and anal
sex. Having a STI increases the risk of acquiring human immune-deficiency virus (HIV),
hence the control of STIs is recommended for HIV prevention. The most common STI disease
presentations to the public health setting in South Africa are male urethritis syndrome (MUS)
and vaginal discharge syndrome (VDS). The main pathogens responsible for these two
syndromes are: Chlamydia trachomatis, Neisseria gonorrhoeae and Trichomonas vaginalis.
In the late 1990s the South African health department introduced the STI syndromic
management approach into the primary health care setting. This approach aims to treat the
common causes of STI syndromes through the use of specific treatment algorithms. It is cost
effective because it allows treating the majority of STI patients without the need of laboratory
diagnosis to determine the aetiological agent. People without any clear symptoms will remain
untreated by the syndromic management approach. Little is known of the STI pathogens
circulating in reproductive age women in the Tshwane region. The purpose of this study was
to determine the prevalence of T. vaginalis and its co-infection in reproductive age women.
This study included self-collected vaginal swabs obtained from 117 consenting reproductive
age women visiting either a public health clinic or a sexual private health clinic. The swabs were cultured upon receipt in the laboratory on chocolate agar and in the InPouchTV for
detection and diagnosis of N. gonorrhoeae and T. vaginalis respectively. The Nugent scoring
system was used to diagnose bacterial vaginosis. The STI causing pathogens were detected on
different molecular platforms which included Anyplex II STI-7 real-time PCR, GeneXpert
CT/NG and GeneXpert TV.
The overall prevalence for both clinics of STIs was 13.7% (16/117) and for T. vaginalis
specifically, a 10.3% (12/117) rate was observed. A co-infection rate of 2.6% (3/117) was
observed in this study. Trichomonas vaginalis occurred mostly with C. trachomatis (12.5%)
followed by N. gonorrhoeae (6.3%). Most co-infections were observed in women of younger
than 30 years old. Age was not significantly associated with the prevalent T. vaginalis
infection in this study but being unmarried showed a significant association (p-value=0.038)
with the prevalent infection in both clinics. The high rates of Trichomonas vaginalis and
coinfections with C. trachomatis and N. gonorrhoeae observed in the asymptomatic women
visiting the two clinics provide evidence that in certain key groups the simultaneous screening
for all three pathogens should be performed.
