Trichomonas vaginalis and bacterial co-infections identified in reproductive age women

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.