1.1 Introduction
Trichomonas vaginalis (TV) is a protozoan parasite responsible for trichomoniasis, one of the most common sexually transmitted infections (STIs) worldwide. Despite its high prevalence and significant public health implications, TV often remains undiagnosed and untreated, leading to complications such as pelvic inflammatory disease, adverse pregnancy outcomes, and increased susceptibility to other STIs, including HIV.
Trichomonas vaginalis is an anaerobic, flagellated protozoan parasite and the causative agent of trichomoniasis. It is the most common pathogenic protozoan infection of humans in industrialized countries. Infection rates between men and women are similar with women being symptomatic, while infections in men are usually asymptomatic. Transmission usually occurs via direct, skin-to-skin contact with an infected individual, most often through sexual intercourse.
The WHO has estimated that 160 million cases of infection are acquired annually worldwide. The estimates for North America alone are between 5 and 8 million new infections each year, with an estimated rate of asymptomatic cases as high as 50%. Usually treatment consists of metronidazole and tinidazole.
As a prelude to other parts of this study, this chapter will discuss the background upon which this study was initiated, the statement of problems that led to this study, the Aim and Objectives of the study. Others are Significance of the study, Scope of work, Research hypothesis and questions, Limitation of the study and Definition of terms.
1.2 Background of Study
Trichomonas vaginalis (TV) infection is a significant public health concern globally, particularly among sexually active adults. Despite its prevalence, TV often goes undiagnosed and untreated, leading to various health complications and increased transmission rates. Understanding the epidemiology and factors influencing the prevalence of TV infection among adults is crucial for developing effective prevention and control strategies. Several factors contribute to the transmission and persistence of TV infection, including unprotected sexual activity, multiple sexual partners, and lack of awareness about STIs. Additionally, socioeconomic factors, such as poverty and limited access to healthcare services, play a role in the prevalence of TV infection, with disparities observed among different demographic groups and geographical regions.
Trichomoniasis is associated with adverse pregnancy outcomes, infertility, postoperative infections, and cervical neoplasia (Soper, 2004). Trichomoniasis is the major problem in developing countries, where parental testing and antibiotics use are not adequately available. According to the African Humanitarian Action (AHA) report of July 2008, high rates of the commonly encountered sexually transmitted infections, in KRC, have been noticed by the 19 new cases of STIs, including Trichomonas vaginalis (Kiziba Refugee Camp Health Center, 2008). On the other hand, according to the recent information from CHUK laboratory, a high number of Trichomoniasis cases were observed each month among the patients visiting the health institution.
Sexually transmitted infections (STIs) are infections that are spread primarily through person-to-person sexual contact: anal, vaginal and oral sexual contact. According to the most recent data available of WHO estimates, that 340 million new cases of curable STIs (Syphilis, Gonorrhea, Chlamydia and Trichomoniasis) occur annually throughout the world in adults aged 15 - 49 years (WHO, 2001). Considering Trichomonas Vaginalis worldwide infections, 12 million cases occur annually with a high number of 4 million cases encountered in sub-Saharan Africa. Notably, Trichomonas vaginalis caused infection is believed to increase the risk of HIV transmission.
In women, the disease encompasses broad range of symptoms ranging from a severe inflammation and irritation with frothy malodorous discharge to a relatively asymptomatic carrier state. But the main clinical manifestation of trichomoniasis is vaginitis, urethritis and prostatitis. The outcome of infection with Trichomonas may be due to genetic variability of the isolates and the host immune response.
The vagina is the most common site of infection in women and the urethra (urine canal) is the most common site of infection in men. The parasite is sexually transmitted through penis-to-vagina intercourse or vulva to-vulva (the genital area outside the vagina) contact with an infected partner. Women can acquire the disease from infected men or women, but men usually contract it only from infected women. Adults with trichomoniasis may have babies who are born early or with low birth weight (low birth weight is less than 5.5 pounds).
Trichomonas vaginalis is an obligate parasite in that it lacks the ability to synthesize many macromolecules de novo, particularly purines, pyrimidines and many lipids. These nutrients are acquired from the vaginal secretions or through phagocytosis of host and bacterial cells. Culture media for Trichomonas vaginalis therefore need to include all the essential macromolecules, vitamins and minerals. In particular, serum is essential for the growth of trichomonads, since it provides lipids, fatty acids, amino acids and trace metals. In vitro, it grows optimally at a pH of 6.0-6.3, although it can also grow through a wide range of pHs, especially in the changing environment of the vagina. The presence of Trichomonas vaginalis in the vagina increases predispositions to mv seroconversion. The genital inflammation caused by trichomoniasis can increase a woman's susceptibility to HIV infection if exposed to the virus. Having trichomoniasis may increase the chance that an HIV-infected woman passes HIV to her sex partner(s). This study aims to address gaps in the current understanding of trichomona vaginalis prevalence among adults by conducting a comprehensive review of existing literature. By synthesizing data from various studies, we seek to elucidate the epidemiological trends, risk factors, and challenges associated with trichomona vaginalis infection among adult populations.
1.3 Statement of Problems
Investigation revealed that despite being one of the most prevalent sexually transmitted infections globally, Trichomonas vaginalis (TV) infection among adults poses several significant challenges:
- Underdiagnosis and Misdiagnosis: TV infection often goes undetected due to its asymptomatic nature in many cases. Moreover, misdiagnosis or lack of awareness among healthcare providers can result in delayed or inadequate treatment.
- Limited Surveillance and Reporting: Inadequate surveillance systems and underreporting of TV cases contribute to a lack of comprehensive data on its prevalence, hindering effective public health interventions.
- Social Stigma and Barriers to Testing: Social stigma associated with STIs, including TV, may discourage individuals from seeking testing and treatment, exacerbating the spread of infection within communities.
- Health Disparities: Certain demographic groups, such as marginalized populations and those with limited access to healthcare services, are disproportionately affected by TV infection due to socioeconomic factors and systemic inequalities.
Furthermore, there is growing concern about the development of drug-resistant strains of Trichomonas vaginalis, which could compromise the effectiveness of current treatment regimens and pose challenges for disease management. Addressing these challenges requires a multifaceted approach, including improved diagnostic techniques, increased awareness and education, enhanced surveillance systems, and targeted interventions to reduce health disparities.
1.4 Aim / Purpose of the Study
The aim of the study is to comprehensively investigate the prevalence of Trichomonas vaginalis (TV) infection among adults, with a focus on identifying epidemiological patterns, risk factors, and regional variations.
1.5 Objectives of the Study
Specifically, the following are the objectives laid out to achieve the stated aim or purpose of the study:
- To identify demographic factors associated with increased risk of trichomonas vaginalis infection among adults, such as age, gender, sexual behavior, and socioeconomic status;
- To assess the methodological approaches used in studies reporting trichomonas vaginalis prevalence, including diagnostic methods and sampling techniques;
- To examine the impact of trichomonas vaginalis infection on reproductive health outcomes, including adverse pregnancy outcomes and complications;
- To explore geographic variations in Trichomonas vaginalis prevalence and factors contributing to regional differences; and
- To propose recommendations for improving prevention, diagnosis, and treatment strategies to reduce the burden of trichomona vaginalis infection among adult populations.
1.6 Research Questions
The study came up with research questions so as to be able to ascertain the above stated objectives. The specific research questions for the study are stated below as follows:
- What are the methodological approaches used in studies reporting trichomona vaginalis prevalence, including diagnostic methods and sampling techniques?
- What are the demographic factors associated with increased risk of trichomona vaginalis infection among adults?
- What are the impact of trichomonas vaginalis infection on reproductive health outcomes, including adverse pregnancy outcomes and complications?
1.7 Significance of Study
The prevalence of Trichomonas vaginalis (TV) infection among adults has significant implications for public health, reproductive health, and healthcare systems. This study holds several key significances:
- Public Health Impact: Understanding the prevalence and epidemiological patterns of TV infection is crucial for developing effective prevention and control strategies. By identifying high-risk populations and geographic regions, public health authorities can target interventions to reduce transmission rates and mitigate the burden of TV infection.
- Reproductive Health Outcomes: TV infection is associated with adverse reproductive health outcomes, including preterm birth, low birth weight, and increased risk of HIV transmission. By elucidating the impact of TV infection on reproductive health among adults, this study can inform efforts to improve maternal and child health outcomes.
- Healthcare Resource Allocation: The economic burden of TV infection on healthcare systems is substantial, encompassing costs associated with diagnosis, treatment, and management of complications. By quantifying the prevalence of TV infection among adults, this study can help policymakers allocate resources more effectively to address the growing public health challenge posed by TV.
- Guiding Clinical Practice: Insights gained from this study can inform clinical practice guidelines for the diagnosis, treatment, and management of TV infection among adults. By raising awareness among healthcare providers and promoting routine screening for TV infection, this study can contribute to early detection and appropriate management of the infection.
- Research Prioritization: Identifying gaps in knowledge and understanding of TV epidemiology can guide future research efforts aimed at improving diagnostics, treatment modalities, and prevention strategies. By prioritizing research in areas with limited data or emerging challenges, this study can drive innovation and advancement in the field of STI prevention and control.
1.8 Scope of Study
The scope of the research is focused on the Prevalence of Trichomona Vaginalis among Adults using Osumenyi in Nnewi South L.G.A. Of Anambra State as a case study.
1.9 Limitations of the Study
During the course of this study, there were some problems encountered which stood as limitations to the research work. Some of the limitations include:
- Time Constraint: The time frame given to accomplish this project was very short due to school academic calendar and it was carried out under pressure which made the researcher not to implement some necessary features.
- Research Material: availability of research material is a major setback to the scope of the study.
- Financial Constraint: Insufficient fund tends to impede the efficiency of the researcher in sourcing for the relevant materials, literature or information and in the process of data collection (internet, questionnaire and interview).
- Initial Cooperation Delay from Respondents: A particular limitation of this work came as a result of the respondent refusal to offer their cooperation at the initial time they were contacted. This contributed in making the success of this research study difficult.
