Original Article

Prevalence of Trichomoniasis in Women Attending Health Centers in Asadabad City, West of Iran, During 2021-2022

Please cite this article as follows: Azimi Kohn A, Foroughi-Parvar F, Matini S, Matini M. Prevalence of trichomoniasis in women attending health centers in Asadabad city, West of Iran, during 2021-2022. Avicenna J Clin Microbiol Infect. 2024; 11(1):38-41. doi:10.34172/ajcmi.3464

Introduction

Trichomonas vaginalis (Trichomonadidae) is a flagellated protozoan that lives in the human urogenital tract. There is no cyst stage in the life cycle of this parasite and it is directly transmitted from one person to another through sexual contact. Trichomonal vaginitis (trichomoniasis), caused by T. vaginalis, is often seen as an asymptomatic infection in women of childbearing age. Reports indicate that 25% to 50% of infected women have no clinical symptoms. Trichomoniasis has a global spread and according to the World Health Organization, its prevalence rate is 5.3% with an annual occurrence of 156 million cases worldwide (1-3). The prevalence of trichomoniasis has been reported to be higher in women (8.1%) than in men (1%) (4).

In addition to vaginitis and cervicitis, trichomoniasis can be associated with complications during pregnancy such as preterm delivery and low birthweight. Additionally, it can increase the possibility of cervical cancer and pelvic inflammatory diseases in women. Trichomoniasis in men is usually asymptomatic, but it can be an important cause of non-gonococcal urethritis in men. Additionally, this parasite can cause prostatitis and epididymitis, and it is also known as a cause of temporary infertility. In recent years, trichomoniasis has received more attention as a public health concern. This is due to the role of the infection in increasing the chance of infection and transmission of human immunodeficiency virus (HIV) in T. vaginalis-infected individuals, especially in women (4-7).

Another health concern related to trichomoniasis is treatment failure and resistance of the parasite to metronidazole. Some estimates indicate an increasing resistance of the parasite to 5-nitroimidazole compounds. According to the Center for Disease Control and Prevention, the rate of resistance of T. vaginalis to metronidazole ranges from 2% to 5% in the United States, however, some studies have reported a resistance rate of between 2% and 13% (7-9). Therefore, considering the health importance of trichomoniasis in society and the need to understand the epidemiological aspects of this infection, the present study was conducted in Asadabad city to investigate the prevalence of trichomoniasis as well as the factors involved in its transmission in this region.

Materials and Methods

This descriptive cross-sectional study was approved by the Ethics Committee of Hamadan University of Medical Sciences (IR.UMSHA.REC.1399.849). Sample collection was carried out from December 2021 to June 2022 using available sampling method. Vaginal swab samples were obtained from 291 women admitted to obstetrics and gynecology clinics in Asadabad city in Hamadan province. After obtaining informed consent, people were asked questions about demographic characteristics and clinical symptoms of trichomoniasis and the data were recorded. Sampling was done by clinicians using a cotton swab from the posterior fornix of the vagina. Two swab samples were taken from the participants. One sample was placed in a sterile tube with a screw cap containing 0.5 mL of Ringer’s solution and 5% glucose for wet mount preparation and the other was taken for culture in Dorset medium. To prevent immobilization of T. vaginalis trophozoites and rapid diagnosis of the parasite, the samples were transferred to the reference laboratory in Asadabad Medical School within a short period of time. The sediment of the samples was immediately examined with a light microscope at 100X and 400X magnifications to observe motile flagellated trophozoites. The Dorset culture medium was incubated at 37 °C and examined daily for 72 hours (10).

Data were analyzed using SPSS 16.0 and chi-square test, and a probability value (P value) of less than 0.05 was considered as the significance level.

Results

Out of 291 women, 7 (2.4%, 95% CI: 0.7-4.1%) were infected with T. vaginalis. Seven positive samples were detected by the culture method and 4 positive samples were detected by the direct wet mount method. The sensitivity of the wet mount method was 57%. The age of the women ranged from 19 to 65 years with an average of 38.2 years. The majority of the participants were in the age group of 29-38 years (40.2%) with the highest rate of infection (4 cases). The education level of the participants ranged from illiterate to college education and the infection was found in all educational groups. Considering marriage and occupation, 97.5% were married and 91.1% were housewives, and all cases of trichomonal vaginitis were observed in these groups. Other demographic characteristics of the participants are presented in Table 1. The most prevalent clinical signs and symptoms in women infected with T. vaginalis were vaginal discharge and pain in the lower abdomen, which were reported in 5 people. Moreover, 4 of the infected individuals had abnormal discharge in terms of color and consistency. Other symptoms included dyspareunia, vaginal burning, and painful urination, which were observed in 2 cases. Additionally, vaginal itching was observed in 1 case. The relationship between trichomoniasis and the investigated variables was not statistically significant (P > 0.05).

Discussion

Most women experience at least one episode of vaginitis during their lifetime, which is accompanied by unpleasant symptoms such as vaginal discharge, itching, and burning of the vulva. Various pathogens, including viruses, fungi, bacteria, and T. vaginalis protozoa can cause this disease. Trichomoniasis is the most common non-viral sexually transmitted infection (STI) in the world; therefore, its prevalence is considerable among high-risk groups. Today, due to the role of this infection in the epidemiology of HIV infection, its public health importance has become more obvious (2,8,11).

In the present study, the prevalence of trichomonal vaginitis in Asadabad was estimated to be 2.4% and no significant relationship was observed between trichomoniasis and the studied variables. In this study, the highest rate of prevalence was observed in the age group of 28-39 years. The highest prevalence of infection has been observed in the age range of 25 to 45 years, when people are more sexually active (12-18).

In Hamadan province, comprehensive studies have been conducted regarding this infection. Studies conducted in Hamadan city since 2005 have reported that the prevalence rate of the infection ranged from 0.6% to 2.2% (2,10,12,13). The lowest prevalence rate (0.6%) was observed among pregnant women (2). In this latter study, which was conducted in 2015, urine samples were used to detect Trichomonas infection (2). T. vaginalis resides in the urinary-genital tract and can be seen in the urine sediment, but the urine sample has lower diagnostic sensitivity compared to vaginal discharge. Therefore, this issue can be one of the reasons for the low prevalence of infection in pregnant women in this region. In a molecular epidemiological study conducted in Hamedan, the prevalence rate was 4.7% in men; however, the parasitological methods were not able to detect the parasite in men (14). The lowest prevalence rate in Hamadan province was reported to belong to Bahar city with a prevalence rate of 0.5% (15). These studies did not demonstrate a significant relationship between trichomoniasis and the possible risk factors. However, one study reported a significant relationship between education level and trichomoniasis (13). In a study conducted in 2015 in Ghorveh city in Kurdistan province, the prevalence of trichomonal vaginitis was determined to be 1.2%. In this research, a significant relationship was observed between infection and education level (16). In Iran, comprehensive studies have been conducted on the prevalence of female trichomoniasis. In a systematic review conducted by Ziaei Hezarjaribi et al, the prevalence of trichomoniasis in Iran was reported to be 8%. In this review study, the studies conducted from 1992 to 2012 in Iran were included (17). In another review study that examined studies conducted from 1992 to 2017, the prevalence of trichomoniasis in Iran was reported to be between 0.4% and 42% (19).

The main risk factors involved in STIs include lack of public health awareness, high-risk sexual behaviors, multiple sexual partners, socio-cultural factors, age, and so on. On the other hand, study design and sample size are other important factors that can affect the significant relationship between epidemiological variables and STIs. Due to the cultural issues in the country, the prevalence of trichomonas in Iran is lower compared to other regions of the world. However, studies conducted in Iran show a wide range of prevalence rates probably due to differences in the method of diagnosis and the populations being studied.

Conclusion

The results of this study show a relatively low prevalence of trichomoniasis in this region of the country. However, due to the role of this infection in the epidemiology of other STIs, it is expected that effective measures will be taken to promote sexual health and sexual education in the society.

Acknowledgements

The authors would like to thank the Vice-chancellor of Research and Technology of Hamadan University of Medical Sciences for the financial support (Project No. 9910237365). This article was extracted from the project approved by the Students Research Center of Hamadan University of Medical Sciences.

Authors’ Contribution

Conceptualization: Faeze Foroughi-Parvar, Mohammad Matini.

Methodology: Mohammad Matini, Faeze Foroughi-Parvar.

Formal analysis: Mohammad Matini, Ali Azimi Kohn, Sepehr Matini.

Funding acquisition: Mohammad Matini.

Investigation: Ali Azimi Kohn, Sepehr Matini.

Project administration: Mohammad Matini.

Resources: Mohammad Matini.

Data curation: Mohammad Matini, Ali Azimi Kohn.

Visualization: Mohammad Matini, Faeze Foroughi-Parvar.

Supervision: Mohammad Matini, Faeze Foroughi-Parvar.

Writing–original draft: Ali Azimi Kohn.

Writing–review & editing: Mohammad Matini, Faeze Foroughi-Parvar.

Competing Interests

The authors declare no conflict of interests.

Ethical Approval

This study was approved by the Research Ethics Committee of Hamadan University of Medical Sciences (IR.UMSHA.REC.1399. 849).

Funding

This study was funded by the Vice-chancellor of Research and Technology of Hamadan University of Medical Sciences (Grant number: 9910237365).

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