Anupama, M P (2013) Comparative study of trichomonas vaginalis infection in symptomatic and asymptomatic female patients attending STD Outpatient department diagnosed by wet mount and culture method. Masters thesis, Madras Medical College, Chennai.
|
Text
202000113anupama.pdf Download (2MB) | Preview |
Abstract
INTRODUCTION: Trichomoniasis also known as trich, is caused by pathogenic protozoan Trichomonas vaginalis (T.vaginalis), which is the most common non-viral sexually transmitted infect ion (STI). Trichomoniasis accounts for more than half of all the curable sexually transmit ted infect ions worldwide. It causes approximately 180 million infect ions worldwide annually. Many infected persons remain asymptomatic, when symptomatic, it presents with vaginitis, cervicitis, PID and infertility in women and non-Gonococcal urethritis in men. Women infected during pregnancy are predisposed to adverse pregnancy outcomes like premature rupture of membrane, premature labour and low birth weight infants. Infect ion with Trichomonas vaginalis is a marker for high-risk sexual behaviour and high prevalence rates in many populations indicate the need for counselling and behavioural change to reduce patients risks for acquiring other STI and Human Immunodeficiency virus infection. Trichomonias is increases the risk of transmission of HIV infect ion to 2 fold rise due to local inflammation and disrupt ion of cervical epithelial barrier. Coinfect ion with T. vaginalis and HIV results in “epidemiological synergy” with prolonged or augmented infectiousness of both the infections. Trichomoniasis is highly prevalent in sexually active women ranging from 5% to 74% and in men prevalence is 5 % to 29%. About 10 to 50% of patients harbor Trichomonads without developing any symptoms that serves as major reservoir of infection. In this background we planned to conduct a study to diagnose and compare Trichomonas infection in asymptomatic and symptomatic female patients attending STD outpatient department, using wet mount and culture as diagnostic methods. AIMS AND OBJECTIVES 1) To study the prevalence of symptomatic and asymptomatic Trichomonas infection in female patients attending STD OP. 2) To study sensitivity pattern of wet mount and culture. 3) To study disease characteristics and associated STD infect ions with Trichomoniasis. 4) To study risk factors associated with Trichomoniasis. MATERIALS AND METHODS: Study Design: Cross-sectional study. Study Group: 500 female patients were enrolled in the study. 250 symptomatic and 250 asymptomatic patients are selected randomly. Patients with complaints of vaginal discharge, dysuria, dyspareunia, pruritus, lower abdominal pain are taken as symptomatic group, and patients attending STD OP for routine checkup & for screening are taken as asymptomatic group. 4 vaginal swabs were taken from the posterior fornix of each patient, one swab was used for wet mount preparation and another swab was inoculated directly into the DiamondsTYIS-33 medium and other two swabs were used for KOH and Grams staining respectively. The Institute ethics committee clearance was obtained and informed consent was taken from the recruited women. Inclusion Criteria: • Patient aged > 18yrs and < 55yrs. • Female patient attending STD OP with complaints of vaginal discharge, dysuria, dyspareunia, pruritus , LAP are taken as symptomatic group, and patients attending STD OP for routine checkup & for screening are taken as asymptomatic group. Exclusion Criteria: • Patients aged <18 to > 55yrs. • Pregnant, lactating and menstruating women. • Patients taken treatment with any antibiotics including Metronidazole 3 weeks prior to study period. • 4 Patients with severe medical disorder. SUMMARY: 1. The total prevalence of Trichomoniasis in our study is 8%. About 12.4% (31 patients) in symptomatic group and 3.6% (9 patients) in asymptomatic group. 2. Isolation of Trichomonas vaginalis is best done by Culture in Diamond’s media on 3rd day of inoculation. 3. Sensitivity and specificity of Culture is 100% in our study. The sensitivity of Wet mount is 67.7% in symptomatic group and 44.4% in asymptomatic group and specificity is 100% in both the groups. Wet mount was negative in 14 patients (10 in symptomatic, 4 in asymptomatic group), these wet mount negative sample were positive by culture. Thus culture is considered as gold standard investigation for Trichomoniasis. 4. Other Investigative procedures: a. The pH > 4.5 had sensitivity of 82.5% and specificity of 79.1% in diagnosing Trichomoniasis. b. Whiff test had sensitivity of 60% (which was comparable to wet mount) and specificity of 82%. c. PAP smear had low sensitivity (12.5%) and high specificity in diagnosis of Trichomoniasis. d. The Gram’s staining for pus cells had 17.5% sensitivity and 98.7% specificity. 5. Demographic and socio-economic factors of Trichomoniasis patients derived from our study are: a. Trichomoniasis seen commonly in age group of 30 ± 4 years both in symptomatic and asymptomatic patients. b. Most of the Trichomonas positive women in our study were residing in urban areas and belongs to lower (class V) socioeconomic status and had low educational status. 6. Clinical characteristics of Trichomonas positive patients derived from our study are: a. The mean duration of onset of symptoms is 30 years and mean duration of vaginal discharge was 4.8 months (149 days) in symptomatic women. b. The most common signs and symptoms of Trichomonias is women in symptomatic group are vaginal discharge (92.5%), frothy foul smelling discharge (58%). The other common symptoms seen along with vaginal discharge are vulval itching, LAP and dysuria. The characteristic features of the infection are seen only in about 40% to 50% of patients. c. The discharge characteristics commonly seen in asymptomatic patients are scanty to moderate, odourless, mucoid discharge. 7. Risk factors associated with Trichomonias is in our study are: a. Women with low socioeconomic status and residing in urban areas. b. Women who were s ingle and separated from their husband. c. Women with multiple sexual partner and d. Women whose husband having extramarital contact. 8. The most common coinfection with Trichomoniasis in our study is Bacterial Vaginos is and Cervicitis. 9. There was no association between Trichomonias is and HIV in our study. (out of 9 positive HIV cases in the study group, one patient in asymptomatic group was dignosed as Trichomonisis). 10. There was also no association between Trichomonias is and cervical cancer in our study. (In the age group of 40-55yrs, 5 patients in symptomatic group with cervical cancer were negative for Trichomonas vaginalis). CONCLUSION: • The Prevalence of Trichomoniasis in Symptomatic Group is 12.4%. • The Prevalence of Trichomoniais in Asymptomatic Group is 3.6%. • Culture is the gold standard investigation in the diagnosis of Trichomoniasis with sensitivity and specificity of 100%. • Wet mount had low sensitivity and high specificity in our study. Wet mount failed to identify 14 cases which was positive by culture (p value is <0.05). • Routine use of Wet mount solely for the diagnosis of Trichomoniasis leads to false negative results, hence culture must be routinely done whenever Wet mount is negative and Trichomoniasis is strongly suspected. • Clinical characteristics of symptomatic patients are moderate to profuse foul smelling frothy mucopurulent vaginal discharge, when compared to scanty, moderate odourless mucoid discharge of asymptomatic patients. • Risk factors associated with Trichomonias is are women with low socioeconomic status, who are s ingle, separated from their husband, having multiple sexual partners and women whose husband has extramarital contact.
| Item Type: | Thesis (Masters) |
|---|---|
| Uncontrolled Keywords: | trichomonas vaginalis infection ; symptomatic and asymptomatic female patients ; STD outpatient department ; wet mount and culture method. |
| Subjects: | MEDICAL > Dermatology Venereology and Leprosy |
| Depositing User: | Punitha K |
| Date Deposited: | 21 Jun 2018 14:22 |
| Last Modified: | 23 Jun 2018 02:29 |
| URI: | http://repository-tnmgrmu.ac.in/id/eprint/8548 |
Actions (login required)
 |
View Item |
