Epidemiology of trichomoniasis in Kumasi, Ghana

Estimates from the WHO indicate that Trichomonas vaginalis (TV) infection is the most common curable sexually transmitted infection world wide. Unfortunately compared to other curable sexually transmitted infections, not much attention has been given to its control. This, however, is changing due to recent reports linking Trichomonas vaginalis infection to adverse birth and reproductive health outcomes and also its facilitation of acquisition of the Human immuno deficiency virus. Studies in this thesis address aspects of the epidemiology of Trichomonas vaginalis infection with a view to enhancing control programmes. Pregnant women attending antenatal clinics in Kumasi, Ghana, participated in the study. Data on socio-demographic characteristics, sexual behaviour, ano-genital hygiene, and partner behaviour were taken. Genital examinations were also done. Vaginal swabs were taken for the detection of Trichomonas vaginalis by 6 methods; latex agglutination, wet prep microscopy, culture, enzyme immuno-assay, polymerase chain reaction, and lateral flow. Women infected with TV were treated with standard 2g metronidazole single dose and had tests of cure done after a week. Four main findings are highlighted; socio-demographic, behavioural and clinical factors independently associated with TV infection were; young age, neither being of Akan nor northern origin, having no religious faith, and douching. Also, not using toilet roll for menstrual hygiene, complaining of a vaginal discharge, clinical detection of vaginal discharge and a vaginal pH more than 5 were independently associated with infection. However, these factors either singly or in combination, could not predict TV infection. using a combination of morphologically based traditional TV diagnostics (wet prep and culture) and molecular techniques (PCR), no evidence for the involvement of rectal and oral trichomonads in the aetiology of vaginal trichomoniasis as speculated recently, was found. iii. a developing country- friendly TV diagnostic, the latex agglutination test, compared favourably with culture, the gold standard in TV diagnosis. With 91% sensitivity and 99% specificity, it is easy to train to use, easy to use, enables same day treatment, and does not require any equipment. It is apparently stable in field temperatures and relatively cheap. iv. the use of 2g single dose metronidazole therapy by a directly observed strategy is feasible. It was well tolerated and had a cure rate of 99.4% after I week. These findings contribute some new information to the epidemiology of TV infection. Such attributes of the latex agglutination test and the excellent clinical efficacy of single dose metronidazole therapy should make the control of TV infection feasible.