Abstract
BackgroundThe services of most clinical laboratories in Africa regarding the diagnosis of Trichomonas vaginalis are largely dependent on the urine direct wet-mount method. However, the exclusive use of urine-based detection may not be appropriate. The culture method is considered the “gold standard” for the diagnosis of T. vaginalis. However, this method has a relatively longer turn-around time and is limited by non-viable organisms in the specimen. This study assessed the prevalence of T. vaginalis and its associated risk factors and evaluated its diagnosis using urine and vaginal samples from symptomatic female out-patients by culture, direct wet-mount, and ELISA method respectively.MethodsThis cross-sectional study was conducted at the Obstetrics and Gynaecology department of the Manhyia District hospital (MDH) and Komfo Anokye Teaching Hospital (KATH), Ghana. Ghanaian sexually active female adults between the ages of 18 and 50 years old were recruited for this study. Vaginal (HVS) and urine samples were collected from each participant, and T. vaginalis infection was assessed based on culture, direct wet mount, and ELISA methods.ResultsThe prevalence of T. vaginalis infection based on the ELISA method, HVS culture, and HVS wet mount were 7.2%, 5.0%, and 1.7%, respectively. Urine culture presented with a 0.6% prevalence rate while urine direct wet mount detected no positive case. There was no statistically significant association between demographic and clinical characteristics and T. vaginalis infection, except for subjects presenting with abdominal pain [OR = 5.42, 95% CI (1.35–21.73), p = 0.017]. Using HVS culture as the reference, ELISA performed best compared to the other methods assessed in this study, presenting with the highest sensitivity [88.9%, 95% CI (54.0–99.8)], specificity [97.1%, 95% CI (93.1–98.9)], AUC (93.0%), and accuracy (96.7%).ConclusionThe prevalence of T. vaginalis infection is high among women in Ghana. With the exception of abdominal pain, there is no significant association between demographic and clinical characteristics and T. vaginalis infection. In the event where the culture method is unavailable or when rapid diagnosis is required, antigenic detection using ELISA is the most accurate for the diagnosis of T. vaginalis infection in women compared to urine wet-mount/culture and the HVS wet-mount method.
Highlights
The services of most clinical laboratories in Africa regarding the diagnosis of Trichomonas vaginalis are largely dependent on the urine direct wet-mount method
The prevalence of T. vaginalis infection based on the enzyme-linked immunosorbent assay (ELISA) method, High vaginal swab (HVS) culture, and HVS wet mount were 7.2%, 5.0%, and 1.7%, respectively
Urine culture presented with a 0.6% prevalence rate
Summary
The services of most clinical laboratories in Africa regarding the diagnosis of Trichomonas vaginalis are largely dependent on the urine direct wet-mount method. This study assessed the prevalence of T. vaginalis and its associated risk factors and evaluated its diagnosis using urine and vaginal samples from symptomatic female out-patients by culture, direct wet-mount, and ELISA method respectively. Trichomoniasis, an infectious disease which mostly occurs in women of reproductive age, is increasing globally It accounted for 59.7 million new cases of infection in 2008, with 42.8 million infections at any point in time [1]. Trichomonas vaginalis, a parasitic protozoan, is the causative agent for trichomoniasis It infects the urogenital tract and has been associated with urethritis, vaginitis, cervicitis, pelvic inflammatory disease, and tubal infertility [4,5,6,7]. T. vaginalis has been shown to facilitate the acquisition of HIV [8] as well as cancer [9, 10], preterm delivery, and low birth weight [11]
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