الفهرس 
AcknowledgementOnly 14 pages are availabe for public view
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Abstract
Trichomonas vaginalis is one of the most common parasitic non viral sexually transmitted infections in the world. The World health organization (WHO) has estimated that 160 million trichomoniasis cases are acquired annually worldwide. The most risky populations for trichomoniasis are teenage, black races, pregnant women and sexually active females. It is more common in women than males.
Trichomoniasis Infection in women leads to vaginitis, vaginal discharge, cervicitis and urinary tract infection, but in men usually a symptomatic but may leads to urethritis.Complications of trichomoniasis in women include: preterm delivery, low birth weight and increased neonatal mortality as well as predispose to HIV infection, AIDS and cervical cancer .
T. vaginalis is associated with other sexually transmitted diseases including human immunodifficiency virus. Accurate diagnosis is necessary for specific treatment that facilitates control of trichomoniasis and prevents complications. T. vaginalis was traditionally diagnosed by a wet mount. Currently, the most common method of diagnosis is via culture. Giemsa stain and Acridine orange fluoresent stain have a potential for sensitive diagnosis of T.vaginalis. Newer methods such as PCR have even greater sensitivity, but are not in widespread use. Also, rapid immunochromatographic strips is used as a rapid and sensitive new method for diagnosis of T.vaginalis.
The control of T. vaginalis requires strategies that target the individual, risk groups and the community. These strategies to reduce T. vaginalis prevalence need to be integrated into national STI /HIV control programs.
The present study aims to evaluate different direct laboratory methods used in diagnosis of vaginal trichomoniasis.
The present study was carried out on 200 non pregnant female patients attending Gynecology & Obstetrics clinic Benha University, suffering from various gynecological complains, aged between 20-50 years old. Two vaginal swabs were taken from every patient after taking a concent. All the samples were examined by wet mount, stained by Giemsa, Acridine Orange and Culture on modified Diamond’s medium.
This study showed that:
Modified diamond culture is the gold standered among diagnostic techniques as it detected T. vaginalis in 11% of suspected patients followed by 9% by acridine orange stain, then 8.5 % by Giemsa stain and lastly wet mount which detected only 6.5 % of cases so the prevalence rate in this study is 11%.
Concerning total time of the procedures, wet mount examination had the shortest time from taking the specimen till confirmation of infection and then AO then Giemsa staining but culture took the longest period of time to know the results. Concerning total cost of the procedure considering availability of equipment, wet mount examination and Giemsa staining were cheaper than AO staining and culture is the most expensive procedure.
Culture gave the highest sensitivity, specificity, accuracy, NPV and PPV followed by AO stain. The least sensitive was wet mount (59%). The least specific (98.2%) and least PPV (88.2%) was Giemsa stain.
There was a statistically significant difference in the prevalence with classification of suspected cases according frequency of symptoms.The prevalence rised up to 50% of total positive cases and 23.4% of suspected cases in patients who complain of combination of vaginal discharge, itching, dysurea, dysparounia, abdominal and back pain. On the other hand The prevalence fall down to only 3.1% of suspected cases among patients who complain of vaginal discharge only and in patients who complain of dysurea ,dysparounia, abdominal and back pain (17.2% of suspected cases), and in patients who complain of dysurea, dysparounia (12.5% of suspected cases), in patients who complain of infertility (9% of suspected cases) , in patients who complain of vaginal discharge & itching (5.3% of suspected cases) and no positive infection was detected in patients suffering only from itching.
Moreover, there was statistically significant relation between trichomoniasis prevalence and the characters of the collected discharge as the prevalence was higher in cases having purulent frothy vaginal discharge (50% of suspected cases, 41% of total positive cases), then non purulent greenish discharge (12.5% of suspected cases) then whitish scanty amount discharge(10% of suspected cases) and the least character is mucoid discharge (2.3% of suspected cases) then whitish curdy (7.1% of suspected cases) and no positive infection was detected in patients complaining of watery or bloody vaginal discharge.
The prevalence of trichomoniasis has statistically significant relation with the age of patients as T. vaginalis infection was most prevalent in the age groups 30-40 years (16.35% of suspected cases) and it was less prevalent in age ranged from 45-50 years (5.2% of suspected cases), (7.4% of suspected cases) in the age ranging between 20-25 years, (8.1% among suspected cases) in the age ranging between 25-30 years and (9.3%) in the age ranging between 40-45.
Trichomoniasis prevalence has no statistically significant relation with the health status of suspected cases.
There was statistically significant relation between trichomoniasis prevalence and marital status, as the prevalence rate is higher in married (12% of suspected cases, 91% of total positive cases) than in unmarried (5.9% of suspected cases).
There was statistically significant relation between trichomoniasis prevalence and contraceptive use, as the prevalence rate in IUD users is (16% of suspected cases, 64% of total positive cases), in hormonal users is (7.2% of suspected cases) and in non contraceptive users is (6.8% of suspected cases).
There was no statistically significant relation between prevalence of trichomoniasis and residence as infection rate of T.vaginalis in patients living in urban area (11.3% of suspected cases) and in rural area (10.7% of suspected cases).
There was no statistically significant relation between trichomoniasis prevalence and education level as the prevalence in illiterate patients is (13.8% of suspected cases), in moderately educated (9.8% of suspected cases) and in highly educated (6.7% of suspected cases).
from the present study it is concluded that:
1- Laboratory diagnosis of trichomoniasis is benficial as diagnosis of the diseases depending on clinical manifestations only is not reliable.
2- The study showed that wet mount method is simple and cheap.Wet mount microscopy is the preferred option for prompt diagnosis of trichomoniasis, also rapid and so enabling patients to receive same day treatment. But it has its shortcomings and the sample should be examined as soon as possible.
3- It is proved that AO is relatively simple to carry out, shows reasonable sensitivity, but requires the use of a fluorescent microscope, which is available during the study but not readily available in many labs.
4- Owing to giving the highest sensitivity of the conventional techniques, culture remains the most accurate single method for detecting the presence of T. vaginalis in patient samples.
5- Diamond’s medium is a suitable culture method and is considered as the gold standard of diagnosis of trichomoniasis.
6- Although culture gave much better sensitivity than wet mount it does not allow same day treatment, especially in asymptomatic patients and the infection may continue to be transmitted.
7- T. vaginalis is most common in patients who have combination of vaginal discharge, itching, dysurea, dysparounia, abdominal and back pain.
8- Purulent frothy yellowish greenish vaginal discharge is the most common character of trichomoniasis vaginal discharge.
9- T. vaginalis is most common in age range 30-40 years and in married womens, and in IUDS users.
10-This study showed that the infection rate of T. vaginalis in Egypt is relatively high, so there must be a policy decision to increase awareness of STDs in the community by mass media.