Trichomoniasis is the most common non-viral sexually transmitted infection (STI) globally, affecting people of all ages, races, and socioeconomic classes (Apalata et al. 2014). T. vaginalis prevalence percentages vary widely worldwide, ranging from 0.9 percent to 80 percent (Valadkhani et al. 2011).
T. vaginalis infection was found to be prevalent in about 12% of women attending ordinary prenatal care filling the inclsion criteria. The occurrence of atypical vaginal discharge and a previous history of infection were both risk factors for infection in this population, as stated elsewhere. A recent study on pregnant women in Egypt found a prevalence of 11.7 %, which is similar to our findings (Kamal et al. 2018). In addition, pregnant women from Durban had a comparable prevalence rate of 10% for T. vaginalis (Dessai et al. 2020).
Despite between mostly asymptomatic sexually transmitted infection, but several sequels and complication can occurs during pregnancy like, early rupture of membranes, premature delivery, and low birth weight therefore exploring the prevalence and the sequel of this infection with pregnancy was the aim of this study
T. vaginalis infection was shown to be prevalent in 11.5 % of women aged 15 to 49 years old in a previous WHO research conducted in the African region (Newman et al. 2015). Another study conducted in Egypt found a higher frequency of 37.7% (El-Gayar, Mokhtar, and Hassan 2016).
In the present study, the high rate of trichomoniasis was observed in the age group of [26- 35], followed by the age group of [18-25]. This finding was consistent with other previous studies (Mabaso et al. 2020; Kamal et al. 2018). Trichomoniasis is one of the sexually transmitted infections commonly associated with patients at child-bearing ages since these ages are more sexually active (Mabaso and Abbai 2021).
Sociodemographic characteristics such as residency, education level, and occupation did not differ between this study cases and control groups. These results contradicted Kamal et al. (2018) findings that were living in a rural location, having a poor socioeconomic standing, and having only a primary education level were associated with T. vaginalis infection. This discrepancy in findings could be attributed to the difference in the number of participants between the two studies.
Ibrahim et al. (2021) study indicated that T. vaginalis infection was more common among women living in rural regions than in urban areas, but there was no statistically significant difference (P=0.28).
A risk factor for Trichomonas vaginalis infection was the presence of abnormal vaginal discharge along with a previous history of genitourinary infection. The bivariate analysis of those who reported vaginal discharge revealed a significant correlation with T.vaginalis infection (P=0.012). Other investigations had reached the same conclusion (Chetty, Mabaso, and Abbai 2020; Ibrahim et al. 2021).
According to many researchers, the Diamond modified broth culture is the standard gold test (Domeika et al. 2010; Kamal et al. 2018). In this investigation, all T. vaginalis infected cases were Diamond diagnosed 24/24 (100 %), the standard gold test so that regarding the result of the wet mount and Giemsa staining tests compared to culture, the sensitivity and specificity of both were 70.8% and 100 %, respectively.
HAMDY and HAMDY (2018) declared that the wet mount and Giemsa stained smear had sensitivities of 16.7% and 50%, respectively, and specificities of 100% and 100%. When compared to the Diamond reference index, Hegazy et al. (2020) showed that Giemsa stained smear and wet mount detected 30/200 (15%) and 26/200 (13%) positive cases, respectively, with sensitivities of 67 %, 58 %, and specificities of 100 %, & 93.5 % respectively.
Also, Ibrahim et al. (2021) reported that direct wet mount smear and Giemsa stained smear detected six cases, compared to nine by Modified Diamond culture with sensitivity and specificity of both were 66.67% & 100% respectively to the Diamond reference.
The present study detected premature rupture of membrane, preterm birth and low birth weight infant in 70.8%, 50% and 70.8% of infected women, respectively.
Several studies have found a link between vaginal trichomoniasis, premature birth, and low birth weight babies (Rasti et al. 2011; Cotch et al. 1997; Kamal et al. 2018). Preterm birth and low birth weight infants were 30 % more probable in pregnant women infected with T. vaginalis than in uninfected women (Cotch et al. 1997). This link was also validated in meta-analysis research (Silver et al. 2014), which aligned with our findings. The increased rate of preterm birth and unfavourable post-delivery outcomes among infected women could be explained by the host's inflammatory response to infection, which may weaken the chorioamnionitis membrane and raise the risk of adverse birth outcomes (Schoonmaker et al. 1989).
Following up on the treatment of positive cases with metronidazole, only 13/24 ( 54.2%) patients received the medicine with good compliance, and 11/24 (45.8%) cases showed non-compliance in treatment with metronidazole. Some of them received repeated courses; nine out of 11 non complianed cases gave birth to a preterm newborn, indicating a statistically significant difference compared to treated instances (81.8% vs. 23.1%; p= 0.004). The short course duration of treatment may explain this, and the repeated exposure to metronidazole in non complained patients.
This outcome contradicted Kamal et al. findings, which found that only six (17.1%) cases of treated one gave birth to a normal baby after being treated with metronidazole.
Also, in the present study, there were 3/13 (23.1%) cases in the complianed group of the patient who gave preterm birth so that the condition may be related to different factors, not only to treatment as the strain virulence may be a cause.
The effect of metronidazole treatment on pregnant women with trichomoniasis was conflicting; several studies were conducted to evaluate drug use. Most of these studies were analysed by Ajiji et al. (2021), who performed a metanalysis to test the effect of metronidazole.
Ajiji et al. (2021) stated no relationship between metronidazole treatment during pregnancy and preterm birth, stillbirth, low birth weight, and caesarian delivery. There are conflicting views on the use of metronidazole in averting or increasing the risk of preterm birth and associated outcomes (Morency and Bujold 2007; Leitich et al. 2003; Okun, Gronau, and Hannah 2005; Sheehy et al. 2015).
Sheehy et al. (2015) stated that, during pregnancy, treating bacterial vaginosis and trichomoniasis with metronidazole is effective and offers no teratogen risk. Benefit of metronidazole in the reduction of preterm birth was demonstrated for the combination of this medication with other antibiotics.
Also, some authors found that pregnant women who were administered metronidazole for less than three days may have an increased risk of preterm birth. The duration of treatment is related to two doses of 2 g administered 48 h apart (Klebanoff et al. 2001) and 400 mg for two days (Odendaal et al. 2002). This finding may support our result.
Klebanoff et al. (2001) hyposis that this regimen might have suppressed competing flora and allowed a particular pathogen to flourish. such a pathogen would have to be associated specifically with T. vaginalis.
So further studies are required to assess the hypothesis that a high dose for a short duration may increase the risk of preterm birth among women with a previous preterm birth compared to a lower dose for a longer duration (Ajiji et al. 2021).
It is essential to investigate and treat patients with trichomoniasis before pregnancy to prevent the bad sequel of trichomoniasis on the outcome of pregnancy and to reduce the probability of metronidazole treatment during pregnancy due to its duotfoul safety during pregnancy