Trichomoniasis and bacterial vaginosis in pregnancy: inadequately managed with the syndromic approach

Abstract

Objective To measure the prevalence of Trichomonas vaginalis (TV) infection and bacterial vaginosis (BV) among pregnant women in Botswana, and to evaluate the syndromic approach and alternative management strategies for these conditions in pregnancy. Methods In a cross-sectional study, 703 antenatal care attendees were interviewed and examined, and specimens were collected to identify TV, BV, Candida species, Chlamydia trachomatis and Neisseria gonorrhoeae. Information on reproductive tract infections earlier in pregnancy was obtained from a structured interview and the antenatal record. Findings TV was found in 19% and BV in 38% of the attendees. Three-fourths of women with TV or BV were asymptomatic. Syndromic management according to the vaginal discharge algorithm would lead to substantial under-diagnosis and over-treatment of TV and BV. Signs of vaginal discharge were more predictive of the presence of these conditions than were symptoms. Among the 546 attendees on a repeat antenatal visit, 142 (26%) had been diagnosed with vaginal discharge earlier in their pregnancy -14 of them twice. In 143 cases, an attendee was diagnosed with vaginal discharge in the second or third trimester; however, metronidazole had been prescribed only 17 times (12%). Conclusion Diagnosis and treatment of TV and BV among pregnant women in sub-Saharan Africa presents major challenges. Half the pregnant women in this study were diagnosed with TV or BV, but these conditions were not detected and treated during antenatal care with syndromic management. Also, health workers did not adhere to treatment guidelines. These results indicate that management guidelines for TV and BV in antenatal care should be revised.

Vaginal infections among pregnant women at Omdurman Maternity Hospital in Khartoum, Sudan

“…This result is higher than the 3.9% observed in Jordan [29] and the 8% reported in pregnant woman in Botswana [30].In developing countries, including Sudan, diagnosis of cervical infections namely due to C. trachomatisis limited to the syndromic approach of relying on the appearance of vaginal discharge [31]. Due to the high prevalence of C. trachomatis infections in this study, routine diagnostic techniques such as the direct fluorescence test or polymerase chain reaction are needed in our hospitals.…”

Prevalence of Bacterial Vaginosis in Pregnancy After 20 Weeks of Gestation

“…15,16,17 The prevalence rates of BV among pregnant women vary from 6.4% to 38%. 18,19 The overall prevalence of BV by Gram stains Nugent scoring criteria in a study by Mengistie et al was 19.4%. 20 The studies done in India and Denmark showed the prevalence as 20.5% and 17%.…”

Comparative aspects of immunity and vaccination in human and bovine trichomoniasis: a review

“…Nearly 50 % of women with Trichomonas vaginalis are asymptomatic (Swygard et al 2004, Romoren et al 2007, and the extent of the inflammatory responses to the parasite determines severity of the symptoms. There are reports of dysuria, lower abdominal discomfort, itchiness of the vagina, leucorrhea, and vaginal odor in some women (Schwebke and Burgess 2004).…”