الفهرس 
TRICHOMONAS VAGINALISOnly 14 pages are availabe for public view
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Abstract
Trichomoniasis is one of the most prevalent sexually transmitted diseases with 180 million people infected annually worldwide. The prevalence varied among different populations which reached up to 50% in females and 10% in males as sexually transmitted disease. In females, trichomoniasis has been associated with vaginitis, cervicitis, urethritis, pelvic inflammatory disease, infertility, in addition to adverse birth outcomes. In males, trichomoniasis is now recognized as an important cause of non gonococcal urethritis. The importance of infection with Trichomonas vaginalis is its association with the dreadful complications of development of cancer cervix and human immunodeffiency virus (HIV) transmission and acquisition in infected patients. Therefore, there is an urge need for a practical easy to perform diagnostic test not requiring instruments, trained personnel or sophisticated techniques.
Diagnosis of trichomoniasis can be achieved using a variety of techniques including culture, wet mount microscopic examination and examination of fixed stained smear.
Culture is the most dependable method for diagnosis of T. vaginalis infection and is considered the ”gold standard” for diagnosis. yet it is not the most widely used method for diagnosis as it is costly and not available in routine laboratories, in addition, it takes longer time till appearance of the organism in culture medium through which the infected person continues to spread the infection before receiving therapy.
The most common and widely used method for diagnosis of trichomoniasis is the microscopic examination of the wet mount smear as it is simple and rapid, but it needs an access to a microscope and a well trained microscopist to identify the parasite.
The Co-agglutination test is a slide agglutination test in which Staphylococcus aureus protein A (SAPA) cell suspension is used to attach to the Fc fragment of specific Immunoglobulins G (IgG) leaving the Fab fragments capable to attach to antigen. When this occurs, a visible agglutination reaction indicates the presence of antigen in the specimen.
The aim of the present study is to use the Co-Agglutination test as a new tool for the detection of trichomonad antigen in vaginal discharge and urine of infected female patients to diagnose Trichomonas vaginalis vaginitis and compare it with other commonly used techniques: wet mount examination, stained smear examination and culture inoculation.
In the present study, vaginal washout and urine samples were collected from females attending the Early Cancer Detection Unit and Gynecology and Obstetric Hospitals, Faculty of Medicine, Ain Shams University.
They were examined for the presence of Trichomonas vaginalis trophozoites by culture, wet mount microscopic examination and fixed stained smear, in addition to cytological examination of Pap smears by a pathologist. Finally Co-agglutination test was performed on both materials using insoluble SAPA cell suspension sensitized by anti-T. vaginalis hyperimmune serum prepared in New Zealand white rabbit.
Culture of the vaginal washout was considered to be the ”gold standard” and the reference test to which results of other tests performed in the present study were compared.
Twenty T. vaginalis positive cases (Group I) were selected according to the presence of T. vaginalis trophozoite in vaginal washout culture either with asymptomatic or symptomatic infection. Group II and Group III included T. vaginalis non-infected individuals as proven by negative vaginal washout culture, Group II included females with vaginal discharge and Group III, females with no vaginal discharge.
Wet mount microscopic examination was performed on vaginal washout samples with 100% sensitivity and specificity. Fixed stained smears examination of vaginal washout samples was performed with 70% sensitivity and 100% specificity. Pap smear was performed by a pathologist on cytologic smears with 30% sensitivity and 95% specificity.
When urine specimens were inoculated on Diamond’s TYM medium, positive culture results were obtained with 90% sensitivity and 100% specificity. Examination of urine samples by wet mount microscopy was performed with 90% sensitivity and 100% specificity. Examination of fixed stained smears of urine samples was done with 50% sensitivity and 100% specificity.
In the present work, Co – agglutination (Co-A) test could diagnose 80% of T. vaginalis infected patients when performed on their vaginal washout samples and 70% when performed on their urine samples. The Co-A test was 100% specific with both vaginal washout and urine samples.
The Co-A test could diagnose 100% of the symptomatic patients when using either the vaginal washout or urine samples, while it could diagnose only 42.9% and 14.3% of asymptomatic patients when performed on vaginal washout and urine samples, respectively.
Thus, Co – agglutination test can be used to diagnose trichomoniasis when there is difficult access to a microscope and when culture media are not available. The Co – agglutination test is not the most sensitive test to diagnose T. vaginalis infection, so when the Co – agglutination test give negative result, it does not exclude trichomoniasis and other more sensitive tests shall be considered to confirm diagnosis.