TRICHOMONIASIS

WHO??

The World Health Organization found that out of 340 million new cases worldwide of sexual transmitted infections, 174 million cases of trichomoniasis were detected (WHO, 2005). T. vaginalis infection is strongly associated with the presence of other STIs, such as gonorrhea, chlamydia, and HIV. Past history of STI is an important indicator of trichomoniasis infection among adolescents (Richard et al, 2000)

EPIDEMIOLOGY IN MALAYSIA

Vol 41 No. 6 November 2010 observational study, 380 women attending a family planning (LPPKN) clinic and Sexually Transmitted Diseases (STD) clinic in Kuala Lumpur between January 2008 and November 2008
The number of subjects enrolled in this study was 380. None (0.0%) of the cases at the STD clinic were positive for trichomonas while 0.36% of the cases at the LPPKN clinic were positive.

 The low incidence rate of trichomonas infection in this study and the decrease of this

infection during the past two decades may be related to many factors. Most of the sex workers at the STD clinic were Chinese. Among the Chinese community, it is common to use herbal and traditional medications for prophylaxis and treatment of STI. The medications may be used for external washing or as internal vaginal suppositories, which could make it difficult to detect T. vaginalis. There was possible mishandling of the culture and the transport medium. It is unclear whether the instructions given to the team members were strictly followed or not. Medications taken for other STI may have had an affect on the identification of Trichomonas vaginalis or resulted in false negative results on culture.

PREVALENCE IN OTHER COUNTRY

The prevalence of Trichomonas vaginalis infection in the United States is estimated to be 2.3 million (3.1%) among women ages 14-49, based on a nationally representative sample of women who participated in NHANES 20012004.

Sutton M, Sternberg M, Koumans EH, McQuillan G, Berman S, Markowitz L. The prevalence of Trichomonas vaginalis infection among reproductive-age women in the United States, 2001-2004. Clin Infect Dis. 2007 Nov 15;45(10):1319-26

STD Surveillance 2010 National Center for HIV/AIDS, Viral Hepatitis, STD, and TB Prevention Division of STD Prevention

Community issues, Contact tracing and Counseling in STD

Principles of STD control

Early treatment Break transmission of STD quickly Prevent development of complications Treatment must be efficacious, safe, simple to

administer, easy to comply, cheap, preferably single dose therapy Contact tracing Counseling
information on STD importance of follow-up treatment safer sexual behaviour

Challenges in STD control

Behaviour change Condom promotion Partner management is not implemented fully

because of social stigma Screening asymptomatic individuals is limited by the unavailability of inexpensive, accurate and rapid diagnostic tests Core and marginalized group who are disproportionately infected with STDs Staff training

Community issues
Diagnosis of a STD signals sexual health risk. STDs facilitate the transmission and acquisition of

other STDs, including human immunodeficiency virus (HIV). Coexisting STDs increase susceptibility of acquiring and transmitting HIV by two- to fivefold. Studies show that aggressive STD prevention, testing, and treatment reduces transmission of HIV Most STDs are asymptomatic, contributing to widespread underdiagnosis estimated at 50% or higher.

Contact tracing
Usually done by public health personnel (contact

tracer) Early referral of asymptomatic or symptomatic partners for diagnosis and treatment
STDs are notifiable diseases

syphilis

gonorrhea

Chlamydia tracomitis

Role of contact tracer

Interview the patient to: Ensure patient has adequate knowledge of the condition to cooperate Establish the at-risk contact Motivate the patient to persuade contacts to attend for examination and if necessary, treatment Re-interview the patient when attending for follow-up to check on progress of contact action and see if he remembered more contacts Secure the attendance of defaulters from follow-up Occasionally go out into the community to find defaulters and contacts

Confidentiality
By law, any information relating to, or capable of,

identifying an individual who had attended the clinic, must not be disclosed to anyone except for the purpose of:
1) securing treatment of the individual 2) prevention of spread of an STD

 Sexual partners who attend as contacts must not: 1) be told who gave their name 2) be told their partners diagnosis if they are not already aware of it 3)see their partners case notes, or anything related to their partner recorded in their own notes

 Do not discuss patients within hearing of others in

the clinic, and not at all outside the clinic Do not give results over the telephone as there is no foolproof way of identifying the patient Case-notes must not be removed from clinic, or left anywhere in the clinic where patients might read them, and they must be locked at the end of the day

Counseling and health education

Prevention of disease transmission Educate on diagnosis, purpose & method of treatment, necessity to complete treatment regime & to report sideeffects if any Important to follow-up for test of cure Importance of sex avoidance until cured

Counseling and health education

Prevention of further infection Abstinence or avoidance of multiple sex partners, sexual contact with person with multiple sexual partners (CSW) or any anonymous person Encourage use (correct) of condoms or other prophylactic barrier Seek medical attention if any symptoms Should not self medicate or seek treatment from unqualified persons

STD counseling aims to empower patients to:

Comply with treatment Modify lifestyle

Detect and treat partners early

Minimize spread of infection Prevent HIV infection

Who needs counseling?

All sexually active adolescents are at increased risk for

STDs and should be offered counselling. Adults should be considered at increased risk and offered counselling if they have:

Current STDs or have had an STD within the past year. Multiple sexual partners.

In communities or populations with high rates of STDs,

all sexually active patients in non-monogamous relationships may be considered at increased risk.

Global Strategy for the Prevention and Control of STDs

Prevention by promoting safer sexual behaviours 2. General access to quality condoms at affordable prices 3. Promotion of early recourse to health services by people suffering from STDs and by their partners 4. Inclusion of STD treatment in basic health services
1.

5. Specific services for populations with frequent or

unplanned high-risk sexual behaviours - such as sex workers, adolescents, long-distance truckdrivers, military personnel, substance users and prisoner 6. Proper treatment of STDs, i.e. use of correct and effective medicines, treatment of sexual partners, education and advice 7. Screening of clinically asymptomatic patients, where feasible; (e.g. syphilis, chlamydia)

8. Provision for counselling and voluntary testing for

HIV infection 9. Prevention and care of congenital syphilis and neonatal conjunctivitis 10. Involvement of all relevant stakeholders, including the private sector and the community, in prevention and care of STDs

Thank you