Frequency of Trichomoniasis and Related Risk Factors in the Women Referred to Bandar Abbas Health Centers, Iran, 2017-2018

AUTHORS

Maryam Ghobahi 1 , Yaghoob Hamedi 2 , Jebreil Shamseddin ORCID 2 , Mehrgan Heydari-Hengami 2 , Khojasteh Sharifi-Sarasiabi ORCID 2 , 3 , *

1 Student Research Committee, Faculty of Medicine, Hormozgan University of Medical Sciences, Bandar Abbass, Iran

2 Infectious and Tropical Diseases Research Center, Hormozgan Health Institute, Hormozgan University of Medical Sciences, Bandar Abbas, Iran

3 Fertility and Infertility Research Center, Hormozgan University of Medical Sciences, Bandar Abbas, Iran

How to Cite: Ghobahi M , Hamedi Y , Shamseddin J, Heydari-Hengami M, Sharifi-Sarasiabi K. Frequency of Trichomoniasis and Related Risk Factors in the Women Referred to Bandar Abbas Health Centers, Iran, 2017-2018, Hormozgan Med J. 2019 ; 23(1):e88906. doi: 10.5812/hmj.88906.

ARTICLE INFORMATION

Hormozgan Medical Journal: 23 (1); e88906
Published Online: March 18, 2019
Article Type: Research Article
Received: January 8, 2019
Revised: February 27, 2019
Accepted: March 5, 2019
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Abstract

Background: Trichomonas vaginalis is one of the most important parasites transmitted through sexual contact. Therefore, it is considered a major public health problem. Best to our knowledge, there are no new reports about the prevalence of T. vaginalis in Bandar Abbas.

Objectives: The present study aimed to determine the frequency of T. vaginalis in women referred to the urban and rural health centers of Bandar Abbas, Iran. In addition, other risk factors associated with this parasite were investigated.

Methods: This descriptive cross-sectional study was conducted between October 2017 and June 2018. Five hundred samples obtained from vaginal discharges or fluid were examined using wet mount and culture in Diamond medium. Moreover, the demographic data and related risk factors were gathered as a questionnaire. To analyze the data, SPSS ver. 20 was used and the statistical tests of chi-square and Fisher’s exact were applied.

Results: In this study, T. vaginalis was detected in 13 (2.6%) out of 500 samples of the vaginal discharges or fluids in which 12 (2.4%) were detected by wet mount and 13 (2.6%) by culture method, respectively. A significant difference was observed between the incidence of the parasite and place of residence, the level of education, and abortion.

Conclusions: The relatively low parasite outbreak in the studied samples is likely as a result of continuous monitoring and appropriate treatment.

Keywords

Trichomonas vaginalis Frequency Bandar Abbas Iran

Copyright © 2019, Hormozgan Medical Journal. This is an open-access article distributed under the terms of the Creative Commons Attribution-NonCommercial 4.0 International License (http://creativecommons.org/licenses/by-nc/4.0/) which permits copy and redistribute the material just in noncommercial usages, provided the original work is properly cited.

1. Background

Trichomonas vaginalis is one of the most important parasites transmitted through sexual contact (1, 2). It also increases the risk of human immunodeficiency virus (HIV) transmission possibly as a result of the local inflammation often caused by the parasite (3, 4). Consistent with the numerous studies in the world, the prevalence of T. vaginalis differs among different geographical regions, communities, cultures, and religions. The multiple sexual partnerships and individual health of the people’s genital organs are related to the parasite transmission (5). The prevalence of T. vaginalis in women differs in different populations, where it is ten times higher than men. The infection comprises the risks of premature delivery birth, low birth weight, infertility, and cervical cancer (6, 7). Clinical manifestations of the parasite are different in men and women. Women sometimes have no clinical symptoms; however, they occasionally present severe clinical manifestations such as burning, pruritus, and leukorrheal secretions. Men are most often without clinical symptoms, but they have the role of parasite carriers for women (8). Trichomoniasis seems to be a common sexually transmitted disease in Iran. The prevalence of the parasite in Iran varied from 0.4% to 42% from 1992 to 2017 (9). In a systematic review in Iran, the average infection rate of trichomoniasis was 8%. While the highest rate was in the central provinces of Iran (15.3%), especially in Tehran, and the least in the eastern provinces (10). According to our information, there are no new reports about the prevalence of T. vaginalis in Bandar Abbas.

2. Objectives

The present study aimed to determine the frequency of T. vaginalis in women referred to 16 urban and rural health centers. In addition, other risk factors associated with this parasite were also investigated.

3. Methods

3.1. Study Site and Study Population

This descriptive cross-sectional study was conducted between October 2017 and June 2018. The estimated sample size was calculated based on the sample size formula for a restricted population; the population of women (N = 240,000), the expected prevalence of 2.8% (11), α= 0.05, β = 0.2, and d = 0.007. The minimum necessary sample was estimated as 500 women. All of the women who referred to the health care centers for periodic monitoring and treatment were included, and the women who had taken antibiotics in the last two weeks were excluded. Five hundred samples of the vaginal discharges or fluid were obtained from women in health centers of Bandar Abbas and the suburbs, Iran. Bandar Abbas city with a population of more than 500,000 people is located in the south of Iran; a tropical region, attached to the Persian Gulf with high humidity (20% - 100%), and warm climate (12).

3.2. Data Collection and Questionnaire

Two swabs of women's vaginal discharge or vaginal fluid were obtained with the assistance of an experienced midwife. The first swab was placed in a test tube containing sterile normal saline and the second in a Diamond culture medium (QUELAB, Canada) (13). In addition, vaginal pH was measured by moistening a pH paper with vaginal fluid obtained from the lateral vaginal wall. We immediately evaluated the wet mount prepared specimens and the tubes containing culture media were subsequently transferred to the parasitology laboratory of the faculty of medicine, Hormozgan University of Medical Sciences, Bandar Abbas and placed in an incubator with 37°C where it was examined after 24 hours and followed up daily for a week. Following the examination of the culture medium using a light microscope, one drop placed on glass slides, fixed by methanol, then stained by Giemsa, and examined using a light microscope at 100X magnification (14).

A questionnaire was prepared regarding demographic characteristics of the participants and risk factors, including age, level of education, occupation, residency (urban or rural), marriage counts, number of partners, abortion, pH of the vagina, and contraceptive method.

3.3. Statistical Analysis

To analyze the results of the tests and the data obtained from the questionnaire, SPSS V. 20 (Chicago, IL, USA) was used and the statistical tests of chi-square and Fisher’s exact were applied. A p-value of less than 0.05 was considered statistically significant.

3.4. Ethical Approval

The study was approved by the Infectious and Tropical Diseases Research Center, Hormozgan Health Institute, Hormozgan University of Medical Sciences, Bandar Abbas, Iran, with the Code of Ethics, HUMS.REC.1396.66. The objectives of the study and the procedures were explained to all of the participants and then written informed consents were obtained.

4. Results

T. vaginalis was detected in 13 (2.6%) out of 500 samples of the vaginal discharge or fluids in which 12 (2.4%) by wet mount and 13 (2.6%) by culture method, respectively. A significant difference was seen between the incidence of the parasite and the place of the residence, the level of education, and abortion. The demographic characteristics and the risk factors of the participants are shown in Tables 1 and 2, respectively.

Table 1. Frequency of Trichomonas vaginalis Based on Demographic Characteristics in 500 Womena
VariablesFrequencyTrichomoniasis PositiveK2P Value
Age group10.61
< 35 year193 (38.6)5 (2.6)
> 35 year307 (61.4)8 (2.6)
Educational level10.017
< Diploma 263 (52.6)11 (4.2)
Diploma or > Diploma237 (47.4)2 (0.8)
Occupation10.523
Housewife476 (95.2)13 (2.7)
Employee24 (4.8)0 (0)
Residency10.008
Urban347 (69.4)13 (3.7)
Rural 153 (30.6)0 (0)

aValues are expressed as No. (%).

Table 2. Frequency of Trichomonas vaginalis Based on Risk Factors in 500 Womena
VariablesFrequencyTrichomoniasis PositiveK2P Value
Marriage counts10.068
One437 (87.4)9 (2.1)
> One63 (12.6)4 (6.3)
Abortion30.023
None374 (74.8)7 (1.9)
One85 (17)2 (2.4)
Two24 (4.8)(8.3)
3 and > 317 (3.4)2 (11.8)
Number of partners10.726
> One12 (23.4)0 (0)
One488 (97.6)13 (2.7)
Contraceptive method40.878
None273 (54.6)6 (2.2)
Condom77 (15.4)3 (3.9)
Tab or Injection109 (21.8)3 (2.8)
Tubectomy or vasectomy27 (5.4)1 (3.7)
IUD14 (2.8)0 (0)
Vaginal pH10.072
4126 (25.2)1 (0.8)
5185 (37)4 (2.2)
6152 (30.4)8 (5.3)
737 (7.4)0 (0)
Symptoms of trichomoniasis
Yes368 (73.6)10 (2.7)10.537
No132 (26.4)3 (2.3)

aValues are expressed as No. (%).

5. Discussion

The frequency of T. vaginalis in this population was 2.6%. This frequency is lower than the anticipated outbreak of the parasite in the world (5%) (15); however, this parasite is less than our finding in the south of Tehran (0.41%), the capital of Iran (7), which is probably associated with the economic, personal hygienic education, and social factors. It is consistent with the prevalence of this parasite in Kashan (2%) (8). The prevalence of this parasite in women referred to the public and private Clinics of Hamedan’s Obstetrics and Gynecology was (2.1%) (16), which is consistent with the findings of our study, but not consistent with the study of Bahram et al. (17) in Zanjan was 6.6%. Many factors affect the frequency of trichomoniasis, including older age, sexual activity, number of sexual partners, co-infection with other sexually transmitted diseases (STDs), phase of the menstrual cycle, methods of diagnosis, and socioeconomic status (2), and also culture, religious beliefs, people's literacy rate, economic welfare, and health (10). The frequency of this parasite in the study of Nourian et al. in Zanjan in pregnant women was 3.3% (18). Other studies are comprised of the results related to the women attending STD clinics in Tehran (4) 3.2%, woman of Ardabil (19), northwest of Iran (4.48%) and women referred to Gynecology Clinic in south-east of Iran (Chabahar) 9.75% (20). They were all higher than the frequency of this parasite in Bandar Abbas. However, in some parts of the world, the prevalence of this parasite is considerably different e.g. Iceland (21) and Poland (22), where no positive samples were found among the participants. In those women attending nine STD clinics in the USA (23), the prevalence rate was 14.6%, in the women of reproductive age in Brazil 16% (14), in women who suffered from problems in the genitourinary system in the south of Iraq was more than 50% (24). Trichomoniasis among pregnant women referring to two hospitals in Ghana was 20.2% (5) and among women treated at a university hospital in southern Brazil was 4.1% (2).

In the present study, there was a significant difference between the incidence of the parasite and the place of residence, the level of education, and abortion.

Trichomoniasis in rural areas was significantly different from that of urban areas because all of our positive samples were from the urban area. Of course, the interpretation of this result is difficult, but it can be as a result of ethical issues in rural areas, as well as the small countryside, and the familiarity of the whole villagers. This study, contrary to the information obtained in the villages of Iraq, shows that the frequency of the parasite in the villages is very high (24), but is similar to study of Nourian et al. in Zanjan (18).

In the present study, there was a significant relationship between abortion and trichomoniasis, which is similar to that of Habibi et al. in Qom (25), but on the contrary to the study of Azambakhtiar et al. (7) in Tehran. Spontaneous abortion could be one of the complications of trichomoniasis (26). The change in the microbial flora of the vagina and probably accompanied by other STDs can increase the risk of abortion (27) that were not studied in this paper. Confirmation of trichomoniasis and the risk of abortion should be investigated with a more appropriate design.

The level of the participants’ literacy had a positive effect on trichomoniasis infection. Most of the positive parasitic cases were in uneducated and under-diploma attendants, which is in agreement with the study of Matini et al. in Hamadan (16) or Jarallah in south Iraq (24). Indeed, literacy has a significant impact on their awareness of health issues.

Although the comparison of diagnostic methods were not the objectives of the study, due to the importance of the subject, we evaluated this issue as well. Several diagnostic methods have been developed to detect T. vaginalis (13, 28). The most cost-effective method for detecting this parasite is the direct method and observing the discharge in the wet samples (29). The direct method does not have enough sensitivity to detect a parasite, it requires several prerequisites such as the skill of the person and the amount of time spent for observation, as well as the interval of the sampling and observation of the slides (18). In this study, we used two methods of diagnosis, including wet mount and culture. Using the wet mount, the frequency of parasites was 2.4% and by culture in Diamond medium, 2.6%. No significant difference was found between the direct and culture methods in the studied samples, which is inconsistent with the study of Manshoori et al. in Rafsanjan (30). It seems the culture method is more susceptible than the wet mount (8, 16, 19). The benefits of applying these two methods at the same time were a quick response to the test allowing the patient to start the treatment easily. The culture method was known as the standard method for the diagnosis of T. vaginalis prior to the molecular methods (28). The culture method is not commonly used in laboratories because it is both time-consuming and suitable condition-dependent such as the culture medium sensitivity, the storage time and fast transmission of the parasite to the appropriate medium after sampling are needed.

We expected to observe more trichomoniasis in the women of under 35 who are more sexually active. In contrast, women over the age of 35 had more sexual intercourses, which increases the chance of having a parasite. In the present study, there was no significant difference in the age of the participants and trichomoniasis, which contradicts the study of Nourian et al. in Zanjan (18).

There was no significant difference in the clinical symptoms of trichomoniasis in detecting the parasite such as the study of Habibi et al. in Qom and it is inconsistent with the study of Manshoori et al. in Rafsanjan (30). Three of the participants who were positive for trichomoniasis did not have any trichomoniasis clinical symptoms. Therefore, in the treatment of patients, it should not emphasize clinical symptoms solely. Obviously, asymptomatic people as carriers have a significant role in the transmission of the parasite. Hence, to accelerate the treatment and reduce the spread of disease, it is necessary to identify them, which can be done through specific tests.

Another factor that contributes to trichomoniasis is the increase in the vaginal pH. In this study, the highest frequency of trichomoniasis was seen in pH = 6. This increase of pH can facilitate the growth and colonization of the protozoan (2). However, no significant difference was found between pH and trichomoniasis.

The frequency of marriage, as well as the number of sexual partners in trichomoniasis, did not show any significant difference in contrast to the study of Oyeyemi et al. in Nigeria (31). Of course, the number of those with such characteristics was low compared to the rest of the participants. As a result, an accurate interpretation of the results is not possible.

Although all positive cases were seen in housewives, there was no significant relationship between trichomoniasis and women's occupation, which may be as a consequence of the low number (4.8%) of employed women. This study is similar to the study of Nourian et al. in Zanjan (18) and Oyeyemi et al. in Nigeria (31).

One of the limitations of the study was the lack of cooperation and the satisfaction of some patients with sampling, which resulted in the sample collection with a prolonged time. In addition, the social panic, stigma, and religious taboos prevented referring of the infected individuals to the health care centers. Therefore, the frequency of the parasite may not be real. The other limitation of the study was the shortage of funding because the sampling should be carried out by an expert, which was affected by the budget of the research. The advantage of the project was the use of both direct and culture methods that have not been carried out so far in this area.

5.1. Conclusions

The relatively low parasite outbreak in the studied samples is likely as a result of continuous monitoring and appropriate treatment.

Acknowledgements

Footnotes

References

  • 1.

    Ambrozio CL, Nagel AS, Jeske S, Braganca GC, Borsuk S, Villela MM. Trichomonas vaginalis prevalence and risk factors for women in Southern Brazil. Rev Inst Med Trop Sao Paulo. 2016;58:61. doi: 10.1590/S1678-9946201658061. [PubMed: 27680166]. [PubMed Central: PMC5048632].

  • 2.

    Gatti FA, Ceolan E, Greco FS, Santos PC, Klafke GB, de Oliveira GR, et al. The prevalence of trichomoniasis and associated factors among women treated at a university hospital in southern Brazil. PLoS One. 2017;12(3). e0173604. doi: 10.1371/journal.pone.0173604. [PubMed: 28346531]. [PubMed Central: PMC5367685].

  • 3.

    Schwebke JR, Burgess D. Trichomoniasis. Clin Microbiol Rev. 2004;17(4):794-803. table of contents. doi: 10.1128/CMR.17.4.794-803.2004. [PubMed: 15489349]. [PubMed Central: PMC523559].

  • 4.

    Rezaeian M, Vatanshenassan M, Rezaie S, Mohebali M, Niromand N, Niyyati M. Prevalence of Trichomonas vaginalis using parasitological methods in Tehran. Iran J Parasitol. 2009;4(4):43-7.

  • 5.

    Asmah RH, Blankson HNA, Seanefu KA, Obeng-Nkrumah N, Awuah-Mensah G, Cham M, et al. Trichomoniasis and associated co-infections of the genital tract among pregnant women presenting at two hospitals in Ghana. BMC Womens Health. 2017;17(1):130. doi: 10.1186/s12905-017-0489-5. [PubMed: 29237446]. [PubMed Central: PMC5729291].

  • 6.

    Nabweyambo S, Kakaire O, Sowinski S, Okeng A, Ojiambo H, Kimeze J, et al. Very low sensitivity of wet mount microscopy compared to PCR against culture in the diagnosis of vaginal trichomoniasis in Uganda: A cross sectional study. BMC Res Notes. 2017;10(1):259. doi: 10.1186/s13104-017-2581-1. [PubMed: 28683790]. [PubMed Central: PMC5501264].

  • 7.

    Azambakhtiar A, Nikmanesh B, Rezaeian M, Dashti N, Safari F, Zarebavani M. The prevalence of Trichomoniasis in Women referred to clinical centers in South of Tehran, Iran during 2015-2016. Iran J Parasitol. 2018;13(1):108-13. [PubMed: 29963092]. [PubMed Central: PMC6019587].

  • 8.

    Arbabi M, Fakhrieh Z, Delavari M, Abdoli A. Prevalence of Trichomonas vaginalis infection in Kashan city, Iran (2012-2013). Iran J Reprod Med. 2014;12(7):507-12. [PubMed: 25114674]. [PubMed Central: PMC4126256].

  • 9.

    Arbabi M, Delavari M, Fakhrieh-Kashan Z, Hooshyar H. Review of Trichomonas vaginalis in Iran, based on epidemiological situation. J Reprod Infertil. 2018;19(2):82-8. [PubMed: 30009141]. [PubMed Central: PMC6010820].

  • 10.

    Hezarjaribi HZ, Fakhar M, Shokri A, Teshnizi SH, Sadough A, Taghavi M. Trichomonas vaginalis infection among Iranian general population of women: A systematic review and meta-analysis. Parasitol Res. 2015;114(4):1291-300. doi: 10.1007/s00436-015-4393-3. [PubMed: 25732256].

  • 11.

    Sharifi I, Khatami M, Tahmors-Kermani E. [Prevalence of Trichomonas vaginalis in women referred to Vali-Asr polyclinic and the health center number 3 in Sirjan city]. J Kerman Univ Med Sci. 1994;1(3):125-32. Persian.

  • 12.

    Heydari-Hengami M, Hamedi Y, Najafi-Asl M, Sharifi-Sarasiabi K. Prevalence of intestinal parasites in food handlers of Bandar Abbas, Southern Iran. Iran J Public Health. 2018;47(1):111-8. [PubMed: 29318125]. [PubMed Central: PMC5756585].

  • 13.

    Radonjic IV, Dzamic AM, Mitrovic SM, Arsic Arsenijevic VS, Popadic DM, Kranjcic Zec IF. Diagnosis of Trichomonas vaginalis infection: The sensitivities and specificities of microscopy, culture and PCR assay. Eur J Obstet Gynecol Reprod Biol. 2006;126(1):116-20. doi: 10.1016/j.ejogrb.2005.07.033. [PubMed: 16249051].

  • 14.

    Glehn MP, Ferreira LC, Da Silva HD, Machado ER. Prevalence of Trichomonas vaginalis and Candida albicans among Brazilian Women of reproductive age. J Clin Diagn Res. 2016;10(11):LC24-7. doi: 10.7860/JCDR/2016/21325.8939. [PubMed: 28050410]. [PubMed Central: PMC5198363].

  • 15.

    Newman L, Rowley J, Vander Hoorn S, Wijesooriya NS, Unemo M, Low N, et al. Global estimates of the prevalence and incidence of four curable sexually transmitted infections in 2012 based on systematic review and global reporting. PLoS One. 2015;10(12). e0143304. doi: 10.1371/journal.pone.0143304. [PubMed: 26646541]. [PubMed Central: PMC4672879].

  • 16.

    Matini M, Rezaie S, Mohebali M, Maghsood A, Rabiee S, Fallah M, et al. Prevalence of Trichomonas vaginalis infection in Hamadan City, Western Iran. Iran J Parasitol. 2012;7(2):67-72. [PubMed: 23109948]. [PubMed Central: PMC3469190].

  • 17.

    Bahram A, Hamid B, Zohre T. Prevalence of bacterial vaginosis and impact of genital hygiene practices in non-pregnant women in zanjan, iran. Oman Med J. 2009;24(4):288-93. doi: 10.5001/omj.2009.58. [PubMed: 22216382]. [PubMed Central: PMC3243866].

  • 18.

    Nourian A, Shabani N, Fazaeli A, Mousavinasab SN. Prevalence of Trichomonas vaginalis in pregnant Women in Zanjan, Northwest of Iran. Jundishapur J Microbiol. 2013;6(8). doi: 10.5812/jjm.7258.

  • 19.

    Ahady MT, Safavi N, Jafari A, Mohammadi Z, Abed S, Pourasgar S. Prevalence of Trichomoniasis among 18-48 Year-old Women in Northwest of Iran. Iran J Parasitol. 2016;11(4):580-4. [PubMed: 28127371]. [PubMed Central: PMC5251188].

  • 20.

    Gharaei AB, Ebrahimzadeh AD, Shah Bakhsh A. Survey of frequency, clinical findings and diagnosis methods for detection of trichomoniasis in women referred to Gynecology Clinic in South-East of Iran. J North Khorasan Univ Med Sci. 2013;5(4):(803-11).

  • 21.

    Hilmarsdottir I, Sigmundsdottir E, Eiriksdottir A, Golparian D, Unemo M. Trichomonas vaginalis is rare among women in Iceland. Acta Derm Venereol. 2017;97(10):1258-60. doi: 10.2340/00015555-2747. [PubMed: 28681060].

  • 22.

    Serwin AB, Bulhak-Koziol V, Sokolowska M, Golparian D, Unemo M. Trichomonas vaginalis is very rare among women with vaginal discharge in Podlaskie province, Poland. APMIS. 2017;125(9):840-3. doi: 10.1111/apm.12713. [PubMed: 28612378].

  • 23.

    Alcaide ML, Feaster DJ, Duan R, Cohen S, Diaz C, Castro JG, et al. The incidence of Trichomonas vaginalis infection in women attending nine sexually transmitted diseases clinics in the USA. Sex Transm Infect. 2016;92(1):58-62. doi: 10.1136/sextrans-2015-052010. [PubMed: 26071390]. [PubMed Central: PMC4874593].

  • 24.

    Jarallah HM. Trichomonas vaginalis infection among women in Basrah marshes villages south Iraq. Egypt J Exp Biol. 2013;9(1):71-4.

  • 25.

    Habibi A, Nateghi Rostami M, Douraghi M, Dolati M, Rashidi BH, Ahangari R. [Frequency of genital infection with Trichomonas vaginalis in women referred to gynecology hospital of the city of Qom]. J Dermatol Cosmetic. 2016;6(4):190-9. Persian.

  • 26.

    Ghaffari S, Esmaeilzadeh S, Kalantari N. The frequency study of trichomoniasis in women referred to gynecology clinic of Ayatollah Rohani Hospital, Babol, Iran, in 2010. AnnTropic Med Public Health. 2012;5(5):498. doi: 10.4103/1755-6783.105143.

  • 27.

    Romero R, Espinoza J, Mazor M. Can endometrial infection/inflammation explain implantation failure, spontaneous abortion, and preterm birth after in vitro fertilization? Fertil Steril. 2004;82(4):799-804. doi: 10.1016/j.fertnstert.2004.05.076. [PubMed: 15482749].

  • 28.

    Nye MB, Schwebke JR, Body BA. Comparison of APTIMA Trichomonas vaginalis transcription-mediated amplification to wet mount microscopy, culture, and polymerase chain reaction for diagnosis of trichomoniasis in men and women. Am J Obstet Gynecol. 2009;200(2):188 e1-7. doi: 10.1016/j.ajog.2008.10.005. [PubMed: 19185101].

  • 29.

    Garber GE. The laboratory diagnosis of Trichomonas vaginalis. Can J Infect Dis Med Microbiol. 2005;16(1):35-8. doi: 10.1155/2005/373920. [PubMed: 18159526]. [PubMed Central: PMC2095007].

  • 30.

    Manshoori A, Mirzaei S, Valadkhani Z, Kazemi Arababadi M, Rezaeian M, Zainodini N, et al. A diagnostic and symptomatological study on Trichomoniasis in symptomatic pregnant women in Rafsanjan, South Central Iran in 2012-13. Iran J Parasitol. 2015;10(3):490-7. [PubMed: 26622305]. [PubMed Central: PMC4662750].

  • 31.

    Oyeyemi OT, Fadipe O, Oyeyemi IT. Trichomonas vaginalis infection in Nigerian pregnant women and risk factors associated with sexually transmitted infections. Int J STD AIDS. 2016;27(13):1187-93. doi: 10.1177/0956462415611292. [PubMed: 26438604].

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