Comparison of Ackers culture to Inpouch culture for the diagnosis of Trichomonas vaginalis among Symptomatic Females at Mulago Hospital

Abstract

Background: Trichomoniasis is the most curable sexually transmitted Infection (STI) in the world, caused by the genital Trichomonas vaginalis infection. The Trichomona vaginalis is a single celled flagellated eukaryote that infects the human urogenital tract of both sexes causing vaginitis in women and non-gonococcal urethritis and prostatitis in men. Symptomatic women present with variable symptoms such as abnormal vaginal discharge, malodor, lower abdominal pain and a strawberry cervix. It is also associated with complications like pelvic inflammatory disease, preterm delivery with low birth weight baby, cervical cancer and HIV transmission. Timely diagnosis and treatment is essential for prevention. The common diagnostic method wet mount microscopy has low sensitivity and the gold standard, culture is not readily available in low socio-economic settings due to the relatively high cost. This study aimed at determining the technical performance of Ackers culture for the diagnosis of T.vaginalis among symptomatic women at Mulago hospital.

Method: The Ackers culture medium was compared against the gold standard Inpouch culture and followed up to seven days. The results were analyzed using SPSS version 20 and Meta disc version 1.4. The sensitivity and specificity were used to determine the technical performance against the Inpouch.

Results: The mean age of the 82 participants was 27years (SD6.9), 44(54%) were single, 37(45.1%) reported secondary level education and 60(73.2%) experienced itching and abnormal vaginal discharge at enrolment. Wet mount detected 2/82(2.4%), Ackers medium (culture) 2/82 (2.4%) and Inpouch culture 6/82(7.3%).The sensitivity and specificity of the wet mount and Ackers medium was at 33.3 % and 100% respectively. The costs of consumables of Ackers are slightly lower than that of Inpouch (no statistics). Conclusion: This study has demonstrated that sheep serum can support the growth of Trichomonas vaginalis in culture medium. However the sensitivity of the Ackers culture medium with this formula was very low. The cost of consumables of Ackers medium is slightly lower than that of the Inpouch T.vaginalis.