ISSN 1011 5528 | www.smltsa.org.za 27 Volume 27 No. 1 | June 2013 Medical Technology SA IntroductIon Before the turn of the century, the World Health Organisation (WHO) reported that amongst the set of curable sexually trans- mitted infections (STI’s), there was an estimated 340 million new cases annually amongst which, Trichomonas vaginalis was recognised as the most common, with an overwhelming inci- dence of approximately 174 million reported cases [1] . In 2010, it was estimated that 32 million individuals suffering from tri- chomoniasis were localised to Sub-Saharan Africa [2] . Developing countries face the challenge of increasing rates in the transmission of microorganisms causing asymptomatic STI’s. Inluential factors that have led to an increase in STI’s amongst populations of developing countries have been identi- ied as a combination of behavioural, socio-demographic and economic. Inadequate health facilities [3] , a lack of education [4] , alcohol and drug abuse, as well as multiple sexual partners [5] have been recognised as signiicant contributing factors to the increasing rate of trichomoniasis [6] . An additional cause behind the increased rate of STI’s, speciically within South Africa, is the common phenomenon of migration by men from rural to urban areas for employment [7] . Male migrant workers have been shown to have high levels of contact with sex workers, as well as a greater number of casual sexual partners [8] . Over a three year period, 50% of the male subjects attending the Steve Biko Academic Hospital, Johannesburg, for an Assisted Reproduc- tive Technology programme had semen samples which showed signiicant levels of positive bacterial cultures [9] . In a study which observed the occurrence of sexually transmitted bacteria amongst 367 black South African men, it was shown that al- most half of the subjects presented urine samples that displayed infectious microorganisms [10] . Amongst African populations, T. vaginalis is one of the top four most common bacteria identi- ied in both male and female subjects which include; Candida albicans, Neisseria gonorrhoea and Chlamydia trachomatis [11] . trIchomonIasIs T. vaginalis is an extracellular lagellated protozoan that can be found in both the male and female urogenital tracts, whereby it primarily infects the squamous epithelium. Trichomonal cytopathogenicity has been recognised as a causative factor behind nongonococcal urethritis and prostatitis in male sub- jects [12] . The organism is localised to the genitourinary system and the pathogen has been found in practically all sites of the genitourinary systems in both sexes infected with T. vaginalis [13] . Despite the fact that the clinical implications of trichomoniasis in sexually active women are well known, the signiicance of the pathogen T. vaginalis for the male partner is still relatively uncertain [14] . Infection in the female is a causative factor behind a number of conditions which include: pelvic inlammatory dis- ease, cervicitis, urethritis, vaginitis as well as adverse pregnancy outcomes and preterm delivery [15, 16, 17] . Bacterial colonisation of the male genital tract (MGT) can result in a variety of clinical manifestations such as; painful ejaculation, testicular sensitivity and urethral discharge [18] . It is furthermore regarded as a con- tributor of male factor infertility [19] . However, infection with T. vaginalis complicates the diagnostic and treatment approach as it presents asymptomatically in male subjects. A study which isolated females with trichomoniasis and examined the sexual partner’s urine and semen samples, showed that an overwhelm- ing 72% of the men also tested positive for T. vaginalis despite the fact that the majority showed no symptoms of the urethral pathogens [20] . hIV and trIchomonIasIs A link between trichomoniasis and the subsequent increased risk for human immunodeiciency virus (HIV) infection has sparked an increased focus on T. vaginalis [21] . With focus on the infection and HIV amongst high risk population groups in Sub- Peer reviewed rEVIEW artIcLE TRICHOMONAS VAGINALIS in Sub-Saharan africa: occurrence and diagnoStic approacheS for the male partner margot Flint (BSc, HSc, MSc) | stefan s du Plessis (BSc, HSc, MSc, MBA, PhD) Division of Medical Physiology, Faculty of Health Sciences, Stellenbosch University, Tygerberg, South Africa Corresponding author: Margot Flint | email: mf@sun.ac.za | +(27) 72 122 2111 abstract The article aims to focus on trichomoniasis as to highlight the prevalence of this sexually transmitted infection (STI) within Sub- Saharan Africa, and to introduce an alternative means of diagnosing the infection. Globally, trichomoniasis is the STI with the highest burden in resource limited countries such as those in Sub-Saharan Africa; however, it is also the most common curable condition. With challenges faced particularly in the context of South Africa’s public health sector, the implementation of affordable and rapid point-of-care diagnostic tests could allow for a more effective strategy in recognising asymptomatic STI’s, where labora- tory infrastructure is lacking. KEyWords Trichomonas vaginalis; trichomoniasis; sexually transmitted infections; human immunodeiciency virus; South Africa