1. health and fitness
2. disease
3. aids and hiv

Trichomonas vaginalis: An
Important but Often Neglected STI
Charlotte A. Gaydos, MS, MPH, DrPH
Professor
Division of Infectious Diseases
Johns Hopkins University
Baltimore, Maryland, USA
AMP
Long Beach, CA
October 24 , 2012
Disclosure
• Dr. Gaydos’ participation in this talk is as a
paid speaker for GenProbe.
• All opinions expressed and implied in this
presentation are solely those of Dr.
Gaydos.
• The content of the talk does not represent
or reflect the views of the Johns Hopkins
University or the Johns Hopkins Health
System.
Objectives
• To review pathogenesis, prevalence,
epidemiology, public health issues, and
association with adverse outcome for
Trichomonas vaginalis
• To discuss association of TV with HIV
transmission and BV
• To provide data from a multisite study to
determine the prevalence in women by age,
race, and region in the U.S., as well as the
multivariate logistic regression analysis of
risk factors associated with TV in women
Trichomonas vaginalis
• More prevalent than CT or GC:




7-8 million cases annually in U.S.
WHO global estimates are 173 million cases/yr
Not a reportable disease
True prevalence unknown
• Women:





Preterm birth, low birth weight (Cotch STD 1997)
PID (Cherpes STD 2006)
Post-hysterectomy infection
HIV (Van Der Pol OR 2.7, 2008; McClelland OR 1.5, 2008, Hughes OR 2.57, 2012)
~50% asymptomatic or discharge
• Men:
 ~50% asymptomatic, NCNGU
 Prostatitis, epididymitis
 Assoc w/ decrease in sperm motility and viability
Pathology of Trichomonas
• Trichomonas attaches to epithelial cells
– releases proteins which destroy the cell and
elicits an intense local cellular immune response
with inflammation resulting in
• punctate mucosal hemorrhages
• Lymphocyte recruitment including CD4+ cells
– bind HIV to gain access
– increases cervical HIV shedding
– Inflammation-related factors
• cytokines
– implicated in pathology
» prostate cancer
Trichomonas Pathogenesis
• Desquamation of vaginal epithelium
Leukocytic inflammation; may persist for years
• Symptoms:
-Women: asymptomatic or itching, burning,
frothy discharge, worsens after menses, chronic,
symptoms and parasite can be persistent
-Men: asymptomatic or mild urethritis: rare
to detect by wet prep in men due to urine flow
• Strawberry hemorrhage in 5% of infected
women w/ no discharge - pathogenesis is not
well understood
Prevalence of Trichomonas in NHANES
studies in the United States
•Sutton et al. CID 2007 Prev Tric: 2001-2004
3.1% in 3754 women; 13.3% Black, 1.3% White
•Allsworth et al. STD 2009 Trich & STDs: 2001-2004
3.2% in 3648 women; If Tric+ HSV more
common; syphilis +6X; HIV 13X risk; attenuated
after adjustment for race, age, PN
Prevalence of Trichomonas Among Young
Adults in the U. S.: Adol Health (N = 12,449)
(2.3%)
Prevalence %
Male
Female
Black Female
White
Latino
Black
Asian
Native American
1.7
2.8
10.5
1.2
2.1
6.9
1.8
4.1
Miller et al STD 2005;32:593-598
Prevalence %
18–20 yr
21–22
23–24
> 25
1.5
2.6
2.2
4.0
West
Midwest
South
Northeast
1.4
2.2
2.8
2.0
% of Positive TV Tests by
Wet Mount vs. APTIMA TV (n=1,086)
25
*
21.6
20
15
*
11
Wet Mount
AP TIMA TV
10.4
10
5
7
4.3
9
5
6
*P<0.0002
0
O utpatient
P hys . G rp
E merg ency
Dept A
E merg ency
Dept B
Urg ent C are
facility
Overall rate of TV detection by APTIMA TV was more
than double that of wet mount (14.5% vs. 7%, p<0.0002)
Munson, et al. J Clin Microbiol 2008;46:3368.
Female Trichomonas via Internet
Recruitment using Vaginal swabs
TV 10%; CT 10%; GC 1.0%; Any STI 18.0%
10.3% Infected
11.5%
Infected
10.4%
Infected
8.3% Infected
Gaydos et al. STD 2011
8.6%
Infected
13.2%
Infected
5.6%
Infected
N = 1525
Female Vaginal Trichomonas
via Internet, N = 1222
Variable
Age
Characteristic
Adjusted OR (95% CI)
14-19 yr
0.80 (0.43-1.46)
20-24 yr
0.62 (0.36-1.07)
25-29 yr
1.18 (0.64-2.17)
>30 yr.
1.0
Black
2.69 (1.71-4.23)*
White, Asian, Other
1.0
Health
Insurance
Without
1.57 (1.06-2.35)*
Education
Without BS Degree
5.53 (2.18-14.00)*
Race
*P<0.05
Female Vaginal Trichomonas
via Internet, N = 1222
Variable
Characteristic
Adjusted OR (95% CI)
Condom Use During
Sex
Most, Some, Never
3.04 (1.35-6.85)
PN had STI
Yes
1.71 (1.02-2.86)*
Number PN Past Year
0-1
1.0
2-15
1.60 (1.03-2.51)*
>16
3.51 (1.30-9.47)*
Yes
2.00 (1.05-3.80)
Bisexual
*P<0.05
Other significant variables in Bivariate analysis which were
Not Significant in Multivariate Analysis: Having TV previously,
Having STI in past
T. vaginalis infection and PID
(N=736)
• Endometrial bx and hysterosalpingitis
results
• Women diagnosed with TV at enrollment
were more likely to have histologic
evidence of acute endometritis
Cherpes et al. STD 2006;33:747-753
Trichomonas and low birth weight /
preterm delivery
• 13,816 women enrolled; TV prevalence 12.6%
• Low birth weight
OR 1.3 (95%CI 1.1-1.5)
• Preterm delivery
OR 1.3 (95%CI 1.1-1.4)
• Preterm delivery of a LBW infant
OR 1.6 (95%CI 1.1-1.6)
• Attributable risk of TV assoc with LBW in
Blacks was 11% vs. 1.6% in Hispanics, and
1.5% in Whites.
*Cotch et al STD. 1997;24:353-360
Association of Trichomonas with
low birth weight / preterm delivery
20
18
% of women
16
14
12
BV- TVBV+ TVBV- TV+
BV+ TV+
10
8
6
4
2
0
LBW
Preterm Del
Cotch et al STD. 1997;24:353-360
Preterm LBW
Trichomonas and BV
• Women with abnormal flora (BV) with 3 mo f/u
are increased risk of acquiring TV infection
• Abn to Abn
OR 9.0
• Normal to Abn
OR 7.1
• Abn to normal
OR 4.5
•
Rathod et al STD 2011; 38:882-886
•TV associated with vaginal microbiota
consisting of low proportions of lactobacilli and
high proportions of mycoplasma, Parvimonas
Sneathia and other anaerobes
•Brothman et al. STD 2012
Association of Trichomonas with
Duration of HPV Infection
• 3 city STD clinics 49 HPV-infected adolescents tested
• Concurrent infections were measured
•Prolonged HPV infection (during the HPV infection) was
associated with
AHR 0.58 (95%CI 0.39-0.84)
Oncogenic HPV
Low (<60%) condom use
AHR 0.53 (95%CI 0.33-0.84)
Coinfection wtih CT
AHR 0.58 (95% CI 0.31-0.89)
Coinfection with Trichomonas AHR 0.32 (95% CI 0.16-0.64)
•HPV infections associated with concurrent T. vaginalis
were slower to clear than those not associated with the
infection (median time to disappearance was 436 days
and 172 days, respectively)
*Shew. Archiv Ped 2006;160:151-156
Persistence of Trichomonas:
Trichomonas vaginalis
infections detected among
women in intervals during
which they were not having
sex. (3,6,9,12 mo f/u)
Each row represents the
history of 1 woman. Shaded
areas are intervals during
which the woman reported
not having sex.
Positive (+) and negative (−)
culture test results for T.
vaginalis are indicated for
each woman.
Peterman et al.
CID 48(2):259-260
Trichomonas and Risk for HIV
• Trichomonas treatment reduces vaginal HIV
shedding
• TV+ and TV- women matched on ART; TV+
women treated for TV effectively less likely to
shed HIV vaginally at 3 mo. RR 0.034, p=0.03; no
change for TV- women
Kissinger et al STD. 2009;36:11-16
• Of 60 HIV + women 18.3% were TV positive after
1 month vs. of 301 HIV – women, 8% were TV + at 1
month
Kissinger et al. Repeat infections with TV among HIV + and HIV – women CID
2008;46:994-999
Trichomonas and Risk for HIV
•
Relative Risks in per-Act Probability Transmission, N = 3297 couples
RR
P value
Plasma HIV copies.ml
2.89
<0.001
Condon Use in F/U
0.22
<0.001
Age, per 5 yr
0.82
0.006
HSV-2 + enrollment
2.14
0/012
GUD
2.65
0.004
Trichomonas
2.57
0.002
Cervicitis/vaginitis
3.63
0.005
Circumcision
0.53
0/37
HIV Infected PN
HIV Uninfected PN
Hughes et al. Determinants per-coital act HIV infectivity in African serodiscordant
couples JID 2012;205:358-365.
86 transmissions; MTF 0.0019; FTM 0.0010
Impact of Trichomonas on HIV Model
• HIV patients interviewed about risk factors
baseline, 3 & 6 mo.
• Mathematical Model to estimate number of HIV
infections attributable to TV in care in NC
• TV prevalence 7.4%; incidence 2-3% at f/u
• Model predicted that 0.062 HIV transmission
events occur/ 100 HIV-infected women without TV
vs. 0.076 HIV transmissions in women with TV
• Indicating 23% of HIV transmission events
may be attributable to TV when 22% of women
are co-infected with TV
Quinlivan et al. Modeling Impact of TV on HIV transmission in HIV-infected
individuals. STD 2012;39:671-677.
TV Therapy on Genital HIV Burden
• Estimated annual number new HIV transmissions
in US attributable to TV cofactor effect of 2-5 fold
increased risk (Shafir, Clin Micro Rev 2009; Chesson STD 2004)
• 557 women not receiving antivirals; 46 f/u; 80%
cured; Plasma viral load not significantly different
•Genital viral load decreased significantly 0.5 log10
• After therapy, mean genital tract load
decreased from 4.66 to 4.18 log10 (p <0.01)
Anderson et al. Effect TV Therapy on Genital HIV Burden STD 2012;39:638-642.
Estimates of Direct Cost/Case and
Burden of Trichomonas in US
Extracted private insurance claims 2001-2005 MEDISTAT
Market Scan database
Outpatient costs: visit $97; drug $9
Most common Dx wet prep
Avg. total cost for women 15-24 yr ($120) significantly
higher all other ages (p<0.01)
Estimated : Overall annual economic burden of
trichomonas to be $18.9 million among all U.S. women;
Incidence rate: all ages 92/100,000 (higher 25-29 yr
@185/100,000 )
Owusu-Edusei, K. et al. Sex Transmit Dis 2009;36:395-399
Estimates of Sequelae
Costs for Trichomonas in US?
• If direct estimated overall annual economic burden of trichomonas is
$18.9 million among all U.S. women, what about the population
attributable cost for possible sequelae, if there are 7.4 million cases of
TV /year?
•Cost of premature infant’s hospitalization? [550,000 babies/ yr]
$49,000 in yr 1 (March of Dimes 2009)
$26 billion /yr (IOM)
•Cost of PID?
•Cost of HIV?
$1378 (Rein-RTI & Gift-CDC) -$1410 (IOM, 2000) /case
$4 billion /yr (AHRQ 2002) [1.2 million visits/yr]
$618,900 /yr [50,000 new HIV infections /yr]
[1.1 million living with HIV/AIDS]
•(Cost of Cancer; association with HPV infection?) ???
•Do we need a C-E study to convince public health officials and law
makers of the necessity of a trichomonas control program in the US?
A Newly Cleared FDA NAAT Assay
for Trichomonas Now Available
Trichomonas NAAT FDA Clinical Trial
(N= 933)
•IRB approval multisite study; prospective samples
tested with APTIMA Trichomonas vaginalis (ATV)
assay on the TIGRIS DTS ® Instrument; compared to
wet prep & culture; mean age 24 yr; prev 11.4-12.7%
Sample type Sensitivity
Specificity
Endocervical 100%
99.4%
Urine
Vaginal
PreservCyt
Liquid Pap
98.9%
99.0%
99.6%
95.2%
100%
100%
59.9% Symptomatic Schwebke et al. JCM 2011;49:4106-4111
U.S. Multisite Prevalence Study:
Methods
•IRB approval for using consecutive de-identified remnant
APTIMA Combo 2 CT/NG samples from females were
obtained by sites
•Clinics: Obstetrics/gynecology, emergency departments,
hospital in-patient, family practice clinics, internal
medicine clinics, jails, STD clinics
•Samples from women ages 18-89 yr. in 21 States were
tested retrospectively using the APTIMA Trichomonas
vaginalis (ATV) assay on the TIGRIS DTS ® Instrumentation
Endocervical
Urine
Vaginal
PreservCyt liquid Pap
National Prevalence Study of
Trichomonas Using Gen-Probe ATV
•N = 7,593 women
ages 18-89 yr.
21 States
•Overall Prevalence
TV
CT
NG
8.7%
6.7%
1.7%
Ginocchio et al. JCM, 50:2601-2608, 2012
APTIMA TV Study Sites
x
Prevalence of TV, CT, and NG
Infections by Age N = 7,593
Overall Prevalence
N*
TV+
CT+
NG+
7593
8.70%
6.70%
1.70%
% (n/N*)
(663/7593) (508/7588) (129/7579)
Age (yr)
Mean
29.82
23.4
24.0
8.50%
8.30%
7.90%
11.30%
13.00%
14.40%
8.00%
2.50%
1.90%
0.90%
3.30%
2.00%
0.80%
0.10%
1.20%
Prevalence (%)* by Age Group
18-19
20-29
30-39
40-49
50+
907
3972
1667
720
324
* In the calculations of prevalence, the denominator may be less than that the N shown due to missing
or invalid assay data.
% Prevalence
Prevalence of TV, CT, and GC
Infections by Age
16
14
12
10
CT
8
GC
6
TV
4
2
0
18-19 20-24 25-29 30-34 35-39 40-44 45-49
>50
National Prevalence Study of
Trichomonas Using Gen-Probe ATV
RACE/Ethnicity
Black
White
Hispanic
Asian
Prevalence
20.2%
5.7%
5.0%
3.8%
Region
Southeast U.S.
Southwest U.S.
Midwest U.S.
Northeast U.S.
Prevalence
14.4%
9.5%
9.5%
4.3%
Prevalence of TV, CT, and GC
Infections by Race
Overall Prevalence
% (n/N*)
Prevalence (%)* by Race
American Indian/ Alaskan
Native
Asian
Black/African American
Hispanic/Latino
Native Hawaiian/ Other
Pacific Island
White
Other/Unknown
N*
7593
TV+
CT+
GC+
8.70%
6.70%
1.70%
(663/7593) (508/7588) (129/7579)
19
10.50%
0.00%
0.00%
131
1382
718
3.80%
20.20%
5.00%
9.90%
12.10%
5.90%
2.30%
4.00%
0.70%
14
7.10%
7.10%
0.00%
1668
3658
5.70%
6.70%
5.70%
5.20%
1.60%
1.10%
* In the calculations of prevalence, the denominator may be less than that the N shown due to
missing or invalid assay data.
Prevalence of TV, CT, and GC
Infections by Collection Site
% Prevalence
25
20
15
10
5
0
CT Positive
GC Positive
TV POSITIVE
Geographic Prevalence of TV
CT and GC Infections
16
14
12
10
CT Positive
8
GC Positive
6
TV POSITIVE
4
2
0
midwest northeast southeast southwest
Multivariant Analysis: Trichomonas
Risk Factors
% Prevalence
Multivariant OR
Age (YR)
18-<20
8.49
1
20-<30
8.33
1.03
30-<40
7.92
1.03
= > 40
11.78
1.51*
White
5.70
1
All others/unknown
6.59
0.92
Black
20.22
4.04*
Hispanic/Latino
5.01
0.88
Race
*P < 0.05
Ginocchio et al. JCM 50: 2601-2608, 2012
Multivariant Analysis: Trichomonas
Risk Factors
% Prevalence
Multivariant OR
Clinic Type
Family Planning
5.36
1
ED, In patient
16.63
3.50*
Family Practice, Int’l Med
6.12
1.27
OB/GYN
7.29
1.33
Jail, STD Clinic
16.41
2.59*
Other/Unknown
5.85
1.67*
Northeast
4.30
1
Southwest
9.51
1.88*
Southeast
14.44
6.32*
Midwest
9.48
2.00*
Region
*P < 0.05
Conclusions
•Trichomonas is highly prevalent in many
populations; often associated with race and
acquisition of HIV
•Diagnostic tests are improving; there is now
an FDA cleared, commercially available NAAT
•In a females screened for CT/GC by NAAT,
TV was highly prevalent:
• Blacks 20.2% and older women (11-13%)
•Public health awareness of TV as associated
health and cost outcomes needs to be
increased, especially with health disparities
and HIV
“Optimal prevention and control
strategies for T. vaginalis infection
should be further explored as a
means of closing the racial
disparity in prevalence and
decreasing other adverse
outcomes associated with this
sexually transmitted infection”
Sutton et al. CID 2007 National Center HIV/AIDS, CDC
Acknowledgements and ?
Mathilda Barnes
Yu-Hsiang Hsieh
Quinn, Nicole
Mary Jett-Goheen
Jeff Holden
Laura Dize
Perry Barnes
Billie Masek
Justin Hardick
Christine Ginocchio
Kimberle Chapin
Jane Schwebke
GenProbe, Inc
Another Recent Study: TV in Different
Age Groups
•Trichomonas PCR in FL, NJ, TX (N = 78,428)
•TV Prevalence: 4.3% (CT 3.8%; GC 0.6%)
•Group with highest prevalence :
•Age 46-55 yr 6.2%
•Age 56-65 yr 6.1%
•Age 12-26 yr 4.6%
Stemmer et al. Amer Soc Colpos and Cervical Path 16, 2012
Female Trichomonas via Internet
Recruitment
•Of 1525 self collected vaginal swabs
collected in the home using mailed kits
•Tested positive 2006-2010 using NAAT
assays
TV
10.0%
CT
10.0%
GC
1.0%
Any STI 18.0%
Gaydos et al. STD 2011
Internet Rectal Kits- Females
In January 2009, IWTK offered self-collected rectal kits
in addition to vaginal kits
From 1,084 women submitting vaginal swabs 2009-10 to
IWTK , 194 (17.9%) reported anal intercourse (AI) in the
last 90 days.
Of these women, 113 (58.2%) also ordered and returned
rectal kits; 95 additional kits were ordered and returned
by women who did not report recent AI
From a total of 406 rectal kits ordered by women overall,
208 (51.2%) were returned; 3 had no consent form;
205 were tested.
Ladd et al. ISSTDR 2011
Internet Rectal Kits- Females (N=205)
•Of those tested, 18.5% were rectal test positive
•12.7% for chlamydia
•2.4% for gonorrhea
•6.3% for trichomonas
•5 co-infected
•Of those infected women who also returned vaginal swabs,
70.5% were positive for at least one of the three STIs
vaginally; multivariate analysis indicated risk factors were
black race and having a vaginal infection
Female
Rectal TV
To Date
536
6.5%
Trichomonas vaginalis Diagnostics
POC vs. culture
OSOM
XenoStrip
Affirm VPIII
Wet Preparation: 50-72% sensitive
Culture: 70-78% Sensitive
PCR
TMA
Sensitivity
83-99%
77-90%
80%
97% Sensitive
96.7-98.2% Sensitive
Scanning Electron Microscopy
Tests for Trichomonas
Range of sensitivity and specificity of tests for trichomonas in women
Test Assay
Sensitivity (%)
Specificity (%)
Wet Preparation*
50-72
100
Culture*
OSOM**
XenoStrip**
Affirm VPIII**
PCR***
TMA****
70-78
83-99
77-90
80
97
96.7-98.2
100
100
93-99
98
98
98
*compared to NAATs; ** compared to culture; ***Compared to culture and other primer
sets for trichomonas;-Madico JCM 1998;36:3205-3210; ****Compared to research PCR—
Huppert CID 2007 & Hardick JCM 2006
Gaydos, C. Rapid Tests for STDs Current Infect Dis Reports 2006;8:115-124
% positive
Trichomonas ASR NAAT
Performance in Two Published
Studies
98.4 96.6
100
90
75.4 75
80
83
82.0
70
60
50.8 54.6
50
40
30
20
10
0
Wet mount
Culture
OSOM
Huppert
Huppert, et al. CID 2007; 45:194-198;
PCR
APTIMA
Nye
Nye, et al. Am J of Obstet Gynecol, Feb 2009
Current Estimation of Types of
Trichomonas Testing Performed
Wet mount/
culture
48%
BD Affirm
13%
NAAT ASR
2%
OSOM
8%
Pap Smear % ?
InPouch
29%
Prevalence of TV in Low STI Setting
STI Prevalence n= 1676
Chapin et al. Expert Rev Mol Diagn 11:1-10, 2011
TV
CT
GC
4.6%
5.3%
0.4%
Time to change in order to do better
at diagnosing TV in our patients?
Wet Prep to Amplified Technology
Time for Value Added for our Patients
for a Undervalued STI?
A Combined Concerted Effort
PUBLIC
HEALTH
LABS
HEALTHCARE
PROVIDERS
PATIENTS
Coinfection of TV, CT, and GC
Infections by Age
Overall Prevalence
% (n/N*)
Age
Mean
Median
Prevalence (%)* by Age
Group
18-19
20-29
30-39
40-49
50+
N* CT+GC+TV+ CT+TV+ CT+GC+ GC+TV+
7593
0.24%
1.30%
0.61%
0.61%
(18/7577) (97/7588) (46/7577) (46/7579)
907
3972
1667
720
324
22.00
21.5
23.41
22
21.89
21
23.15
21.5
0.20%
0.40%
0.00%
0.00%
0.00%
2.10%
1.70%
0.40%
0.40%
0.00%
1.30%
0.83%
0.10%
0.00%
0.00%
0.90%
0.90%
0.20%
0.00%
0.30%
* In the calculations of prevalence, the denominator may be less than that the N shown due to missing
or invalid assay data.
Coinfection of TV, CT, and GC
Infections by Race
CT+GC+TV+ CT+TV+
Overall Prevalence
% (n/N*)
CT+GC+
GC+TV+
0.24%
1.30%
0.61%
0.61%
(18/7577)
(97/7588)
(46/7577)
(46/7579)
Prevalence (%)* by Race
American Indian/ Alaskan
Native
Asian
0.00%
0.00%
0.00%
0.00%
0.00%
0.80%
0.80%
0.00%
Black/African American
0.70%
3.60%
1.70%
1.70%
Hispanic/Latino
Native Hawaiian/ Other
Pacific Island
White
Other/Unknown
0.00%
0.60%
0.00%
0.10%
0.00%
0.00%
0.00%
0.00%
0.10%
0.20%
0.60%
0.90%
0.40%
0.40%
0.50%
0.40%
* In the calculations of prevalence, the denominator may be less than that the N shown due to
missing or invalid assay data.
Estimates of
Sexually Transmitted Infections in the US
Placement of Trichomonas in the
Test Menu
• Educate healthcare providers
 Don’t know the prevalence or the sequelae
• Highlight the prevalence in older age
 STD diagnosis vs vaginosis
• Educate the public
 The most common treatable STI is one that your
physician may not be testing for??
 What STD is a college student’s MOM more likely to
have then their college student?
• Combine it with CT/GC testing in age groups
where STIs is a consideration
 Make it easy to collect and order
 Validate it for as many specimens as possible
What do labs need to adopt Trich?
• Physician education
Differences in different risk populations
 Highlight the sequelae and high prevalence
 Cost of another public health screening test
 Not reportable
• Lab education
 FDA-cleared test
 Review workflow and capacity
 Providers familiar with CT/GC TAT
 Budget
 Currently reimbursed
Trichomonas vaginalis
Wet Preparation
Scanning Electron Microscopy
Trichomonas and Risk for HIV
•
213 women who experienced HIV seroconversion
(cases) longitudinal study; 4450 HIV - women in Uganda
& Zimbabwe were matched (controls)
• Prevalence T. vaginalis infection before HIV infection
was 11.3% in cases and 4.5% in controls (P = .002)
• Controlling for hormonal contraception, other STIs,
behavioral, and demographic factors, the aOR for HIV
acquisition was 2.74 (95% CI 1.25– 6.00) for TV cases.
Van Der Pol et al. Trichomonas vaginalis Infection and Human Immunodeficiency Virus
Acquisition in African Women CID 2008;197:548-54
• Infection w/ TV increases risk of HIV acquisition
• aHR 1.52 (95% CI 1.04-2.24 ) in 1335 women in Mombasa
McClelland et al. JID 2007;195:698-702.)
Trichomonas vaginalis Infection:
Can We Afford to Do Nothing?
•Many calls for control strategy; many questions; consider
PH response
•Can we afford to undertake a program? Can we afford not
to?
•Should Tric become a reportable disease?
McClelland JID 197:487-9, 2008
•“Optimal prevention and control strategies for T. vaginalis
infection should be further explored as a means of closing
the racial disparity in prevalence and decreasing other
adverse outcomes associated with this sexually
transmitted infection”
Sutton et al. CID 2007 National Center HIV/AIDS, CDC
In Summary
•TV: 18-39 yr:
>40 yr:
7.5 - 8.6%
9.8%
•TV most Prevalent @ all ages except for
ages 18-19 yr. (CT 14.3%; TV 8.5%)
•Family Planning Clinics
•Jails
•Coinfection:
5.4%
22.3%
<1% most ages
•Overall Trichomonas Prevalence
8.7%
Conclusions
•Routine screening for TV should be considered for
all women being screened for CT/GC
•Screening all high-risk women over 40 for TV
should also be considered
•The use of the highly accurate, fully-automated
ATV assay for testing non-invasive samples that
can be run together with APTIMA CT/GC assays will
facilitate co-testing of TV with CT and GC in the
U.S.