High prevalence of trichomoniasis in rural men in Mwanza, Tanzania: results from a population based study

Abstract

Objectives:To measure the prevalence of urethral infections including trichomoniasis in rural Tanzanian men, to assess the prevalence of symptoms and signs among men with Trichomonas vaginalis, and to analyse the risk factors for trichomoniasis. Design: A cross sectional study of 1004 men aged 15-54 years in a rural community in north west Tanzania. Methods: Participants were interviewed about sexual behaviour and symptoms of sexually transmitted diseases. First fraction urine samples and urethral swabs were collected and used to test for T vaginalis by wet preparation and culture, Neisseria gonorrhoeae by culture, Chlamydia trachomatis by ligase chain reaction and non-specific urethritis by Gram stain. Urine was also tested for the presence of leucocytes using a leucocyte esterase dipstick. Men were re-interviewed 2 weeks later to document new symptoms and signs of urethritis. Results: Complete laboratory results were available on 980 men. One in four men had laboratory evidence of urethritis. T vaginalis was found in 109 individuals (11%), gonorrhoea in eight (0.8%), and chlamydial infection in 15 (1.5%). Over 50% of men with urethritis were asymptomatic. The prevalence of signs and symptoms was similar among men with T vaginalis alone compared with men with other urethral infections. The sensitivity and specificity of the leucocyte esterase dipstick (LED) test for detecting T vaginalis were 80% and 48% respectively in symptomatic men and 60% and 68% in asymptomatic men. Factors associated with trichomoniasis included religion, type of employment, and marital status. Conclusions: A high prevalence of urethritis was found in men in this community based study. More than half of the urethral infections detected were asymptomatic. The most prevalent pathogen was T vaginalis. Studies are needed on the prevalence of trichomoniasis in men presenting to health services with complaints suggestive of urethritis since treatment for T vaginalis is not included in the syndromic management of urethritis in most countries. The performance of the LED test as a screening test for trichomoniasis was unsatisfactory in both symptomatic and asymptomatic men. Improved screening tests are urgently needed to identify urethral infections that are asymptomatic and which are not covered by current syndromic management algorithms. (Sex Transm Inf 2000;76:355-362)

Aetiology of male urethritis in patients recruited from a population with a high HIV prevalence

“…These findings suggest that this organism is not an important cause of urethritis in our population. This is surprising because of the high prevalence of trichomoniasis in antenatal clinic attendees in our area [11] and the high rates reported in males from most parts of Africa [3,4,21,22]. Our findings are however consistent with a recent population-based study from Tanzania where high T. vaginalis prevalence was found (11%).…”

“…Our findings are however consistent with a recent population-based study from Tanzania where high T. vaginalis prevalence was found (11%). Only 50% of these patients were symptomatic; in most cases, with dysuria as the single complaint, and the majority had no microscopic urethritis (78%) [21]. Two other studies from Africa reported a significantly higher rate of T. vaginalis infection among patients with urethritis compared to a control group comprising men presenting to a clinic without genitourinary related complaints.…”

Current Issues and Considerations Regarding Trichomoniasis and Human Immunodeficiency Virus in African-Americans

“…This strong biological plausibility is supported by empirical studies from Africa documenting that Trichomonas may increase HIV transmission by as much as threefold. Infection can persist at least a year, particularly in asymptomatic men (75,103), and a long-term-carrier state may result in an increased duration of elevated infectiousness for trichomoniasis and HIV (38). Moreover, although imperfect, the available data suggest that T. vaginalis is a highly prevalent infection, particularly among African-American women in urban communities of the United States.…”

Socio‐cultural, psychosexual and biomedical factors associated with genital symptoms experienced by men in rural India

“…Our study could not confirm or outrule the presence of a visible discharge as researchers could not interfere with the providers' treatment procedures who typically did not examine patients. In studies of male urethritis in Africa, however, most men with complaints of a urethral discharge have also been found to have visible signs of discharge (Grosskurth et al 1996;Pepin et al 2001); and, conversely, urethral pathogens have also been found in men who complained of a discharge in whom a discharge was not visualized (Watson-Jones et al 2000;Pepin et al 2001), as well as in men with no complaints at all of a urethral discharge (Grosskurth et al 1996;WatsonJones et al 2000). The lack of complete diagnostics for men appropriate to our field conditions also meant that we could not study the aetiologies and roles of other STIs that are associated with urethral discharge in men, particularly Trichomonas vaginalis (TV).…”