Trichomonas vaginalis and Human Immunodeficiency Virus Coinfection Among Women Under Community Supervision: A Call for Expanded T. vaginalis Screening

Abstract

Background The United States has a large community supervision population, a growing number of whom are women. Trichomonas vaginalis infection is strongly associated with an increased risk of HIV acquisition and transmission, particularly among women, but there is a paucity of research on HIV and T. vaginalis co-infection among women under community supervision. Methods This paper examines the prevalence of T. vaginalis infection and T. vaginalis and HIV co-infection at baseline among women under community supervision in New York City. It also examines the 12-month outcomes of women treated for T. vaginalis. Women received biological tests for HIV and T. vaginalis at baseline and 12 months follow-up. Results Of the 333 women tested for sexually transmitted infections, 77 women (23.1%) tested positive for T. vaginalis at baseline and 44 (13.3%) were HIV positive. HIV-positive women had significantly higher rates of T. vaginalis infection than HIV-negative women (36.4% vs. 21.3%, p≤0.05). Sixteen women (4.8%) were co-infected with T. vaginalis and HIV. Of the 77 women who were positive for T. vaginalis infection at baseline, 58 (75.3%) received treatment by a healthcare provider. Of those who received treatment, 17 (29.3%) tested positive for T. vaginalis at the 12 month follow-up. Conclusions Given the high prevalence of T. vaginalis among this sample of women, particularly among HIV positive women, and high levels of reinfection or persistent infection, screening for T. vaginalis among women under community supervision may have a substantial impact on reducing HIV acquisition and transmission among this high risk population.

Prevalence and risk factors for Trichomonas vaginalis infection among adults in the U.S., 2013–2014

“…[7,29] Recent studies suggest that infection with TV may enhance acquisition and transmission of HIV-1 through increased inflammation and breakdown of the normal epithelial barrier. [8,9] Accurate diagnosis of this infection is also important as high levels of reinfection or persistent infection in high-risk groups has been documented. [5] International literature focused on women's health outcomes suggests that treatment and prevention of TV infection could reduce global HIV risk.…”

“…However, screening for TV infection in populations at risk for HIV may affect HIV transmission. [8,9] Identification and treatment of TV infection could have an impact on U.S. morbidity and mortality, especially if targeting high-risk populations. Historically, TV has not been routinely tested as it is thought to be a minor, non-ulcerative, easily treatable infection.…”

“…Given the high prevalence in select populations of U.S. women, clinicians may consider including TV in their screening algorithm for the prevention of transmission of other STIs, and reproductive morbidity (preterm delivery, infertility, pelvic inflammatory disease). [8] However, there is insufficient evidence to support such practice. There is one randomized trial that showed lack of preterm labor benefit of eradicating TV using metronidazole, resulting in a recommendation against screening and treating for TV in pregnant women.…”

“…[7] Recently, less benign findings including infertility, chronic urogenital inflammation and increased transmission of HIV-1 have been associated with TV infection. [8,9] A prior review of National Health and Nutrition Examination Survey (NHANES) data from 2001-2004 estimated TV prevalence of 3.2% in adult females in the United States. [10] Prevalence is significant enough to suggest the screening of high-risk groups in clinical practice.…”

Loop mediated isothermal amplification assay for detection of Trichomonas vaginalis in vaginal swabs among symptomatic women from North India

“…The disease is usually asymptomatic; however, clinical manifestations such as purulent vaginal discharge, abnormal vaginal odour, pruritis, dyspareunia, and dysuria can be seen in women, and urethritis, prostatitis, balanitis, and epididymitis in men (Schwebke and Burgess, 2004). Complications such as Letters in Applied Microbiology 70, 196--202 © 2019 The Society for Applied Microbiology pelvic inflammatory disease, infertility, and adverse outcomes of pregnancy such as low birth weight and preterm births are also described (Swygard et al 2004;Ambrozio et al 2016) An increase in the risk of human immunodeficiency virus (HIV) transmission has also been associated with the infection (Moodley et al 2002;Davis et al 2016).…”