Epidemiology of Undiagnosed Trichomoniasis in a Probability Sample of Urban Young Adults

Susan M Rogers,Elizabeth Eggleston,Marcia Hobbs,James R Chromy,Laxminarayana Ganapathi,Emily Erbelding,Anthony M Roman,Charles F Turner,William C Miller,Maria A Villarroel,Sylvia Tan

doi:10.1371/journal.pone.0090548

Abstract

T. vaginalis infection (trichomoniasis) is the most common curable sexually transmitted infection (STI) in the U.S. It is associated with increased HIV risk and adverse pregnancy outcomes. Trichomoniasis surveillance data do not exist for either national or local populations. The Monitoring STIs Survey Program (MSSP) collected survey data and specimens which were tested using nucleic acid amplification tests to monitor trichomoniasis and other STIs in 2006–09 among a probability sample of young adults (N = 2,936) in Baltimore, Maryland — an urban area with high rates of reported STIs. The estimated prevalence of trichomoniasis was 7.5% (95% CI 6.3, 9.1) in the overall population and 16.1% (95% CI 13.0, 19.8) among Black women. The overwhelming majority of infected men (98.5%) and women (73.3%) were asymptomatic. Infections were more common in both women (OR = 3.6, 95% CI 1.6, 8.2) and men (OR = 9.0, 95% CI 1.8, 44.3) with concurrent chlamydial infection. Trichomoniasis did not vary significantly by age for either men or women. Women with two or more partners in the past year and women with a history of personal or partner incarceration were more likely to have an infection. Overall, these results suggest that routine T vaginalis screening in populations at elevated risk of infection should be considered.

Highlights

Trichomonas vaginalis is the most common cause of curable sexually transmitted infection (STI) in the United States [1,2]
Accounting for missing specimens with multiple imputation, the prevalence estimate was 7.4%, virtually equivalent to that obtained from the tested specimens alone
Our subsequent analyses only present estimates derived from participants providing specimens for testing

Summary

Introduction

Trichomonas vaginalis is the most common cause of curable sexually transmitted infection (STI) in the United States [1,2]. Using a urine-based PCR, the trichomoniasis prevalence was 2.3% (95% CI 1.8, 2.7) in the 2001–2002 National Longitudinal Study of Adolescent Health (Add Health), a cohort of 18 to 26 year-olds who were U.S students in grades 7 through 12 in 1994–95 [11]. In the 2001–2004 National Health and Nutrition Examination Survey (NHANES), the prevalence of trichomoniasis was 3.1% (95% CI 2.3, 4.3) of U.S women aged 14 to 49 years based on PCR of vaginal swabs [12]. Both surveys reported few symptoms among those infected and estimated substantially higher prevalence of infection among Black women (Add Health: 10.5%, 95% CI 8.3, 13.3; NHANES: 13.3%, 95% CI 10.0, 17.7)

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Discussion

Conclusion