Abstract
Trichomonas vaginalis (TV), the most common non-viral sexually-transmitted infection is considered a neglected infection and its epidemiology is not well known. This study determined TV-infection dynamics in a retrospective cohort of Colombian women and evaluated associations between risk factors and TV-outcome. TV was identified by PCR. Cox proportional risk models were used for evaluating the relationship between TV-outcome (infection, clearance and persistence) and risk factors (sexually-transmitted infections and sociodemographic characteristics). Two hundred and sixty-four women were included in the study; 26.1% had TV at the start of the study, 40.9% suffered at least one episode of infection and 13.0% suffered more than one episode of TV during the study. Women suffering HPV had a greater risk of TV-infection (aHR 1.59), high viral-load (> 102) for HPV-16 being related to a greater risk of persistent parasite infection; a high viral load (> 102) for HPV-18 and -33 was related to a lower probability of TV-clearance. Ethnicity (afrodescendent/indigenous people: aHR 5.11) and having had more than two sexual partners (aHR 1.94) were related to greater risk of infection, contrasting with women having a background of abortions and lower probability of having TV (aHR 0.50). Women aged 35- to 49-years-old (aHR 2.08), increased years of sexual activity (aHR 1.10), multiple sexual partners (aHR 8.86) and multiparous women (aHR 3.85) led to a greater probability of persistence. Women whose cervical findings worsened had a 9.99 greater probability of TV-persistence. TV distribution was high in the study population; its coexistence with HPV and other risk factors influenced parasite infection dynamics. The results suggested that routine TV detection should be considered regarding populations at risk of infection.
Highlights
Trichomonas vaginalis (TV), the most common non-viral sexually-transmitted infection is considered a neglected infection and its epidemiology is not well known
A clinically relevant characteristics of T. vaginalis is that it has been shown to increase the risk of acquiring other sexually-transmitted infections (STI) including C. trachomatis which has been associated with parasitic infection[5]; Previous studies have indicated that C. trachomatis-related concurrent infection is a predictive factor for acquiring T. vaginalis[6,7]
A quarter of the women who began the study were infected by TV; such prevalence was greater than that reported from the USA1, Senegal[3] and B razil[21], but similar to that found in other studies involving a heterogeneous population[6,22,23]
Summary
Trichomonas vaginalis (TV), the most common non-viral sexually-transmitted infection is considered a neglected infection and its epidemiology is not well known. A clinically relevant characteristics of T. vaginalis is that it has been shown to increase the risk of acquiring other STIs including C. trachomatis which has been associated with parasitic infection[5]; Previous studies have indicated that C. trachomatis-related concurrent infection is a predictive factor for acquiring T. vaginalis[6,7]. Studies have suggested that the internalisation and inflammation resulting from parasite infection produces changes in epithelial integrity, promoting the appearance of micro-abrasions facilitating HPV entry to the cervical epithelium’s differentiated base layers[12,13]. This is why parasite infection is considered a key risk factor regarding HPV persistence[12,13,14]. The parasite has been little studied worldwide in spite of TV infection’s significance, thereby contributing to the lack of attention being paid to it by public health entities[17]; data about its distribution and the natural history
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