Abstract
Background. Data on the incidence of Trichomonas vaginalis and use of hormonal contraception (HC) are limited. Methods. 2,374 sexually active women aged 15–49 years from cohort surveys in Rakai, Uganda, were included. Incidence of T. vaginalis was estimated per 100 person years (py) and association between HC (DMPA, Norplant, and oral contraceptives) and T. vaginalis infection was assessed by incidence rate ratios (IRR), using Poisson regression models. Results. At baseline, 34.9% had used HC in the last 12 months, 12.8% HIV+, 39.7% with high BV-scores (7–10), and 3.1% syphilis positive. The 12-month incidence of T. vaginalis was 2.4/100 py; CI (1.90, 3.25). When stratified by type of HC used, compared to women who did not use HC or condoms, incidence of T. vaginalis was significantly higher among users of Norplant (adj.IRR = 3.01, CI: 1.07–8.49) and significantly lower among DMPA users (adj.IRR = 0.55, CI: 0.30, 0.98) and women who discontinued HC use at follow-up (adj.IRR = 0.30, CI: 0.09, 0.99). HIV infection was associated with an increase in incidence of T. vaginalis (adj.IRR = 2.34, CI: 1.44, 3.78). Conclusions. Use of Norplant and being HIV+ significantly increased the risk of T. vaginalis, while use of DMPA and discontinuation of overall HC use were associated with a decreased incidence of T. vaginalis.
Highlights
Trichomonas vaginalis (T. vaginalis) is the most common curable sexually transmitted infection (STI), and despite high prevalence rates ranging from 5–75%, and adverse health consequences such as pelvic inflammatory disease and adverse pregnancy outcomes, it has received little attention globally [1]
The analyses assessed risk of T. vaginalis associated with overall hormonal contraception (HC) use as well as stratified by type of HC used: Depo-Provera (DMPA), combined oral contraceptives (COCs), and implants (Norplant)
Studies have not found an increase in the prevalence, incidence, persistence, or recurrence of T. vaginalis among women who are HIVpositive [18], our study found a significantly higher incidence of T. vaginalis among women who were HIV-positive, but the possibility of confounding due to correlated sexual behaviours cannot be excluded
Summary
Trichomonas vaginalis (T. vaginalis) is the most common curable sexually transmitted infection (STI), and despite high prevalence rates ranging from 5–75%, and adverse health consequences such as pelvic inflammatory disease and adverse pregnancy outcomes, it has received little attention globally [1]. Dual use of efficacious contraceptives and condoms continues to be encouraged to prevent unwanted pregnancies and the high rates of HIV and STIs; dual use continues to be uncommon, especially among stable unions. The use of hormonal contraception (HC) and especially injectable contraceptives (ICs) is gaining popularity in SubSaharan Africa [5], and the two latest Ugandan demographic and health survey (DHS) show an increase in use of HCs among currently married women aged 15 to 49 years from 13.4% in 2005/6 [6] to 19.7% in 2011 [7]. Use of Norplant and being HIV+ significantly increased the risk of T. vaginalis, while use of DMPA and discontinuation of overall HC use were associated with a decreased incidence of T. vaginalis
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