Trichomonas vaginalis in a Population at High Risk for Other STI and HIV

Background:
T. vaginalis is recognized by the WHO as the most common non-viral STI worldwide. T. vaginalis has been shown to be strongly associated with increased risk of HIV acquisition. Therefore, control of this pathogen is warranted in populations at risk for HIV exposure. However, few resources are allocated to public health control of this pathogen.

Objective:
To describe the effect of a surveillance project in a high-risk population

Method:
PCR to detect T. vaginalis DNA was performed from August-September, 2007 on all samples routinely collected for Chlamydia trachomatis and Neisseria gonorrhoeae screening in a setting comprised predominately of female sex workers: Liberty Hall, a privately operated 300-bed residential treatment facility that provides a specialized women's program for Marion County (Indiana) Offenders. The number of cases of T. vaginalis identified were compared to the number identified in April-May, 2007 as a control period during which only targeted testing was performed. To control for the possibility of rapid shifts in disease prevalence, the rates of C. trachomatis and N. gonorrhoeae were compared across the two periods as well.

Result:
Screening all “attendees” identified 63/141 (44.7%) cases of T. vaginalis compared to targeted diagnostics that identified 7/12 (58.3%) in a similar time frame. The rates of chlamydia were 20/158 (12.7%) and 11/94 (11.7%) over the surveillance period and the control period, respectively. Similarly rates of gonorrhea were 9/158 (5.7%) and 10/94 (10.6%).

Conclusion:
T. vaginalis is highly prevalent in this population that is also at high risk for other STI and HIV. Control of this disease is unlikely to occur with only targeted diagnostics since a substantial proportion of cases appear to be missed using this strategy.

Implications:
A public health mandate to provide funding for improved control of T. vaginalis is warranted, particularly in high-risk populations.