A Trich-y Question: Should Trichomoniasis Be a Nationally Notifiable Disease?

Background: Trichomoniasis is the most prevalent curable sexually transmitted disease (STD) in the United States. Due to its high prevalence, its association with HIV, and the recent introduction of highly sensitive detection assays, some have suggested that trichomoniasis should become a nationally notifiable disease.   

Objectives: To evaluate whether trichomoniasis warrants addition to the National Notifiable Diseases Surveillance System (NNDSS).

Methods: Using previously published criteria for evaluating surveillance systems, and reviewing scientific literature, we evaluated whether trichomoniasis meets seven criteria for recommended surveillance: frequency, associated disparities, communicability, severity, cost, preventability, and public interest.

Results: Trichomoniasis meets the criteria for high frequency of cases (up to an estimated 7.4 million cases per year), associated disparities (prevalence among black women >10 times that among white women), and communicability. Although associated with preterm birth and increased HIV acquisition and transmission, many cases of trichomoniasis (70%) are asymptomatic, so it may or may not meet the severity criterion. In addition, because most cases are undiagnosed, counting diagnosed cases would reflect testing trends rather than trends in prevalence. The total direct medical cost of trichomoniasis (not including HIV) has been estimated at $35 million; costs of implementing a surveillance system and control program would likely exceed that. Experience with chlamydia, another prevalent STD, suggests that current prospects for prevention and control of trichomoniasis are limited. Finally, trichomoniasis is not currently reportable in any state, and does not meet the public interest criterion at this time.

Conclusions: Trichomoniasis currently meets three of the seven criteria (frequency, associated disparities, and communicability). While screening and sentinel surveillance of certain populations, particularly those at high risk of acquiring HIV, may be warranted, we do not currently recommend implementing nationwide case reporting for trichomoniasis.

Implications for Programs, Policy, and Research: Trichomoniasis should not be added to the NNDSS at this time.