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A Prospective Cohort Study Comparing the Effect of Single-Dose 2 g Metronidazole on Trichomonas vaginalis Infection in HIV-Seropositive Versus HIV-Seronegative Women

Balkus, Jennifer E. PhD, MPH*†; Richardson, Barbra A. PhD*‡; Mochache, Vernon MBChB§; Chohan, Vrasha BSc; Chan, Jeannie D. PharmD; Masese, Linnet MBChB, MPH; Shafi, Juma MSc§; Marrazzo, Jeanne MD, MPH; Farquhar, Carey MD, MPH†¶**; McClelland, R. Scott MD, MPH†§¶**

Sexually Transmitted Diseases: June 2013 - Volume 40 - Issue 6 - p 499–505
doi: 10.1097/OLQ.0b013e31828fce34
Original Study

Background This analysis compared the frequency of persistent Trichomonas vaginalis (TV) among HIV-seropositive and HIV-seronegative women.

Methods Data were obtained from women enrolled in an open cohort study of sex workers in Kenya. Participants were examined monthly, and those diagnosed as having TV by saline microscopy were treated with single-dose 2 g oral metronidazole. All women on antiretroviral therapy (ART) used nevirapine-based regimens. Generalized estimating equations with a logit link were used to compare the frequency of persistent TV (defined as the presence of motile trichomonads by saline microscopy at the next examination visit within 60 days) by HIV status.

Results Three-hundred sixty participants contributed 570 infections to the analysis (282 HIV-seropositive and 288 HIV-seronegative). There were 42 (15%) persistent infections among HIV-seropositive participants versus 35 (12%) among HIV-seronegative participants (adjusted odds ratio, 1.14; 95% confidence interval [CI], 0.70–1.87). Persistent TV was highest among HIV-seropositive women using ART (21/64 [33%]) compared with HIV-seropositive women not using ART (21/217 [10%]). Concurrent bacterial vaginosis (BV) at TV diagnosis was associated with an increased likelihood of persistent TV (adjusted odds ratio, 1.90; 95% confidence interval, 1.16–3.09).

Conclusions The frequency of persistent TV infection after treatment with single-dose 2 g oral metronidazole was similar by HIV status. Alternative regimens including multiday antibiotic treatment may be necessary to improve cure rates for women using nevirapine-based ART and women with TV and concurrent BV.

The authors compared the proportion of HIV-seropositive and HIV-seronegative women with persistent Trichomonas vaginalis after treatment with single-dose 2 g oral metronidazole and observed similar proportions of T. vaginalis persistence by HIV serostatus.

From the *Fred Hutchinson Cancer Research Center, Vaccine and Infectious Disease Division, Seattle, WA; †Departments of Epidemiology and ‡Biostatistic, University of Washington, Seattle, WA; §University of Nairobi, Institute of Tropical and Infectious Diseases, Nairobi, Kenya; and ¶Department of Medicine, ∥School of Pharmacy, Harborview Medical Center, and **Department of Global Health, University of Washington, Seattle, WA

The authors gratefully acknowledge the support from their clinic staff, laboratory staff, and administrators for their dedication and hard work. The authors express their appreciation to the Municipal Council of Mombasa and the administration of Coast Provincial General Hospital for use of their facilities. Finally, they sincerely thank the women whose time, effort, and commitment made this research possible.

This research was support by at grant from the National Institutes of Health (P01 HD64915). J.E. Balkus was supported by a grant from the University of Washington Center for AIDS and STDs (T32 AI007140-32). Infrastructure support for the Mombasa Field Site was received from the University of Washington Center for AIDS Research, a National Institutes of Health–funded program (P30 AI027757).

Potential conflicts of interest: R.S. McClelland has received research funding from Gen-Probe and honoraria and a donation of study product for an ongoing clinical trial from Embil Pharmaceutical Company. All other authors declare no commercial or other associations that might pose a conflict of interest.

This abstract was presented at the Annual Scientific Meeting and Symposium of the Infectious Diseases Society for Obstetrics and Gynecology, in Whistler, Canada; August 8–11, 2012.

Correspondence: Jennifer E. Balkus, PhD, MPH, Fred Hutchinson Cancer Research Center, Mail Stop M2-C200, 1100 Fairview Ave N, Seattle, WA 98109. E-mail: jbalkus@fhcrc.org.

Received for publication October 30, 2012, and accepted January 9, 2013.

© Copyright 2013 American Sexually Transmitted Diseases Association