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Patient-Delivered Partner Treatment and Trichomonas vaginalis Repeat Infection Among Human Immunodeficiency Virus-Infected Women

Gatski, Megan MSN, PHD*; Mena, Leandro MD; Levison, Judy MD; Clark, Rebecca A. MD§; Henderson, Harold MD; Schmidt, Norine MPH*; Rosenthal, Susan L. PHD; Martin, David H. MD§; Kissinger, Patricia PHD*

Sexually Transmitted Diseases: August 2010 - Volume 37 - Issue 8 - p 502-505
doi: 10.1097/OLQ.0b013e3181d891fc
Original Study

Background: Repeat infections with Trichomonas vaginalis (TV) among human immunodeficiency virus (HIV)-infected women are common and may increase the risk of HIV transmission. Patient delivered partner treatment (PDPT) has been shown to reduce repeat infections of other sexually transmitted diseases. The purpose of this study was to evaluate adherence to PDPT and possible causes of repeat TV infection among HIV-infected women.

Methods: A multicentered cohort study was conducted in 3 US cities. Women coinfected with HIV and TV were treated with metronidazole and given treatment to deliver to all reported sex partners. A test-of-cure visit was conducted 6 to 12 days post index treatment completion and behavioral data were collected.

Results: Of 252 women (mean age = 40 years, s.d. 9.1) enrolled, 92.5% were black, 26.2% had CD4 cell counts <200/mm3, 34.1% had plasma viral loads >10,000 copies, 58.3% were taking antiretrovial therapy, and 15.1% had multiple partners. Of the 183 women with partners at baseline, 75.4% provided PDPT to all partners and 61.7% reported they were sure all of their partners took the medication. Factors associated with not giving medications to all partner(s) were multiple sex partners, being single, and having at least one partner unaware of the index woman's HIV status. At test-of-cure, 10.3% were TV-positive and 16.7% reported having sex since baseline. Of the 24 repeat infections, 21 (87.5%) reported adherence to medication and no sexual exposure.

Conclusion: HIV-infected women with TV reported high adherence to PDPT, and treatment failure was the most common probable cause of repeat infection.

HIV-infected women with Trichomonas vaginalis, who were given patient-delivered partner treatment to prevent reinfection, reported wide acceptance of patient-delivered partner treatment. Repeat TV infections (10.3%) were likely because of treatment failure.

From the *Department of Epidemiology, Tulane University School of Public Health and Tropical Medicine, New Orleans, LA; †Department of Medicine, University of Mississippi, Jackson, MS; ‡Department of Medicine, Baylor College of Medicine, Houston, TX; §Department of Medicine, Louisiana State University, Baton Rouge, LA; and ¶Department of Pediatrics, Columbia University Medical Center, New York, NY

The authors thank the participation of the following in the data collection: Tina Barnes, MPH, Amber Thomas, MPH, Heather King, NP, and Andrea Covington, MPH.

Supported by funds from NIAID U19 AI61972.

Correspondence: Patricia Kissinger, PhD, Department of Epidemiology, Tulane University School of Public Health and Tropical Medicine, SL-18, 1440 Canal St, New Orleans, LA 70112. E-mail: kissing@tulane.edu.

Received for publication July 20, 2009, and accepted January 10, 2010.

© Copyright 2010 American Sexually Transmitted Diseases Association