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Trichomonas vaginalis in Selected US Sexually Transmitted Disease Clinics: Testing, Screening, and Prevalence

Meites, Elissa MD, MPH*; Llata, Eloisa MD, MPH*; Braxton, Jim*; Schwebke, Jane R. MD; Bernstein, Kyle T. PhD, ScM; Pathela, Preeti DrPH§; Asbel, Lenore E. MD; Kerani, Roxanne P. PhD∥**; Mettenbrink, Christie J. MSPH††; Weinstock, Hillard S. MD*

doi: 10.1097/OLQ.0000000000000038
Original Study

Background Trichomonas vaginalis is the most prevalent nonviral sexually transmitted infection in the United States, affecting 3.1% of women of reproductive age. Infection is associated with HIV acquisition and pelvic inflammatory disease. In the United States, Centers for Disease Control and Prevention guidelines recommend testing all women with vaginal discharge for T. vaginalis, but except for HIV-infected women, there are no national guidelines for screening asymptomatic persons. The objective of this analysis is to assess testing and screening practices for T. vaginalis among symptomatic and asymptomatic women in the sexually transmitted disease (STD) clinic setting.

Methods We analyzed data on demographics, clinical presentation, and laboratory testing for all women visiting a clinician in 2010 to 2011 at any of 15 STD clinics participating in the STD Surveillance Network. Prevalence of laboratory-confirmed T. vaginalis infection was calculated among symptomatic women tested and among asymptomatic women screened.

Results A total of 59,176 women visited STD clinicians: 39,979 were considered symptomatic and 19,197 were considered asymptomatic for T. vaginalis infection, whereas 211 were HIV-infected. Diagnostic practices varied by jurisdiction: 4.0% to 96.1% of women were tested or screened for T. vaginalis using any laboratory test. Among 17,952 symptomatic women tested, prevalence was 26.2%. Among 3909 asymptomatic women screened, prevalence was 6.5%. Among 92 HIV-infected women tested/screened, prevalence was 29.3%.

Conclusions Trichomoniasis is common among STD clinic patients. In this analysis, most STD clinics tested symptomatic women seeking care, in accordance with national guidelines. All HIV-infected women should be screened annually. Additional evidence and national guidance are needed regarding potential benefits of T. vaginalis screening in other asymptomatic women.

Among 59,176 women visiting clinicians at 15 US sexually transmitted disease clinics, Trichomonas vaginalis prevalence was 26.2% among 39,979 symptomatic women tested and 6.5% among 19,197 asymptomatic women screened; practices varied widely.

From the *Division of STD Prevention, Centers for Disease Control and Prevention, Atlanta, GA; †University of Alabama at Birmingham, Birmingham, AL; ‡San Francisco Department of Public Health, San Francisco, CA; §New York City Department of Health and Mental Hygiene, New York, NY; ¶Philadelphia Department of Public Health, Philadelphia, PA; ∥Public Health, Seattle and King County, Seattle, WA; **University of Washington, Seattle, WA; and ††Denver Public Health Department, Denver, CO

Acknowledgments: The authors thank Darlene Davis, Robert Kirkcaldy, Ellen Klinger, Lauri Markowitz, Tremeka Sanders, Mark Stenger, Elizabeth Torrone, and Kimberly A. Workowski.

Source of funding: The Centers for Disease Control and Prevention provided funding support for this work. The findings and conclusions in this report are those of the authors and do not necessarily represent the official position of the Centers for Disease Control and Prevention.

Conflicts of interest: Jane Schwebke has received research support from Embil Pharmaceuticals and Gen-Probe. For the remaining authors, no conflicts of interest were declared.

Correspondence: Elissa Meites, MD, MPH, Division of STD Prevention, Centers for Disease Control and Prevention, 1600 Clifton Road NE, MS E-02, Atlanta, GA 30333. E-mail:

Received for publication June 05, 2013, and accepted August 26, 2013.

© Copyright 2013 American Sexually Transmitted Diseases Association