T. vaginalis disproportionately affects blacks

Trichomonas vaginalis , the world’s most common nonviral sexually transmitted infection, disproportionately affects blacks in United States, according to researchers.

The trend is especially true for black women and requires increased screening, among other interventions, they wrote in Clinical Infectious Diseases.

“These findings are likely reflective of real social and structural disparities, such as lower access to health care, that result in high infection rates in the black community,” researcher Aaron Tobian, MD, PhD, an associate professor of pathology at the Johns Hopkins University School of Medicine, said in a news release. “Targeted public health education about Trichomonas will be critical.”

When symptomatic, T. vaginalis can cause discharge, painful urination and abdominal pain in both sexes. If left untreated, it can cause pelvic inflammatory disease, perinatal morbidity and infertility, among other conditions, in women, as well as problems including prostatitis and epididymitis in men.

T. vaginalis is also associated with an increased risk for HIV infection and transmission. Although the CDC recommends screening for the infection in those who have HIV, there is no routine surveillance of T. vaginalis, and trichomoniasis has been deemed a neglected parasitic infection.

To determine the prevalence of T. vaginalis in the U.S., the researchers examined data from the 2013-2014 National Health and Nutrition Examination Survey (NHANES), conducted by the National Center for Health Statistics.

The 2013-2014 survey included people aged 18 to 59 years. Tobian and colleagues examined data from 4,057 participants who provided urine samples and had T. vaginalis test results.

Overall prevalence of T. vaginalis was 0.5% among men and 1.8% among women. It was 0.03% among nonblack men and 0.8% among nonblack women but jumped to 4.2% among black men and 8.9% among black women.

T. vaginalis infection was associated with being female (adjusted probability ration [aPR] = 6.1; 95% CI, 3.3-11.3), black race vs. nonblack race (aPR = 7.9; 95% CI, 3.9-16.1), living below the poverty level (aPR = 4; 95% CI, 2.1-7.7) and having at least two sexual partners in the past year (aPR = 3.6; 95% CI, 2-6.6). Those with less than a high school education were twice as likely to be infected (aPR = 2; 95% CI, 1-4.1).

Infection was also associated with older age compared with the youngest participants aged 18 to 24 years. Those aged between 25 and 39 years old were three times as likely to have T. vaginalis (aPR = 3; 95% CI, 1.2-7.1), and the chances were even greater for those aged 40 to 59 years (aPR = 3.5; 95% CI, 1.3-9.4).

Among other interventions, the researchers suggested incorporating T. vaginalis into existing STI prevention campaigns and routine screening in high-prevalence communities. Efforts like those could help address the racial disparities, they said.

“While there may indeed be insufficient empirical evidence that these strategies will lead to epidemic control or a reduction in the racial disparity of [T. vaginalis] infection in the U.S., it would be an injustice to the black population to continue to ignore this STI until such evidence is available,” they wrote. – by Joe Green

Disclosures: The authors report no relevant financial disclosures.