T vaginalis retesting rates found low despite disease prevalence

T vaginalis retesting rates found low despite disease prevalence | Image Credit: © New Africa - © New Africa - stock.adobe.com.

According to a recent study published in the American Journal of Obstetrics & Gynecology, Trichomonas vaginalis, retesting in a hospital-based obstetrics and gynecology clinic population is lacking.

Trichomonias is has a prevalence rate of 2% to 10%, making it the most common nonviral sexually transmitted infection (STI) in the United States. Non-Hispanic Black women are disproportionately affected, with rates of 9% to 23%.

Trichomonas vaginalis infection makes HIV infection 2 to 3 times more likely, along with adversely affecting pregnancy outcomes. This has led the CDC to recommend screening in high-risk populations.

As T vaginalis has high rates of reinfection, the CDC also recommends women diagnosed with trichomoniasis be tested for reinfection 2 to 12 weeks after treatment. However, there is currently little data on adherence to these guidelines.

Investigators conducted a study to evaluate adherence to the CDC’s retesting guidelines in women with trichomoniasis and determine the outcomes in women who did not receive retesting. Participants included patients who were tested for T vaginalis from January 1, 2015, to December 31, 2019, at a hospital-based clinic.

Yale University’s Joint Data Analytics Team extracted individual and encounter-level data from the clinic’s electronic health record (EHR). Demographic and clinical characteristics were categorized using descriptive statistics, while 1 or more positive trichomoniasis test was determined using bivariate and multivariable logistic regression.

Nucleic acid amplification tests, T vaginalis antigen tests, and transcription-mediated amplification tests were included in the analysis. Patient characteristics included race, ethnicity, age, smoking history, and marital status.

The primary outcome of the study was the prevalence of patients with trichomoniasis who were retested within 3 months. This outcome was determined by documentation of a test performed in this timeframe.

Women who were pregnant while testing for T vaginalis were evaluated for characteristics of trichomoniasis during pregnancy, with pregnancy determined by a prenatal visit or International Classification of Diseases encounter consistent with pregnancy. Investigators also evaluated the prevalence of T vaginalis within the patient population.

There were 8809 patients who received testing for T vaginalis during the study period, 9.1% of which received at least 1 positive test. Of patients, 61% were aged 25 to 44 years, 79% were Black or Hispanic, 69% of single marital status, 73% multigravidas, and 63% never-smokers. A positive HIV diagnosis was seen in 1% of patients receiving testing.

T vaginalis was seen in 6% to 8% of patients per year. The risk of trichomoniasis was 3 times greater in non-Hispanic Black women than non-Hispanic White women. Significantly increased odds of trichomoniasis were also seen in current or former smokers.

Of the 799 patients with trichomoniasis during the study period, 57% were retested, with 27% being retested within 90 days or less. Of patients who received retesting, 24% tested positive for T vaginalis. Age over 44 years was the only variable significantly associated with a positive retest.

A median 100 days occurred between a positive test and repeated testing. The odds of retesting in the recommended timeframe were significantly lower in non-Hispanic Black patients than non-Hispanic White patients.

There were 3493 patients who were pregnant at the time of T vaginalis testing, 5.6% of which tested positive. Similar characteristics and associations with trichomoniasis were seen in pregnant patients compared to the general study population.

These results indicated low rates of adherence to retesting guidelines despite a high prevalence of trichomoniasis reinfection. Investigators recommended strategies be implemented to improve retesting rates.

Reference

Getaneh FW, Oliveira CR, Pathy S, Sheth SS. Disparities in adherence to retesting guidelines in women with Trichomonas vaginalis infection. Am J Obstet Gynecol. 2023;229(3):284.E1-284.E10. doi:10.1016/j.ajog.2023.06.045