By Rebecca Bowers

EXECUTIVE SUMMARY

Results of a new analysis indicate that trichomoniasis disproportionately affects the black community. Data indicate that while the prevalence of Trichomonas vaginalis infection was 0.03% and 0.8% among males and females of other races/ethnicities, the prevalence was significantly higher among black males and females at 4.2% and 8.9%, respectively.

  • Trichomoniasis is the most common curable sexually transmitted infection. An estimated 3.7 million people in the United States have the infection.
  • Trichomoniasis is a facilitator of HIV transmission and acquisition. If infection is left untreated in women, it can lead to pelvic inflammatory disease and infertility.

Check the data from the Centers for Disease Control and Prevention (CDC) trichomoniasis is the most common curable sexually transmitted infection. An estimated 3.7 million people in the United States have the infection, which is caused by a protozoan parasite called Trichomonas vaginalis (TV).1 Although symptoms of the disease vary, most people who have the parasite cannot tell they are infected.

Results of a new analysis indicate that trichomoniasis disproportionately affects the black community.2 To examine the prevalence of the infection, researchers from Johns Hopkins University and the National Institute of Allergy and Infectious Diseases looked at data from the 2013-2014 National Health and Nutrition Examination Survey, a collection of health information from the United States’ noninstitutionalized, civilian population. Data were gathered from urine sample analysis from men and women 18 to 59 years of age.

The 4,057 total participants in the analysis included 1,942 males and 2,115 females; 822 participants identified as non-Hispanic black and 3,235 identified as other races/ethnicities. The study indicates that although the prevalence of TV infection was 0.03% and 0.8% among males and females of other races/ethnicities, the prevalence of the infection was significantly higher among black males and females at 4.2% and 8.9%, respectively.2

The study found that a higher prevalence of infection with T. vaginalis was associated with patients who were female, black, and older, and with those who had less than a high school education and were living below the poverty level. These factors were independent of having multiple sexual partners. The prevalence of infection also was linked with socioeconomic status. Those living below the poverty level had a prevalence of 3.9%, compared to 0.6% for those living at or above the poverty level. People without a high school education had a prevalence of 2.9%, compared to 0.8% for those who had at least a high school education.

“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,” says Aaron Tobian, MD, PhD, associate professor of pathology at the Johns Hopkins University School of Medicine and the study’s senior author. “Targeted public health education about Trichomonas will be critical.”

Many Are Asymptomatic

It is estimated that 70% of people infected with Trichomonas vaginalis do not have any signs or symptoms. When symptoms are present, they can range from mild irritation to severe inflammation. Some patients may present with symptoms within five to 28 days after being infected, while others do not develop symptoms until much later, according to the CDC.1

Men with trichomoniasis may present with symptoms such as:

  • Itching or irritation inside the penis;
  • Burning after urination or ejaculation; or
  • Discharge from the penis.

Women with trichomoniasis may have symptoms such as:

  • Itching, burning, redness, or soreness of the genitals;
  • Discomfort with urination; or
  • A change in vaginal discharge, such as a thin discharge or increased volume, that can be clear, white, yellowish, or greenish, with an unusual fishy smell.1

How can trichomoniasis can be treated? Clinicians may prescribe either oral metronidazole or tinidazole, reminding patients not to drink alcohol within 24 hours after taking such medication.

One challenge with trichomoniasis is reinfection. It is estimated that about one in five people become infected again within three months after receiving treatment.3 To help patients avoid reinfection, providers should emphasize the importance of treating all sex partners. Clinicians also should counsel patients to wait seven to 10 days after both partners have been treated before having sex again.

Strides to Be Made

Trichomoniasis is a facilitator of HIV transmission and acquisition.4 If infection is left untreated in women, it can lead to pelvic inflammatory disease and infertility.

Screening for T. vaginalis infection currently is recommended only for people who are HIV-positive. Findings from the current study should encourage broader screening initiatives, educational programming, and policy changes to ensure access to sexual health care, says Eshan Patel, MPH, a research data analyst at Johns Hopkins University and lead author of the study.

“It’s unfortunate that TV infection hasn’t received a stronger public health response, especially since it is easy to diagnose and treat,” said Patel in a press statement. “TV infection can be detected using the same diagnostic platform as the one used for chlamydia and can be cured with just one pill (metronidazole).”

The current study underscores the importance of providing a large number of condoms to women and men in various healthcare settings, says Robert Hatcher, MD, MPH, professor emeritus of gynecology and obstetrics at Emory University School of Medicine in Atlanta. It also points to the importance of providing treatment for both partners when just one partner is found to have a T. vaginalis infection, he states.

REFERENCES

  1. Centers for Disease Control and Prevention. Trichomoniasis. Fact sheet. Available at: https://bit.ly/2qmbG54. Accessed April 18, 2018.
  2. Patel EU, Gaydos CA, Packman ZR, et al. Prevalence and correlates of Trichomonas vaginalis infection among men and women in the United States. Clin Infect Dis 2018; doi: 10.1093/cid/ciy079.
  3. Menezes CB, Frasson AP, Tasca T. Trichomoniasis are we giving the deserved attention to the most common non-viral sexually transmitted disease worldwide? Microb Cell 2016;3:404-419.
  4. Kissinger P. Trichomonas vaginalis: A review of epidemiologic, clinical and treatment issues. BMC Infect Dis 2015;15:307.