High prevalence of trichomoniasis in rural men in Mwanza, Tanzania: results from a population based study

Deborah Watson-Jones^1,5, Kokungoza Mugeye², Philippe Mayaud^1,3, Leonard Ndeki², James Todd¹, Frank Mosha⁵, Beryl West^1,5, Bernadette Cleophas-Frisch³, Heiner Grosskurth¹, Marie Laga⁴, Richard Hayes¹, David Mabey¹ and Anne Buvé⁴

¹ London School of Hygiene and Tropical Medicine, London, UK
² Municipal Office of Health, Mwanza, Tanzania
³ African Medical and Research Foundation (AMREF), Mwanza, Tanzania
⁴ Institute of Tropical Medicine, Antwerp, Belgium
⁵ National Institute of Medical Research, Mwanza, Tanzania

Correspondence to:
Professor Mabey d.mabey{at}lshtm.ac.uk

Objectives: To measure the prevalence of urethral infections including trichomoniasis in rural Tanzanian men, to assess the prevalence of symptoms and signs among men with Trichomonas vaginalis, and to analyse the risk factors for trichomoniasis.

Design: A cross sectional study of 1004 men aged 15–54 years in a rural community in north west Tanzania.

Methods: Participants were interviewed about sexual behaviour and symptoms of sexually transmitted diseases. First fraction urine samples and urethral swabs were collected and used to test for T vaginalis by wet preparation and culture, Neisseria gonorrhoeae by culture, Chlamydia trachomatis by ligase chain reaction and non-specific urethritis by Gram stain. Urine was also tested for the presence of leucocytes using a leucocyte esterase dipstick. Men were re-interviewed 2 weeks later to document new symptoms and signs of urethritis.

Results: Complete laboratory results were available on 980 men. One in four men had laboratory evidence of urethritis. T vaginalis was found in 109 individuals (11%), gonorrhoea in eight (0.8%), and chlamydial infection in 15 (1.5%). Over 50% of men with urethritis were asymptomatic. The prevalence of signs and symptoms was similar among men with T vaginalis alone compared with men with other urethral infections. The sensitivity and specificity of the leucocyte esterase dipstick (LED) test for detecting T vaginalis were 80% and 48% respectively in symptomatic men and 60% and 68% in asymptomatic men. Factors associated with trichomoniasis included religion, type of employment, and marital status.

Conclusions: A high prevalence of urethritis was found in men in this community based study. More than half of the urethral infections detected were asymptomatic. The most prevalent pathogen was T vaginalis. Studies are needed on the prevalence of trichomoniasis in men presenting to health services with complaints suggestive of urethritis since treatment for T vaginalis is not included in the syndromic management of urethritis in most countries. The performance of the LED test as a screening test for trichomoniasis was unsatisfactory in both symptomatic and asymptomatic men. Improved screening tests are urgently needed to identify urethral infections that are asymptomatic and which are not covered by current syndromic management algorithms.

Key Words: urethritis; Tanzania; Trichomonas vaginalis

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