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O11.3 Trichomonas vaginalis risk and cofactors among peripartum kenyan women: protective association with male partner circumcision
  1. J Pintye1,2,
  2. AL Drake1,
  3. JA Unger3,
  4. D Matemo4,
  5. J Kinuthia4,
  6. RS McClelland1,5,6,7,
  7. G John-Stewart1,5,6,8
  1. 1Department of Global Health, University of Washington, Seattle, USA
  2. 2Department of Nursing, University of Washington, Seattle, USA
  3. 3Department of Obstetrics and Gynecology, University of Washington, Seattle, USA
  4. 4Department of Research Programs, Kenyatta National Hospital, Nairobi, Kenya
  5. 5Department of Medicine, University of Washington, Seattle, USA
  6. 6Department of Epidemiology, University of Washington, Seattle, USA
  7. 7Institute of Tropical and Infectious Diseases, University of Nairobi, Kenya
  8. 8Department of Pediatrics, University of Washington, Seattle, USA

Abstract

Introduction Trichomonas vaginalis (TV) is the most common non-viral sexually transmitted infection (STI) worldwide and has implications for reproductive health in young women. We measured risk and correlates of peripartum TV.

Methods Kenyan women participating in a prospective study of peripartum HIV acquisition were enrolled during pregnancy and attended monthly follow-up visits until 9 months postpartum; HIV-seroconverters were excluded. TV was assessed every 1–3 months using wet mount microscopy and treated per Kenyan national guidelines. Recurrent TV was defined as TV detected ≥30 days after treatment or documented TV clearance. Male partner characteristics were reported by women. Andersen-Gill survival models were used to measure correlates of TV adjusting for age, socio-economic status, marital status, male partner circumcision status, and other STIs.

Results 1271 women enrolled at a median of 22 weeks gestation (interquartile range [IQR] 18–26), representing 1223 person-years. Most women were married (78%), reported no prior STIs (94%) and had uncircumcised male partners (69%); median age was 22 years (IQR 19–27). Overall, 196 TV infections were detected (81 prevalent at baseline, 115 incident during follow-up) and 56 (28%) were recurrent; 25% of infections were symptomatic. TV incidence was 9.4 per 100 person-years. In multivariate analyses, women with circumcised male partners had a 36% lower risk of incident TV compared to women with uncircumcised partners (adjusted hazard ratio [aHR] 0.64, 95% CI 0.43–0.94, p = 0.023). Having lower education (<8 years) (aHR 1.74, 95% CI 1.18–2.57, p = 0.005), being unmarried (aHR 1.75, 95% CI 1.10–2.78, p = 0.017), and recent Chlamydia trachomatis infection (aHR 2.06, 95% CI 1.24–3.44, p = 0.006) were associated with TV. Compared to nonuse, postpartum injectable or oral hormonal contraception use was not associated with TV risk.

Conclusion TV was relatively common in this peripartum cohort. Male circumcision promotion for HIV prevention may confer benefits in preventing TV among women in this setting.

Disclosure of interest statement We have no conflicts of interest to disclose.

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