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Male partner circumcision associated with lower Trichomonas vaginalis incidence among pregnant and postpartum Kenyan women: a prospective cohort study
  1. Jillian Pintye1,2,
  2. Alison L Drake1,
  3. Jennifer A Unger1,3,
  4. Daniel Matemo4,
  5. John Kinuthia4,
  6. R Scott McClelland1,5,6,7,
  7. Grace 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. 7University of Nairobi Institute of Tropical and Infectious Diseases, University of Nairobi, Nairobi, Kenya
  8. 8Department of Pediatrics, University of Washington, Seattle, USA
  1. Correspondence to Jillian Pintye, Department of Global Health, University of Washington, 325 Ninth Ave., Box 359909, Seattle, WA 98104, USA; jpintye{at}uw.edu

Abstract

Objective Trichomonas vaginalis is the world's most common curable STI and has implications for reproductive health in women. We determined incidence and correlates of T. vaginalis in an HIV-uninfected peripartum cohort.

Methods Women participating in a prospective study of peripartum HIV acquisition in Western Kenya were enrolled during pregnancy and followed until 9 months post partum. T. vaginalis was assessed every 1–3 months using wet mount microscopy. Correlates of incident T. vaginalis were determined using Cox proportional hazards models.

Results Among 1271 women enrolled, median age was 22 years (IQR 19–27) and gestational age was 22 weeks (IQR 18–26); most (78%) were married and had uncircumcised male partners (69%). Prevalent T. vaginalis was detected in 81 women (6%) at enrolment. Among women without T. vaginalis at enrolment, 112 had T. vaginalis detected during 1079 person-years of follow-up (10.4 per 100 person-years). After adjustment for socio-economic factors, male partner circumcision status, pregnancy status and other STIs, T. vaginalis incidence was higher during pregnancy than post partum (22.3 vs 7.7 per 100 person-years, adjusted HR (aHR) 3.68, 95% CI 1.90 to 7.15, p<0.001). Women with circumcised male partners had a 58% lower risk of incident T. vaginalis compared with women with uncircumcised partners (aHR 0.42, 95% CI 0.23 to 0.76, p=0.004). Employed women had lower risk of incident T. vaginalis than unemployed women (aHR 0.49, 95% CI 0.31 to 0.79, p=0.003); recent STI was associated with increased T. vaginalis risk (aHR 2.97, 95% CI 1.49 to 5.94, p=0.002).

Conclusions T. vaginalis was relatively common in this peripartum cohort. Male circumcision may confer benefits in preventing T. vaginalis.

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Footnotes

  • Handling editor Jackie A Cassell

  • Contributors JP, ALD, JK, JAU, DM, RSMcC and GJ-S conceived the question and designed the study. GJ-S obtained funding for the study. ALD, JK, JAU, DM, RSMcC and GJ-S participated in data collection. JP, ALD and GJ-S conducted the data analyses. All authors participated in preparation of the manuscript and approved the final draft for submission.

  • Funding This study was funded through National Institutes of Health grant (P01 HSD 064915; T32 T32AI07140 to JP; K01 AI116298 to ALD; K24 HD054314 to GJ-S) and received assistance from the University of Washington Center for AIDS Research (P30 AI27757). The Mama Salama Study Team was supported by the University of Washington's Global Center for Integrated Health of Women Adolescents and Children (Global WACh).

  • Competing interests None declared.

  • Patient consent Obtained.

  • Ethics approval All study procedures were approved by the Kenyatta National Hospital/University of Nairobi Ethical Research Committee (#P11/4/2010) and the University of Washington Institutional Review Board (#38472A) prior to study initiation.

  • Provenance and peer review Not commissioned; externally peer reviewed.

  • Data sharing statement Detailed information on study data is available from GJ-S upon request at gjohn@uw.edi

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