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A cross-sectional analysis of Trichomonas vaginalis infection among heterosexual HIV-1 serodiscordant African couples
  1. Aaron F Bochner1,2,
  2. Jared M Baeten1,2,3,
  3. Alison S Rustagi4,
  4. Edith Nakku-Joloba5,
  5. Jairam R Lingappa2,3,6,
  6. Nelly R Mugo2,7,
  7. Elizabeth A Bukusi2,8,
  8. Saidi Kapiga9,
  9. Sinead Delany-Moretlwe10,
  10. Connie Celum1,2,3,
  11. Ruanne V Barnabas1,2,3
  12. for the Partners in Prevention HSV/HIV Transmission Study and Partners PrEP Study Teams
    1. 1 Department of Epidemiology, University of Washington, Seattle, Washington, USA
    2. 2 Department of Global Health, University of Washington, Seattle, Washington, USA
    3. 3 School of Medicine, University of Washington, Seattle, Washington, USA
    4. 4 Department of Medicine, University of California, San Francisco, California, USA
    5. 5 School of Public Health, Makerere University, Kampala, Uganda
    6. 6 Department of Pediatrics, University of Washington, Seattle, Washington, USA
    7. 7 Center for Clinical Research, Kenya Medical Research Institute, Nairobi, Kenya
    8. 8 Center for Microbiology Research, Kenya Medical Research Institute, Nairobi, Kenya
    9. 9 Department of Infectious Disease Epidemiology, London School of Hygiene and Tropical Medicine, London, UK
    10. 10 Wits Reproductive Health and HIV Institute, University of Witwatersrand, Johannesburg, South Africa
    1. Correspondence to Dr Aaron Bochner, University of Washington, 325 9th Ave, Box 359932, Seattle, WA 98104, USA; bochner{at}uw.edu

    Abstract

    Objectives Trichomonas vaginalis is the most prevalent curable STI worldwide and has been associated with adverse health outcomes and increased HIV-1 transmission risk. We conducted a cross-sectional analysis among couples to assess how characteristics of both individuals in sexual partnerships are associated with the prevalence of male and female T. vaginalis infection.

    Methods African HIV-1 serodiscordant heterosexual couples were concurrently tested for trichomoniasis at enrolment into two clinical trials. T. vaginalis testing was by nucleic acid amplification or culture methods. Using Poisson regression with robust standard errors, we identified characteristics associated with trichomoniasis.

    Results Among 7531 couples tested for trichomoniasis, 981 (13%) couples contained at least one infected partner. The prevalence was 11% (n=857) among women and 4% (n=319) among men, and most infected individuals did not experience signs or symptoms of T. vaginalis. Exploring concordance of T. vaginalis status within sexual partnerships, we observed that 61% (195/319) of T. vaginalis-positive men and 23% (195/857) of T. vaginalis-positive women had a concurrently infected partner. In multivariable analysis, having a T. vaginalis-positive partner was the strongest predictor of infection for women (relative risk (RR) 4.70, 95% CI 4.10 to 5.38) and men (RR 10.09, 95% CI 7.92 to 12.85). For women, having outside sex partners, gonorrhoea, and intermediate or high Nugent scores for bacterial vaginosis were associated with increased risk of trichomoniasis, whereas age 45 years and above, being married, having children and injectable contraceptive use were associated with reduced trichomoniasis risk. Additionally, women whose male partners were circumcised, had more education or earned income had lower risk of trichomoniasis.

    Conclusions We found that within African HIV-1 serodiscordant heterosexual couples, the prevalence of trichomoniasis was high among partners of T. vaginalis-infected individuals, suggesting that partner services could play an important role identifying additional cases and preventing reinfection. Our results also suggest that male circumcision may reduce the risk of male-to-female T. vaginalis transmission.

    • TRICHOMONAS
    • AFRICA
    • HORMONAL CONTRACEPTION
    • BACTERIAL VAGINOSIS
    • CIRCUMCISION

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    Footnotes

    • Handling editor Jackie A Cassell

    • Collaborators Partners PrEP Study Team: University of Washington Coordinating Center and Central Laboratories, Seattle: Connie Celum (principal investigator, protocol cochair), Jared M Baeten (medical director, protocol co-chair), Deborah Donnell (protocol statistician), Robert W Coombs, Lisa Frenkel, Craig W Hendrix, Jairam Lingappa, and M Juliana McElrath. Study sites and site principal investigators: Eldoret, Kenya (Moi University; Indiana University): Kenneth Fife, Edwin Were; Kabwohe, Uganda (Kabwohe Clinical Research Center): Elioda Tumwesigye; Jinja, Uganda (Makerere University; University of Washington): Patrick Ndase, Elly Katabira; Kampala, Uganda (Makerere University): Elly Katabira, Allan Ronald; Kisumu, Kenya (Kenya Medical Research Institute, University of California San Francisco): Elizabeth Bukusi, Craig Cohen; Mbale, Uganda (The AIDS Support Organization; Centers for Disease Control and Prevention, Uganda): Jonathan Wangisi, James Campbell, Jordan Tappero; Nairobi, Kenya (University of Nairobi; University of Washington): James Kiarie, Carey Farquhar, Grace John-Stewart; Thika, Kenya (University of Nairobi; University of Washington): Nelly Rwamba Mugo; Tororo, Uganda (Centers for Disease Control and Prevention, Uganda; The AIDS Support Organization): James Campbell, Jordan Tappero, Jonathan Wangisi. Data management for the HIV-serodiscordant couples studies was provided by DF/Net Research, and site laboratory oversight was provided by Contract Laboratory Services (University of the Witwatersrand, Johannesburg, South Africa). Study medication was donated by Gilead Sciences. The Partners in Prevention HSV/HIV Transmission Study Team: University of Washington Coordinating Center and Central Laboratories, Seattle, USA: Connie Celum (principal investigator), Anna Wald (protocol co-chair), Jairam R Lingappa (medical director), Jared M Baeten, Mary S Campbell, Lawrence Corey, Robert W Coombs, James P Hughes, Amalia Magaret, M Juliana McElrath, Rhoda Morrow, James I Mullins. Study site principal investigators and study coordinators at sites contributing data and samples to this study: Cape Town, South Africa (University of Cape Town): David Coetzee; Eldoret, Kenya (Moi University, Indiana University): Kenneth Fife, Edwin Were; Gaborone, Botswana (Botswana Harvard Partnership): Max Essex, Joseph Makhema; Kampala, Uganda (Infectious Disease Institute, Makerere University): Elly Katabira, Allan Ronald; Kisumu, Kenya (Kenya Medical Research Institute, University of California San Francisco): Elizabeth Bukusi, Craig Cohen; Moshi, Tanzania (Kilimanjaro Christian Medical College, Harvard University): Saidi Kapiga, Rachel Manongi; Nairobi, Kenya (University of Nairobi, University of Washington): Carey Farquhar, Grace John-Stewart, James Kiarie; Kitwe, Zambia (Rwanda Zambia HIV Research Group, and Emory University): Susan Allen, William Kanweka; Ndola, Zambia (Rwanda Zambia HIV Research Group, and Emory University): Susan Allen, Mubiana Inambao; Orange Farm, South Africa (Reproductive Health Research Unit, University of the Witwatersrand): Sinead Delany-Moretlwe, Helen Rees; Soweto, South Africa (Perinatal HIV Research Unit, University of the Witwatersrand): Guy de Bruyn, Glenda Gray, James McIntyre; Thika, Kenya (University of Nairobi, University of Washington): Nelly Rwamba Mugo.

    • Contributors AFB, JMB, ASR and RVB designed the study. JMB, EN-J, JRL, NRM, EAB, SK, SD-M and CC contributed to data collection. AFB developed the statistical analysis plan, performed the statistical analyses and led manuscript development. All authors contributed to the writing of this manuscript. The authors designed and executed the study, had full access to the raw data, performed all analyses, wrote the manuscript, and had final responsibility for the decision to submit for publication.

    • Funding The Bill and Melinda Gates Foundation (grant ID #26469 and #47674).

    • Competing interests None declared.

    • Patient consent Obtained.

    • Ethics approval University of Washington Human Subjects Review Committee (institutional review board ID: STUDY00000172 and STUDY00000867) as well as ethics review committees at each study site.

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

    • Data sharing statement Detailed information on study data is available upon request from RVB at rbarnaba@uw.edu.

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