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The influence of bacterial vaginosis on the response to Trichomonas vaginalis treatment among HIV-infected women
  1. Megan Gatski1,
  2. David H Martin2,
  3. Judy Levison3,
  4. Leandro Mena4,
  5. Rebecca A Clark2,
  6. Mary Murphy2,
  7. Harold Henderson4,
  8. Norine Schmidt1,
  9. Patricia Kissinger1
  1. 1Department of Epidemiology, Tulane University School of Public Health and Tropical Medicine, New Orleans, Louisiana, USA
  2. 2Department of Medicine, Louisiana State University, New Orleans, Louisiana, USA
  3. 3Baylor College of Medicine, Department of Obstetrics and Gynecology, Houston, Texas, USA
  4. 4Department of Medicine, University of Mississippi, Jackson, Mississippi, USA
  1. Correspondence to Dr Patricia Kissinger, Tulane University School of Public Health and Tropical Medicine, Department of Epidemiology SL-18, 1440 Canal Street, New Orleans, LA 70112, USA; kissing{at}


Objective Trichomonas vaginalis (TV) is common in HIV+ women, and host factors may play a role in TV treatment outcomes. The purpose of this study was to examine the influence of bacterial vaginosis (BV) on the response to TV treatment among HIV+ women.

Methods A secondary analysis was conducted of a clinical trial which randomised HIV+/TV+ women to metronidazole (MTZ) treatment: 2 g (single-dose) versus 7 day 500 mg twice daily (multidose). BV was classified using Nugent scores from baseline Gram stains. Women were recultured for TV at test-of-cure (TOC) and again at 3 months if TV-negative at TOC. Repeat TV infection rates were compared for women with a baseline TV/BV coinfection versus baseline TV infection only, and stratified by treatment arm.

Results Among 244 HIV+/TV+ women (mean age=40.3, ±9.5; 92.2% African–American), the rate of BV was 66.8%. Women with BV were more likely to report douching and ≥1 recent sex partners. HIV+ women with baseline TV/BV coinfection were more likely to be TV-positive at TOC than women with baseline TV infection only (RR 2.42 (95% CI 0.96 to 6.07; p=0.05)). When stratified by treatment arm, the association was only found in the single-dose arm (p=0.02) and not in the multidose arm (p=0.92). This interaction did not persist at 3 months.

Conclusions For HIV+/TV+ women, the rate of BV was high, and BV was associated with early failure of the MTZ single-dose treatment for TV. Biological explanations require further investigation.

  • Trichomonas vaginalis
  • Bacterial vaginosis
  • HIV-infected women
  • bacterial vaginosis
  • trichomonas

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  • Funding This study was supported by NIH grant no U19 AI061972.

  • Competing interests None.

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