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Poster Presentations
PS02 – POSTER VIEWING SESSION – TUESDAY
Tuesday, July 16, 2019 5:45 PM – 7:00 PM
P790 Determining the origins of repeat trichomonas vaginalis infections using clinical versus genotype-informed criteria
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  1. Patricia Kissinger1,
  2. Martina Bradic2,
  3. Christina Muzny3,
  4. Leandro Mena4,
  5. Rebecca Lillis5,
  6. Jane Schwebke3,
  7. Laura Beauchamps4,
  8. Stephanie Taylor5,
  9. Norine Schmidt6,
  10. Peter Augostini7,
  11. William Secor7,
  12. Jane Carlton2,
  13. David Martin6
  1. 1Tulane School of Public Health and Tropical Medicine, New Orleans, USA
  2. 2New York University, Center for Genomics and Systems Biology, New York, USA
  3. 3University of Alabama at Birmingham, Medicine, Birmingham, USA
  4. 4University of Mississippi Medical Center, Medicine, Jackson, USA
  5. 5Louisiana State University, Department of Health Sciences, New Orleans, USA
  6. 6Tulane University School of Public Health and Tropical Medicine, Epidemiology, New Orleans, USA
  7. 7Centers for Disease Control and Prevention, Division of Parasitic Diseases and Malaria, Atlanta, USA

Abstract

Background High rates of repeat T. vaginalis infections post-treatment have been reported. It is essential to understand the origin of these infections (i.e. treatment failure or reinfection) to determine the best secondary prevention measures. Self-reported sexual behavior and medication adherence can be subject to bias. The purpose of this study is to examine the origins of early repeat T. vaginalis infections in women using clinical versus genotype-informed criteria.

Methods Women with T. vaginalis confirmed by culture or nucleic acid amplification test (NAAT), who were randomized to receive 2 g or 7-day 500 mg BID metronidazole (MTZ), were retested 3–12 weeks post treatment at test-of-cure (TOC). Viable isolates from women who were TOC TV+ were genotyped (baseline and TOC isolates) and MTZ susceptibility (TOC only) was evaluated. Sexual and treatment adherence histories were elicited by computer-assisted self-administered survey. Treatment failure was defined using two criteria: 1) clinical (a combination of MTZ adherent per self-report+ no follow-up sexual exposure per self-report + no MTZ resistance), and 2) genotype-informed (concordant baseline and TOC genotype with no follow-up sexual exposure per self-report).

Results Of 80 repeat positives, 78 were evaluated using clinical and 49 using genotype-informed criteria. Per clinical criteria, 87.2% were treatment failure, 7.7% were reinfection and 5.1% were new infection. Per genotype-informed criteria, 51.0% were treatment failure, 10.2% were reinfection and 38.3% were new infection. In subset analysis, comparing the 49 with both clinical and genotype-informed assessments, 61.2% agreed and 38.8% disagreed (kappa 0.29 indicating poor reliability). Of 44 women who denied having a new partner during follow-up, 14 (31.8%) had a discordant genotype.

Conclusion Using either criteria, most TOC T. vaginalis positives were treatment failure rather than re-infections. Clinical and genotype-informed classification were not well correlated. Possible explanations for this will be discussed.

Disclosure No significant relationships.

  • Trichomonas

https://doi.org/10.1136/sextrans-2019-sti.845

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