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Supplemental Trichomonas vaginalis testing is required to maintain control following a transition from Pap smear to HPV DNA testing for cervical screening: a mathematical modelling study
  1. David Gabriel Regan1,
  2. Ben B Hui1,
  3. Rebecca J Guy1,
  4. Basil Donovan1,2,
  5. Jane S Hocking3,
  6. Matthew G Law1
  1. 1 Kirby Institute, UNSW Sydney, Sydney, New South Wales, Australia
  2. 2 Sydney Sexual Health Centre, Sydney, New South Wales, Australia
  3. 3 Melbourne School of Population and Global Health, University of Melbourne, Melbourne, Victoria, Australia
  1. Correspondence to Dr David Gabriel Regan, Kirby Institute, UNSW Sydney, Sydney NSW 2052, Australia; dregan{at}


Objectives Using mathematical modelling, we have previously shown that the prevalence of infection with Trichomonas vaginalis (TV) is likely to increase in the general population in Australia with the transition from Pap smear-based cervical screening to human papillomavirus (HPV) DNA testing. Here we use the existing model to estimate the level of supplemental testing required to maintain TV control.

Methods A compartmental mathematical model describing the transmission of TV in the general heterosexual population in Australia was used to evaluate the impact of a range of screening scenarios on TV prevalence over time following the transition to HPV DNA testing for cervical screening. Scenarios considered were the inclusion of a TV test with the HPV test and the addition of TV testing to routine chlamydia testing conducted in primary care.

Results Our modelling suggests that with sufficient coverage, inclusion of TV testing with routine chlamydia screening in general practice, TV prevalence can be reduced over time, but at the current reported coverage will gradually increase following the transition to HPV testing. Inclusion of TV testing with HPV testing in the cervical screening programme is preferable to no supplemental testing but is considerably less effective in controlling TV.

Conclusions These findings support the inclusion of TV testing with routine chlamydia testing of young people.

  • Trichomonas vaginalis
  • mathematical model
  • pap smear
  • chlamydia
  • cervical screening
  • sexually transmitted infections
  • HPV DNA tests

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  • Handling editor Jackie A Cassell

  • Contributors BBH and DGR designed, developed and calibrated the mathematical model, implemented the evaluation scenarios, and conducted the analyses of model output. RJG, BD, JSH and MGL contributed to study design and provided clinical and epidemiological advice. DGR wrote the first draft of the manuscript, and all authors contributed to the revised and final versions.

  • Funding This study was funded by the National Health and Medical Research Council (Program Grant 568971).

  • Competing interests None declared.

  • Patient consent for publication Not required.

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

  • Data availability statement Model code (written in Matlab) is available from the authors on request.