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Spontaneous resolution of Trichomonas vaginalis infection in men
  1. Olivia T. Van Gerwen1,
  2. Kristal J. Aaron1,
  3. Julia Schroeder1,
  4. Patricia J. Kissinger2,
  5. Christina A. Muzny1
  1. 1Division of Infectious Diseases, University of Alabama at Birmingham, Birmingham, Alabama, USA
  2. 2Department of Epidemiology, Tulane University School of Public Health and Tropical Medicine, New Orleans, Louisiana, USA
  1. Correspondence to Dr Olivia T. Van Gerwen, University of Alabama at Birmingham, Birmingham, AL 35294, USA; oliviavangerwen{at}


Objectives We aimed to investigate the early natural history of Trichomonas vaginalis in men recently testing positive for this infection by a nucleic acid amplification test (NAAT). We hypothesised that 50% of men would spontaneously resolve their infection (in the absence of treatment) on repeat T. vaginalis NAAT.

Methods Men ages ≥18 years at the Jefferson County Health Department Sexual Health Clinic testing positive for T. vaginalis by NAAT during standard-of-care (SOC) within the past 30 days and presenting to the clinic for treatment were approached. At enrolment, participants completed a questionnaire, provided urine for repeat T. vaginalis NAAT, and were treated with 2 g oral metronidazole. Those with a repeat positive enrolment NAAT were seen for a 4-week test-of-cure (TOC) visit. At TOC, men provided urine for repeat NAAT. We determined the proportion of men with spontaneous resolution of T. vaginalis and evaluated predictors of spontaneous resolution. In those with a repeat positive enrolment T. vaginalis NAAT, we evaluated the proportion with persistent infection at TOC as a secondary outcome.

Results Between October 2021 and January 2023, 53 men with a recent positive SOC T. vaginalis NAAT were approached; 37 (69.8%) participated. The mean participant age was 32.9 years (SD 9.9); all identified as Black. The majority (97.3%) reported sex with women only; 35.1% reported sex with >1 partner in the last month. At enrolment, 26/37 (70.3%) had a repeat positive T. vaginalis NAAT in the absence of treatment after an average of 8.4 days (SD 5.9). Sexual partner gender, number of recent sexual partners, genital symptoms, unprotected sex with any partner and recent antibiotic use were not associated with spontaneous resolution. Of the 26 men attending a TOC visit, 17 (65.4%) returned and all except one (94.1%) were cured.

Conclusion Most men do not spontaneously clear T. vaginalis infection during early repeat testing.

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  • Handling editor Miguel Fernández-Huerta

  • X @ChristinaMuzny

  • Contributors OVG: conceptualisation, investigation, writing (original draft and reviewing/editing). KJA: formal analysis, data curation, writing (reviewing/editing). JS: investigation, writing (reviewing/editing). PK: conceptualisation, funding acquisition, methodology, investigation, formal analysis, writing (reviewing/editing). CAM: conceptualisation, funding acquisition, investigation, project administration, methodology, writing (reviewing/editing).

  • Funding This study was funded by a 2021-2023 AMC21 Award granted to CAM by the UAB Heersink School of Medicine. OVG is currently funded by a 2022-2024 Frommeyer Career Development Award from the UAB Department of Medicine.

  • Competing interests OVG has received research grant support from NIH, Abbott Molecular, Gilead Sciences, Visby and Moderna, served on a scientific advisory board for Scynexis, and done consulting for El Sevier, GSK, Abbott Molecular and Thermo Fisher for which she received honoraria. CAM has received research grant support to her institution from NIH/NIAID, Lupin Pharmaceuticals, Gilead Sciences, Visby Medical and Abbott Molecular. She also reports honorarium and/or consulting fees from Scynexis, Cepheid, BioNTech, BioMed Diagnostics, Visby Medical, Elsevier, UpToDate, Abbott Molecular and Roche. All other authors have no relevant interests to disclose.

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