SM Rogers FOR MSSP RESEARCH TEAM

Increased risk for T. vaginalis in an urban

population of young adults

Monitoring STIs in the Population Research Team

• Susan M Rogers, Research Triangle Institute• Charles F Turner, City University of New York• Bill Miller, University of North Carolina, Chapel Hill• Emily Erbelding, Johns Hopkins Medical Institutions• Marcia Hobbs, University of North Carolina, Chapel

Hill• Elizabeth Eggleston, Research Triangle Institute• Anthony Roman, University of Massachusetts• Sylvia Tan, Research Triangle Institute• James Chromy, Research Triangle Institute• Ravikiran Muvva, Baltimore City Health Department

Trichomoniasis

Most common, curable sexually transmitted disease worldwide (WHO 2001, CDC)

Associated with increased risk for HIV, HSV-2, PID

Caused by motile protozoan, T. vaginalisVariety of diagnostic tools available

MAY 2011: FDA approved PCR (Gen-Probe)

Epidemiology of T. vaginalis

Current understanding largely limited to clinical settings and special populations

U.S. population assessments 2001-04 NHANES 2001-02 Add Health

Case reporting data not available in U.S.

In general, epidemiological studies suggest T. vaginalis:

Is more common among women than menVaries by race/ethnicity, ageGenerally asymptomaticFrequent co-morbidity with other STIsAmong population subgroups, TV prevalence

exceeds that of other STIs, i.e., CT and GC

Monitoring STIs in the Population (MSSP) Study Objectives

Assess prevalence of T. vaginalis and C. trachomatis among young adults, Baltimore, MD 2006-09

Identify characteristics and behaviors associated with TV and CT infection

Compare trends in infection prevalence over time

2006-09 MSSP: Survey methods

Probability sample of 15-35 year-olds residing in Baltimore with land-line telephone

Telephone-ACASI on sexual behaviors and STI history

Mail-out, mail-back specimen collection, TMA testing for TV and APTIMA (Gen-Probe) for CT

Sampling weights derived

2006-09 MSSP: Results

4,996 eligible households identifiedInterviews completed with 2,936 (59%)

1843 women, 1093 men Mean age, 24.6 yrs. 62.3% Black, 76.8% never married

2,120 (73%) provided valid specimens for STI testing

Imputation for specimen non-response

Estimated prevalence of TV and CT

Prevalence

Estimated prevalence of TV and CT infection

From bio-specimens alone

TV 7.5% (6.0, 9.0)

CT 3.9% (2.7, 5.0)Bio-specimens plus imputations (MI of 5-2-2011)

TV 7.6% (6.1, 9.0) CT 4.1% (2.9, 5.3)

Estimated prevalence of T. vaginalis: sex and race

Estimated prevalence of C. trachomatis: sex and race

Estimated prevalence of TV and CT by age

Estimated prevalence of T. vaginalis: age and sex

Other Risk factors for TV and CT

TV CTPR (95% CI)* PR (95% CI)*

New partner past 3 months

1.8 (1.2, 2.8) 3.7 (2.1, 6.7)

3+ partners past year

1.6 (1.1, 2.4) 3.0 (1.7, 5.3)

Previous STI 1.9 (1.3, 2.8) 1.0 (0.6, 1.9)

Multiple infections

3.4 (1.8, 6.3) 3.7 (1.9, 7.7)

Partner concurrency

1.4 (0.9, 2.2) 1.5 (0.8, 2.7)

*Models control for age, sex, and race/ethnicity

Trends in TV and CT, 2006-09

Methodological considerations/lessons

Challenges of population-based studies

Expensive T-ACASI Specimen collection Mail-out, mail-back Representativeness/response rates

Increased use of cell phones, decrease in land-lines

Methodological considerations/lessons

Specimen testing

Use of non-FDA approved test for TV diagnosis Test performance in low prevalence population Disclosure of research results

Conclusions: 2006-09 MSSP

Epidemiology of T. vaginalis: Higher prevalence of TV than CT TV more common among women than men,

particularly high among Black women (16.1%)

Substantial co-infection with CT Prevalence of TV was consistently high

across all age groups Majority infections asymptomatic

Trend analysis: rates similar over period observed

Implications of these results

Routine screening for TV in conjunction with CT in populations at elevated risk of infection should be considered

Expand our understanding of TV epidemiology Improve detection and enhance treatment to

avoid health complications

Research Support

NIH grant R01-HD047163 from the National Institute of Child Health and Human Development