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