Adolescent Trichomonas vaginalis in a High-burdened Region of the Southern United States.
Journal
Sexually transmitted diseases
ISSN: 1537-4521
Titre abrégé: Sex Transm Dis
Pays: United States
ID NLM: 7705941
Informations de publication
Date de publication:
07 2020
07 2020
Historique:
pubmed:
23
5
2020
medline:
27
4
2021
entrez:
23
5
2020
Statut:
ppublish
Résumé
We evaluated the clinical management and risk factors for Trichomonas vaginalis-positive adolescents in upstate South Carolina. An Epic electronic medical record report was generated to identify any physician-ordered T. vaginalis test from February 2016 to December 2017 for patients aged 12 to 18 years within the Prisma Health Upstate system. Utilizing a case-control study design of patients with a documented T. vaginalis diagnostic result, we reviewed records of patients with physician-ordered T. vaginalis tests for demographics, clinical disease course, sexually transmitted infection test results, treatment order and dosage, infection risk factors, comorbidities, pregnancy term, and neonatal birth outcomes. Of 789 male and female adolescents with physician-ordered T. vaginalis tests, 44% had a documented result. Of those with a document test result, 13% were T. vaginalis positive. Cases (n = 45) and randomly selected negative controls (n = 45) were all girls. Cases were more likely to be African American, symptomatic, and present with vaginal discharge, pain, and vulvar itch. T. vaginalis patients were more likely to have documented histories of chlamydia (P < 0.0001) and gonorrhea (P = 0.0191), with 18% having concurrent triple infections (T. vaginalis, chlamydia, and gonorrhea). All 26 pregnant girls with T. vaginalis delivered full-term, healthy infants. We identified a disproportionally high burden of T. vaginalis infection, with an alarmingly high rate of triple infections, among a population of suspected high-risk adolescents. Our results indicate the need to clarify infection prevalence, develop pediatrician-focused education campaigns, and elucidate potentially modifiable risk factors for these high-risk patients.
Sections du résumé
BACKGROUND
We evaluated the clinical management and risk factors for Trichomonas vaginalis-positive adolescents in upstate South Carolina.
METHODS
An Epic electronic medical record report was generated to identify any physician-ordered T. vaginalis test from February 2016 to December 2017 for patients aged 12 to 18 years within the Prisma Health Upstate system. Utilizing a case-control study design of patients with a documented T. vaginalis diagnostic result, we reviewed records of patients with physician-ordered T. vaginalis tests for demographics, clinical disease course, sexually transmitted infection test results, treatment order and dosage, infection risk factors, comorbidities, pregnancy term, and neonatal birth outcomes.
RESULTS
Of 789 male and female adolescents with physician-ordered T. vaginalis tests, 44% had a documented result. Of those with a document test result, 13% were T. vaginalis positive. Cases (n = 45) and randomly selected negative controls (n = 45) were all girls. Cases were more likely to be African American, symptomatic, and present with vaginal discharge, pain, and vulvar itch. T. vaginalis patients were more likely to have documented histories of chlamydia (P < 0.0001) and gonorrhea (P = 0.0191), with 18% having concurrent triple infections (T. vaginalis, chlamydia, and gonorrhea). All 26 pregnant girls with T. vaginalis delivered full-term, healthy infants.
CONCLUSIONS
We identified a disproportionally high burden of T. vaginalis infection, with an alarmingly high rate of triple infections, among a population of suspected high-risk adolescents. Our results indicate the need to clarify infection prevalence, develop pediatrician-focused education campaigns, and elucidate potentially modifiable risk factors for these high-risk patients.
Identifiants
pubmed: 32443082
doi: 10.1097/OLQ.0000000000001186
pii: 00007435-202007000-00014
doi:
Types de publication
Journal Article
Randomized Controlled Trial
Langues
eng
Sous-ensembles de citation
IM
Pagination
499-502Références
Mielczarek E, Blaszkowska J. Trichomonas vaginalis: Pathogenicity and potential role in human reproductive failure. Infection 2016; 44:447–458.
Allsworth JE, Ratner JA, Peipert JF. Trichomoniasis and other sexually transmitted infections: Results from the 2001–2004 National Health and nutrition examination surveys. Sex Transm Dis 2009; 36:738–744.
Sena AC, Miller WC, Hobbs MM, et al. Trichomonas vaginalis infection in male sexual partners: Implications for diagnosis, treatment, and prevention. Clin Infect Dis 2007; 44:13–22.
Kissinger P. Trichomonas vaginalis: a review of epidemiologic, clinical and treatment issues. BMC Infect Dis 2015; 15:307.
Daugherty M, Glynn K, Byler T. The prevalence of Trichomonas vaginalis infection among US males, 2013–2016. Clin Infect Dis 2018.
Yang S, Zhao W, Wang H, et al. Trichomonas vaginalis infection-associated risk of cervical cancer: A meta-analysis. Eur J Obstet Gynecol Reprod Biol 2018; 228:166–173.
Fastring DR, Amedee A, Gatski M, et al. Co-occurrence of Trichomonas vaginalis and bacterial vaginosis and vaginal shedding of HIV-1 RNA. Sex Transm Dis 2014; 41:173–179.
Moodley P, Wilkinson D, Connolly C, et al. Trichomonas vaginalis is associated with pelvic inflammatory disease in women infected with human immunodeficiency virus. Clin Infect Dis 2002; 34:519–522.
Satterwhite CL, Torrone E, Meites E, et al. Sexually transmitted infections among US women and men: Prevalence and incidence estimates, 2008. Sex Transm Dis 2013; 40:187–193.
Miller WC, Swygard H, Hobbs MM, et al. The prevalence of trichomoniasis in young adults in the United States. Sex Transm Dis 2005; 32:593–598.
Patel EU, Gaydos CA, Packman ZR, et al. Prevalence and correlates of Trichomonas vaginalis infection among men and women in the United States. Clin Infect Dis 2018.
Goyal M, Hayes K, McGowan KL, et al. Prevalence of Trichomonas vaginalis infection in symptomatic adolescent females presenting to a pediatric emergency department. Acad Emerg Med 2011; 18:763–766.
Silver BJ, Guy RJ, Kaldor JM, et al. Trichomonas vaginalis as a cause of perinatal morbidity: A systematic review and meta-analysis. Sex Transm Dis 2014; 41:369–376.
Incidence, Prevalence, and Cost of Sexually Transmitted Infections in the United States. In: National Center for HIV/AIDS VH, STD, and TB Prevention, ed: Centers for Disease Control and Prevention; 2013.
Kann L, McManus T, Harris WA, et al. Youth risk behavior surveillance—United States, 2017. MMWR Surveill Summ 2018; 67:1–114.
South Carolina's STD/HIV/AIDS data, surveillance report Decembere 31, 2016. South Carolina Department of Health Environmental Control; 2017.
Davis M, South Carolina Department of Health and Environmental Control, Public Health Laboratory. Trichomonas screening pilot in South Carolina, May 2016. 2018.
Owusu-Edusei K Jr., Chesson HW, Gift TL, et al. The estimated direct medical cost of selected sexually transmitted infections in the United States, 2008. Sex Transm Dis 2013; 40:197–201.
2018; Pages. Accessed at https://hsc.ghs.org/facilities/. Accessed 16 November 2018.
DSTDP. Strategic Summary 2017–2022. In: Prevention STDDoS, ed; 2017.
Sexually transmitted diseases treatment guidelines, 2015. MMWR Recomem Rep: Centers for Disease Control and Prevention; 2015:1–137.
Hobbs MM, Seña AC. Modern diagnosis of Trichomonas vaginalis infection. Sex Transm Infect 2013; 89:434–438.
de Brum Vieira P, Tasca T, Secor WE. Challenges and persistent questions in the treatment of trichomoniasis. Curr Top Med Chem 2017; 17:1249–1265.
Meites E, Gaydos CA, Hobbs MM, et al. A review of evidence-based care of symptomatic trichomoniasis and asymptomatic Trichomonas vaginalis infections. Clin Infect Dis 2015; 61(Suppl 8):S837–S848.
de Waaij DJ, Dubbink JH, Ouburg S, et al. Prevalence of Trichomonas vaginalis infection and protozoan load in South African women: A cross-sectional study. BMJ Open 2017; 7:e016959.
Bonney LE, Cooper HL, Caliendo AM, et al. Access to health services and sexually transmitted infections in a cohort of relocating African American public housing residents: An association between travel time and infection. Sex Transm Dis 2012; 39:116–121.
Fortenberry JD, Brizendine EJ, Katz BP, et al. Subsequent sexually transmitted infections among adolescent women with genital infection due to chlamydia trachomatis, Neisseria gonorrhoeae, or Trichomonas vaginalis. Sex Transm Dis 1999; 26:26–32.
Ricketts EJ, Francischetto EO, Wallace LM, et al. Tools to overcome potential barriers to chlamydia screening in general practice: Qualitative evaluation of the implementation of a complex intervention. BMC Fam Pract 2016; 17:33.
Van Der Pol B, Williams JA, Orr DP, et al. Prevalence, incidence, natural history, and response to treatment of Trichomonas vaginalis infection among adolescent women. J Infect Dis 2005; 192:2039–2044.
Lang AS, An der Heiden M, Jansen K, et al. Not again! Effect of previous test results, age group and reason for testing on (re-)infection with Chlamydia trachomatis in Germany. BMC Infect Dis 2018; 18:424.
Turpin R, Brotman RM, Miller RS, et al. Perceived stress and incident sexually transmitted infections in a prospective cohort. Ann Epidemiol 2019; 32:20–27.
Balkus JE, Richardson BA, Rabe LK, et al. Bacterial vaginosis and the risk of Trichomonas vaginalis acquisition among HIV-1–negative women. Sex Transm Dis 2014; 41:123–128.