title: The epidemiology of trichomoniasis in women in four African cities.
abstract: OBJECTIVE
  To describe the epidemiology of Trichomonas vaginalis infection and its association with HIV infection, in women in four African cities with different levels of HIV infection.
  
  
  METHODS
  Cross-sectional study, using standardized methods, including a standardized questionnaire and standardized laboratory tests, in four cities in sub-Saharan Africa: two with a high prevalence of HIV infection (Kisumu, Kenya and Ndola, Zambia), and two with a relatively low prevalence of HIV (Cotonou, Benin and Yaoundé, Cameroon).
  
  
  METHODS
  In each city, a random sample of about 2000 adults aged 15-49 years was taken. Consenting men and women were interviewed about their socio-demographic characteristics and their sexual behaviour, and were tested for HIV, syphilis, herpes simplex virus type 2 (HSV-2), gonorrhoea, chlamydial infection, and (women only) T. vaginalis infection. Risk factor analyses were carried out for trichomoniasis for each city separately. Multivariate analysis, however, was only possible for Yaoundé, Kisumu and Ndola.
  
  
  RESULTS
  The prevalence of trichomoniasis was significantly higher in the high HIV prevalence cities (29.3% in Kisumu and 34.3% in Ndola) than in Cotonou (3.2%) and Yaoundé (17.6%). Risk of trichomoniasis was increased in women who reported more lifetime sex partners. HIV infection was an independent risk factor for trichomonas infection in Yaoundé [adjusted odds ratio (OR) = 1.8, 95% confidence interval (CI) = 0.9-3.7] and Kisumu (adjusted OR = 1.7, 95% CI = 1.1-2.7), but not in Ndola. A striking finding was the high prevalence (40%) of trichomonas infection in women in Ndola who denied that they had ever had sex.
  
  
  CONCLUSIONS
  Trichomoniasis may have played a role in the spread of HIV in sub-Saharan Africa and may be one of the factors explaining the differences in levels of HIV infection between different regions in Africa. The differences in prevalence of trichomoniasis between the four cities remain unexplained, but we lack data on the epidemiology of trichomoniasis in men. More research is required on the interaction between trichomoniasis and HIV infection, the epidemiology of trichomoniasis in men, and trichomonas infections in women who deny sexual activity.
authors.affiliation: Department of Microbiology, Institute of Tropical Medicine, Antwerp, Belgium. abuve@itg.be
authors.forename: A
authors.initials: A
authors.lastname: Buvé
authors.forename: H A
authors.initials: HA
authors.lastname: Weiss
authors.forename: M
authors.initials: M
authors.lastname: Laga
authors.forename: E
authors.initials: E
authors.lastname: Van Dyck
authors.forename: R
authors.initials: R
authors.lastname: Musonda
authors.forename: L
authors.initials: L
authors.lastname: Zekeng
authors.forename: M
authors.initials: M
authors.lastname: Kahindo
authors.forename: S
authors.initials: S
authors.lastname: Anagonou
authors.forename: L
authors.initials: L
authors.lastname: Morison
authors.forename: N J
authors.initials: NJ
authors.lastname: Robinson
authors.forename: R J
authors.initials: RJ
authors.lastname: Hayes
mesh_terms: D000293:Adolescent; D000328:Adult; D017954:Africa South of the Sahara / Q000453:epidemiology; D000818:Animals; D003430:Cross-Sectional Studies; D005260:Female; D015658:HIV Infections / Q000150:complications / Q000453:epidemiology; D006801:Humans; D008875:Middle Aged; D015995:Prevalence; D011897:Random Allocation; D012307:Risk Factors; D012725:Sexual Behavior; D011795:Surveys and Questionnaires; D014247:Trichomonas Vaginitis / Q000453:epidemiology* / Q000469:parasitology; D014246:Trichomonas vaginalis