Temporal associations with declining Trichomonas vaginalis diagnosis rates among women in the state of Victoria, Australia, 1947 to 2005.
BACKGROUND
To investigate the temporal associations between Trichomonas vaginalis (TV) diagnoses in women at a large urban sexual health clinic and a major Papanicolaou (Pap) smear screening laboratory in Victoria, Australia with Pap smear screening rates and the introduction of nitroimidazole treatments.


METHODS
An ecological analysis of TV diagnosis rates at the Melbourne Sexual Health Centre and the Victorian Cytology Service, Pap smear screening rates and nitroimidazole prescription data.


RESULTS
Diagnoses of TV at the Melbourne Sexual Health Centre peaked in the 1950s at 20% to 30% and then rapidly declined through the 1960s and 1970s to below 1% in 1990. A similar pattern was observed at the Victorian Cytology Service. Metronidazole prescribing and opportunistic Pap smear screening began in Victoria in the 1960s coinciding with declining TV. The availability of tinidazole in 1976 led to further declines in TV in the late 1970s. A national cervical screening program introduced in 1991 was temporally associated with further declines in TV.


CONCLUSIONS
Our analyses suggest that the introduction of metronidazole was associated with a large reduction in TV among Victorian women in the 1960s. The subsequent availability of tinidazole and increased Pap smear screening may have contributed to the current low TV prevalence in Victoria.
Marrone
John
J
School of Population Health, University of Melbourne, Victoria, Australia.
Fairley
Christopher K
CK
Saville
Marian
M
Bradshaw
Catriona
C
Bowden
Francis J
FJ
Horvath
Leonie B
LB
Donovan
Basil
B
Chen
Marcus
M
Hocking
Jane S
JS
D000554:Ambulatory Care Facilities; D000818:Animals; D000981:Antiprotozoal Agents / Q000627:therapeutic use; D005260:Female; D006801:Humans; D008795:Metronidazole / Q000627:therapeutic use; D065006:Papanicolaou Test; D015995:Prevalence; D014011:Tinidazole / Q000627:therapeutic use; D014247:Trichomonas Vaginitis / Q000175:diagnosis* / Q000453:epidemiology* / Q000469:parasitology; D014246:Trichomonas vaginalis / Q000302:isolation & purification*; D014505:Urban Population; D014626:Vaginal Smears / Q000706:statistics & numerical data; D014739:Victoria / Q000453:epidemiology
D000981:Antiprotozoal Agents; D014011:Tinidazole; D008795:Metronidazole