Early repeated infections with Trichomonas vaginalis among HIV-positive and HIV-negative women.
BACKGROUND
The purpose of the study was to examine whether early repeated infections due to Trichomonas vaginalis among human immunuodeficiency virus (HIV)-positive and HIV-negative women are reinfections, new infections, or cases of treatment failure.


METHODS
Women attending an HIV outpatient clinic and a family planning clinic in New Orleans, Louisiana, who had culture results positive for T. vaginalis were treated with 2 g of metronidazole under directly observed therapy. At 1 month, detailed sexual exposure and sexual partner treatment information was collected. Isolates from women who had clinical resistance (i.e., who tested positive for a third time after treatment at a higher dose) were tested for metronidazole susceptibility in vitro.


RESULTS
Of 60 HIV-positive women with trichomoniasis, 11 (18.3%) were T. vaginalis positive 1 month after treatment. The 11 recurrences were classified as 3 probable reinfections (27%), 2 probable infections from a new sexual partner (18%), and 6 probable treatment failures (55%); 2 of the 6 patients who experienced probable treatment failure had isolates with mild resistance to metronidazole. Of 301 HIV-negative women, 24 (8.0%) were T. vaginalis positive 1 month after treatment. The 24 recurrences were classified as 2 probable reinfections (8%) and 22 probable treatment failures (92%); of the 22 patients who experienced probable treatment failure, 2 had strains with moderate resistance to metronidazole, and 1 had a strain with mild resistance to metronidazole.


CONCLUSIONS
HIV-positive women were more likely to have sexual re-exposure than were HIV-negative women, although the rate of treatment failure was similar in both groups. High rates of treatment failure among both HIV-positive and HIV-negative women indicate that a 2-g dose of metronidazole may not be adequate for treatment of some women and that rescreening should be considered.
Kissinger
Patricia
P
Department of Epidemiology, Tulane University School of Public Health and Tropical Medicine, Louisiana State University Health Sciences Center, New Orleans, Louisiana, USA. kissing@tulane.edu
Secor
W Evan
WE
Leichliter
Jami S
JS
Clark
Rebecca A
RA
Schmidt
Norine
N
Curtin
Erink
E
Martin
David H
DH
D000293:Adolescent; D000328:Adult; D000818:Animals; D005260:Female; D015658:HIV Infections / Q000150:complications; D006801:Humans; D008145:Louisiana / Q000453:epidemiology; D008795:Metronidazole / Q000008:administration & dosage / Q000494:pharmacology / Q000627:therapeutic use; D021261:Parasitic Sensitivity Tests; D012008:Recurrence; D014245:Trichomonas Infections / Q000188:drug therapy / Q000453:epidemiology* / Q000469:parasitology* / Q000517:prevention & control; D014246:Trichomonas vaginalis / Q000187:drug effects / Q000302:isolation & purification*
D008795:Metronidazole