Epidemiology of Trichomonas vaginalis and human papillomavirus infection detected by real-time PCR in flanders.
OBJECTIVE
The goal of this cross-sectional laboratory-based study is to investigate the association between Trichomonas vaginalis (TV) and human papillomavirus (HPV) infections in cervical samples in Flanders.


METHODS
Liquid-based cervical cytology samples from unselected women, covering a population of 14-97 years of age (n = 62,636), and from professional sex workers of the region of Antwerp (n = 308), all residents of Flanders (North Belgium) and participating in cervical cancer screening, were assessed for the presence of TV and HPV.


METHODS
During 7 months in 2008, 62,944 consecutive liquid-based cytology cervical cancer screening samples were assessed for cytological abnormalities. All samples were tested by real-time quantitative PCR for the presence of TV as well as for low-risk HPV (lrHPV) types 6, 11, 53, 66 and 67, and high-risk HPV (hrHPV) types 16, 18, 31, 33, 35, 39, 45, 51, 52, 56, 58, 59, and 68. Association between TV and HPV infections with age, geographic area and occurrence of cytologic lesions were investigated.


RESULTS
The overall prevalence of TV in the general population in Flanders was 0.37%, with the highest prevalence in women aged 41-45 years (0.53%). HPV was detected in 15.1% of cervical samples and peaked in younger women of ages 21-25 years (26.8%). The prevalence of TV was higher in women with HPV infections as compared to women without HPV (0.61 vs. 0.33%, p < 0.0001). In women of suggestive foreign origin, TV prevalence was 4 times higher than in the probably autochthonous population (1.16 vs. 0.29%, p < 0.0001). Working in the sex industry had an increased risk of both HPV and TV when compared to other women (OR 8.6, 95% CI 4.4-16.9, p < 0.0001) and a higher rate of TV was also observed in urban regions, compared to rural areas (OR 1.7 (1.3-2.2), p = 0.0002).


CONCLUSIONS
The prevalence of TV in Flanders is lower compared to data from the literature, whereas the prevalence of HPV infection is similar to that reported in other European countries with similar test systems. Both TV and HPV are sexually transmitted infections, but our prevalence data suggest that the epidemiology of HPV and TV are different in Flanders. Highest HPV prevalence is found in young women whereas TV is more frequent in older women. Although some epidemiological peculiarities of the society, such as promiscuity and import from overseas countries, can possibly account for the differences in epidemiology, the exact reasons remain to be elucidated in further studies.
Laboratory for Clinical Pathology and Molecular Biology, University of Antwerp, Antwerp, Belgium. Christophe.Depuydt @ riatol.be
Christophe E
CE
Depuydt
Elke
E
Leuridan
Pierre
P
Van Damme
Johannes
J
Bogers
Annie J
AJ
Vereecken
Gilbert G G
GG
Donders
D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D001530:Belgium / Q000453:epidemiology; D002584:Cervix Uteri / Q000469:parasitology / Q000473:pathology / Q000821:virology; D003430:Cross-Sectional Studies; D005260:Female; D006801:Humans; D008875:Middle Aged; D027383:Papillomaviridae / Q000235:genetics / Q000302:isolation & purification*; D030361:Papillomavirus Infections / Q000150:complications / Q000175:diagnosis / Q000453:epidemiology*; D016133:Polymerase Chain Reaction; D011477:Sex Work; D014247:Trichomonas Vaginitis / Q000150:complications / Q000175:diagnosis / Q000453:epidemiology*; D014246:Trichomonas vaginalis / Q000235:genetics / Q000302:isolation & purification*