title: Male partner circumcision associated with lowerTrichomonas vaginalisincidence among pregnant and postpartum Kenyan women: a prospective cohort study.
abstract: Trichomonas vaginalisis the world's most common curable STI and has implications for reproductive health in women. We determined incidence and correlates ofT. vaginalisin an HIV-uninfected peripartum cohort.
  
  
  
  Women participating in a prospective study of peripartum HIV acquisition in Western Kenya were enrolled during pregnancy and followed until 9 months post partum.T. vaginaliswas assessed every 1-3 months using wet mount microscopy. Correlates of incidentT. vaginaliswere determined using Cox proportional hazards models.
  
  
  
  Among 1271 women enrolled, median age was 22 years (IQR 19-27) and gestational age was 22 weeks (IQR 18-26); most (78%) were married and had uncircumcised male partners (69%). PrevalentT. vaginaliswas detected in 81 women (6%) at enrolment. Among women withoutT. vaginalisat enrolment, 112 hadT. vaginalisdetected during 1079 person-years of follow-up (10.4 per 100 person-years). After adjustment for socio-economic factors, male partner circumcision status, pregnancy status and other STIs,T. vaginalisincidence was higher during pregnancy than post partum (22.3 vs 7.7 per 100 person-years, adjusted HR (aHR) 3.68, 95% CI 1.90 to 7.15, p<0.001). Women with circumcised male partners had a 58% lower risk of incidentT. vaginaliscompared with women with uncircumcised partners (aHR 0.42, 95% CI 0.23 to 0.76, p=0.004). Employed women had lower risk of incidentT. vaginalisthan unemployed women (aHR 0.49, 95% CI 0.31 to 0.79, p=0.003); recent STI was associated with increasedT. vaginalisrisk (aHR 2.97, 95% CI 1.49 to 5.94, p=0.002).
  
  
  
  T. vaginaliswas relatively common in this peripartum cohort. Male circumcision may confer benefits in preventingT. vaginalis.
authors: Department of Global Health, University of Washington, Seattle, USA.|Department of Nursing, University of Washington, Seattle, USA.
authors: Jillian
authors: 0000-0003-1255-7191
authors: J
authors: Pintye
authors: Department of Global Health, University of Washington, Seattle, USA.
authors: Alison L
authors: 0000-0002-4178-7706
authors: AL
authors: Drake
authors: Department of Global Health, University of Washington, Seattle, USA.|Department of Obstetrics and Gynecology, University of Washington, Seattle, USA.
authors: Jennifer A
authors: JA
authors: Unger
authors: Department of Research & Programs, Kenyatta National Hospital, Nairobi, Kenya.
authors: Daniel
authors: D
authors: Matemo
authors: Department of Research & Programs, Kenyatta National Hospital, Nairobi, Kenya.
authors: John
authors: J
authors: Kinuthia
authors: Department of Global Health, University of Washington, Seattle, USA.|Department of Medicine, University of Washington, Seattle, USA.|Department of Epidemiology, University of Washington, Seattle, USA.|University of Nairobi Institute of Tropical and Infectious Diseases, University of Nairobi, Nairobi, Kenya.
authors: R Scott
authors: RS
authors: McClelland
authors: Department of Global Health, University of Washington, Seattle, USA.|Department of Medicine, University of Washington, Seattle, USA.|Department of Epidemiology, University of Washington, Seattle, USA.|Department of Pediatrics, University of Washington, Seattle, USA.
authors: Grace
authors: G
authors: John-Stewart
mesh_terms: D000328:Adult; D002944:Circumcision, Male / Q000706:statistics & numerical data*; D005260:Female; D006801:Humans; D015994:Incidence; D007630:Kenya / Q000453:epidemiology; D008297:Male; D049590:Postpartum Period; D011247:Pregnancy; D011251:Pregnancy Complications, Infectious / Q000453:epidemiology* / Q000517:prevention & control*; D015995:Prevalence; D011446:Prospective Studies; D012747:Sexual Partners; D014245:Trichomonas Infections / Q000453:epidemiology* / Q000517:prevention & control*; D014246:Trichomonas vaginalis
keywords: EPIDEMIOLOGY (CLINICAL); PREGNANCY; TRICHOMONAS; WOMEN