title: A cross-sectional analysis ofTrichomonas vaginalisinfection among heterosexual HIV-1 serodiscordant African couples.
abstract: Trichomonas vaginalisis the most prevalent curable STI worldwide and has been associated with adverse health outcomes and increased HIV-1 transmission risk. We conducted a cross-sectional analysis among couples to assess how characteristics of both individuals in sexual partnerships are associated with the prevalence of male and femaleT. vaginalisinfection.
  
  
  
  African HIV-1 serodiscordant heterosexual couples were concurrently tested for trichomoniasis at enrolment into two clinical trials.T. vaginalistesting was by nucleic acid amplification or culture methods. Using Poisson regression with robust standard errors, we identified characteristics associated with trichomoniasis.
  
  
  
  Among 7531 couples tested for trichomoniasis, 981 (13%) couples contained at least one infected partner. The prevalence was 11% (n=857) among women and 4% (n=319) among men, and most infected individuals did not experience signs or symptoms ofT. vaginalis. Exploring concordance ofT. vaginalisstatus within sexual partnerships, we observed that 61% (195/319) ofT. vaginalis-positive men and 23% (195/857) ofT. vaginalis-positive women had a concurrently infected partner. In multivariable analysis, having aT. vaginalis-positive partner was the strongest predictor of infection for women (relative risk (RR) 4.70, 95% CI 4.10 to 5.38) and men (RR 10.09, 95% CI 7.92 to 12.85). For women, having outside sex partners, gonorrhoea, and intermediate or high Nugent scores for bacterial vaginosis were associated with increased risk of trichomoniasis, whereas age 45 years and above, being married, having children and injectable contraceptive use were associated with reduced trichomoniasis risk. Additionally, women whose male partners were circumcised, had more education or earned income had lower risk of trichomoniasis.
  
  
  
  We found that within African HIV-1 serodiscordant heterosexual couples, the prevalence of trichomoniasis was high among partners ofT. vaginalis-infected individuals, suggesting that partner services could play an important role identifying additional cases and preventing reinfection. Our results also suggest that male circumcision may reduce the risk of male-to-femaleT. vaginalistransmission.
authors.affiliation: Department of Epidemiology, University of Washington, Seattle, Washington, USA.|Department of Global Health, University of Washington, Seattle, Washington, USA.
authors.forename: Aaron F
authors.initials: AF
authors.lastname: Bochner
authors.affiliation: Department of Epidemiology, University of Washington, Seattle, Washington, USA.|Department of Global Health, University of Washington, Seattle, Washington, USA.|School of Medicine, University of Washington, Seattle, Washington, USA.
authors.forename: Jared M
authors.initials: JM
authors.lastname: Baeten
authors.affiliation: Department of Medicine, University of California, San Francisco, California, USA.
authors.forename: Alison S
authors.initials: AS
authors.lastname: Rustagi
authors.affiliation: School of Public Health, Makerere University, Kampala, Uganda.
authors.forename: Edith
authors.initials: E
authors.lastname: Nakku-Joloba
authors.affiliation: Department of Global Health, University of Washington, Seattle, Washington, USA.|School of Medicine, University of Washington, Seattle, Washington, USA.|Department of Pediatrics, University of Washington, Seattle, Washington, USA.
authors.forename: Jairam R
authors.initials: JR
authors.lastname: Lingappa
authors.affiliation: Department of Global Health, University of Washington, Seattle, Washington, USA.|Center for Clinical Research, Kenya Medical Research Institute, Nairobi, Kenya.
authors.forename: Nelly R
authors.initials: NR
authors.lastname: Mugo
authors.affiliation: Department of Global Health, University of Washington, Seattle, Washington, USA.|Center for Microbiology Research, Kenya Medical Research Institute, Nairobi, Kenya.
authors.forename: Elizabeth A
authors.initials: EA
authors.lastname: Bukusi
authors.affiliation: Department of Infectious Disease Epidemiology, London School of Hygiene and Tropical Medicine, London, UK.
authors.forename: Saidi
authors.initials: S
authors.lastname: Kapiga
authors.affiliation: Wits Reproductive Health and HIV Institute, University of Witwatersrand, Johannesburg, South Africa.
authors.forename: Sinead
authors.initials: S
authors.lastname: Delany-Moretlwe
authors.affiliation: Department of Epidemiology, University of Washington, Seattle, Washington, USA.|Department of Global Health, University of Washington, Seattle, Washington, USA.|School of Medicine, University of Washington, Seattle, Washington, USA.
authors.forename: Connie
authors.initials: C
authors.lastname: Celum
authors.affiliation: Department of Epidemiology, University of Washington, Seattle, Washington, USA.|Department of Global Health, University of Washington, Seattle, Washington, USA.|School of Medicine, University of Washington, Seattle, Washington, USA.
authors.forename: Ruanne V
authors.initials: RV
authors.lastname: Barnabas
mesh_terms: D000328:Adult; D002944:Circumcision, Male; D003430:Cross-Sectional Studies; D016054:DNA, Protozoan; D005260:Female; D015658:HIV Infections / Q000453:epidemiology* / Q000517:prevention & control; D018023:HIV Seronegativity; D006679:HIV Seropositivity; D015497:HIV-1; D020010:Heterosexuality / Q000706:statistics & numerical data*; D006801:Humans; D008297:Male; D008875:Middle Aged; D011247:Pregnancy; D011251:Pregnancy Complications, Infectious / Q000453:epidemiology / Q000517:prevention & control; D015995:Prevalence; D011446:Prospective Studies; D012307:Risk Factors; D012725:Sexual Behavior; D012747:Sexual Partners; D014247:Trichomonas Vaginitis / Q000175:diagnosis / Q000453:epidemiology* / Q000517:prevention & control / Q000635:transmission; D014246:Trichomonas vaginalis / Q000235:genetics / Q000302:isolation & purification*
chemical_list: D016054:DNA, Protozoan
keywords: AFRICA; BACTERIAL VAGINOSIS; CIRCUMCISION; HORMONAL CONTRACEPTION; TRICHOMONAS