(P449-LB) Trichomoniasis testing amongst women in Maryland who self-Collect specimens through a mail-in STI testing program (IWantTheKit)

Background

According to the CDC, the prevalence of trichomoniasis in the United States was estimated to be 2.6 million infections in 2018. Trichomoniasis is associated with an increased HIV risk. Currently, trichomoniasis is not a reportable sexually transmitted infection (STI) which leads to under-testing and treatment. We sought to describe Trichomonas vaginalis (TV)prevalence amongst users of an online STI testing platform.

Methods

IWantTheKit (IWTK) provides free STI testing using mail-in, self-collected samples. From January 1^st, 2021 to December 31^st, 2022, all vaginal samples received by IWTK were tested for TV using the Aptima nucleic acid amplification assay (Hologic, San Diego) and included in this analysis. A multivariable logistic regression of self-reported demographic data was conducted to identify factors associated with positive results.

Results

Of 3,894 vaginal swabs tested through IWTK from Maryland residents, 3.67% (n=143) tested positive for TV. Users with a positive versus negative test had an older median age 30 (IQR 26-35) vs 28 (IQR 24-33) p< 0.001] respectively. Participants whose age was > 25 and < 40 were 1.63 times more likely to test positive for TV than participants ≤ 25 years old (95% CI 1.09-2.45 p = 0.018). Participants who were older than 40 were 2.32 times more likely to test positive for TV than participants ≤ 25 years old (95% CI 1.30-4.17 p=0.005). Self-identified Black users were 3.47 times more likely to have a positive result compared to White users (95% CI 2.07- 5.80 p< 0.001). Individuals with concurrent Neisseria gonorrhoeae or Chlamydia trachomatis were 2.26 times more likely to have a positive TV result (95% CI 1.28-3.99 p=0.005).

Conclusion

Among users providing a vaginal swab to an online self-collection STI testing service, trichomoniasis prevalence was high particularly in those who identify as Black, older than 25, and with other reportable STIs. Our findings suggest that mail-in self-collection STI testing services may offer an opportunity to diagnose and treat trichomoniasis as part of HIV prevention and reduce adverse reproductive health outcomes.