(P448) Prevalence and incidence of Trichomonas vaginalis in pregnant women in South Africa

Wednesday, July 26, 2023

16:00 – 18:00 CST

Primary Presenter(s)

MM

Mandisa Mildred Mdingi, MSc (she/her/hers)

Research Project Manager
Foundation for Professional Development
Black, Eastern Cape, South Africa

Co-author(s)

RG

Ranjana M.S Gigi

Foundation for Professional Development, United States
Remco P.H Peters, MD, PhD

Head of Clinical Research
Foundation for Professional Development
East London, South Africa
Chibuzor M. Babalola, MD, MPH

Postdoctoral Research Associate & Part-time Professor
Keck School of Medicine Department of Population and Public Health Sciences, University of Southern California, United States
CT

Christopher M. Taylor, PhD

Department of Microbiology, Immunology, and Parasitology, Louisiana Health Sciences Center New Orleans, United States
Christina A. Muzny, MD, MSPH (she/her/hers)

Associate Professor of Medicine, Epidemiology, and Obstetrics & Gynecology
Division of Infectious Diseases, University of Alabama at Birmingham
Birmingham, Alabama, United States
Nicola Low, MD (she/her/hers)

Professor of Epidemiology and Public Health
University of Bern
Bern, Bern, Switzerland
AM

Andrew Medina-Marino

Desmond Tutu Health Foundation, South Africa, United States
Jeffrey D. Klausner, MD (he/him/his)

Clinical Professor
Department of Population and Public Health Sciences, University of Southern California
Los Angeles, California, United States

Background

Trichomonas vaginalis (TV) is the most common curable sexually transmitted infection (STI). It is associated with adverse pregnancy outcomes and increased risk of HIV transmission. We aimed to determine the incidence and prevalence of TV at two time-points during pregnancy.

Methods

Women attending their first antenatal care visit were enrolled in an implementation-effectiveness study of STI screening strategies in East London, South Africa. Inclusion criteria were women ≥18 years and < 27 gestational weeks, irrespective of HIV-infection status. Trained research nurses performed physical examination and vaginal swab collection. Screening included onsite testing at baseline and at 30-34 gestational weeks using the GeneXpert TV assay. Women with positive results were treated with 7 days of metronidazole 400mg twice daily and offered partner notification slips. Data were collected on treatment adherence, partner notification and treatment.

Results

From March 2021 to November 2022, we tested 171 women at baseline and 30-34 gestational weeks. TV test at baseline was positive for 17 (10%, 95% confidence interval, CI 6-16%); all were treated. TV infection was more common among women living with HIV compared to women without (9/46 (20%, CI 10-34) versus 8/125 (6%, CI 3-13), p=0.01). Self-reported adherence data were available for 11/17 (65%) of positive women; all reported to have finished the full course of treatment provided. Ten women informed their partner of their STI diagnosis; 5 partners were reportedly treated. At the 30-34 week visit, 5/171 (3%) women tested positive for TV, of which 4 had been positive at baseline (i.e. 4 of 17 (24%) of those with positive TV test at baseline) and 1 had a new infection after previous negative test. The incidence rate for baseline negative participants was 0.013 per 100 woman-years (CI 0.00- 0.09).

Conclusion

TV was prevalent among pregnant women in our setting, and more common among HIV infected women. Incident infection was low at the repeat visit at 30-34 weeks suggesting once off diagnostic testing may be sufficient. However, when previously treated, repeat TV test positivity was high at 30-34 weeks despite reported excellent treatment adherence.