Trichomonas vaginalis causes an estimated 175 million sexually transmitted infections (STIs) worldwide annually,1 yet receives limited attention in clinical practice. In women, the prevalence of this infection is estimated to range from 3–48%.2,–4 Vaginitis is a frequent result of infection; pelvic inflammatory disease, cervical neoplasia, and pre-term delivery are also associated with T vaginalis.5,–7 In men, T vaginalis is infrequently diagnosed due to fewer symptoms and the use of insensitive diagnostic tests. However, the organism can lead to urethritis, epididymitis, prostatitis, and infertility8 and may also increase the transmission of HIV.9,–10
Investigators from the University of North Carolina, Chapel Hill; Durham County, Wake County, and Jefferson County Health Departments, NC; and the University of Alabama, Birmingham, conducted a prospective, multicenter study to evaluate T vaginalis infection in male partners of women with trichomoniasis. Between November 2001 and July 2003, 3,836 women were pre-screened for trichomoniasis in three STD clinics. A total of 790 women (median age 29, range 18–69, 93% black) with T vaginalis infection were identified (prevalence 20.6%). Of this group, 540 infected women were enrolled. A total of 261 males (median age 30, range 18–79, 98% black) identified as the most frequent partner of an enrolled woman participated in the study. Of the 261 women with enrolled partners, 153 (58.6%) reported vaginal discharge and 70 (26.8%) were asymptomatic. Based on the results of urine and urethral culture, 15.6% of the enrolled men were identified as having trichomoniasis. However, using cultures and urine PCR, 71.7% of men were found to have trichomoniasis; among the 53 men who also provided semen for culture and PCR, the rate of infection was 81.1%. Of the 177 men who tested positive for T vaginalis, 136 (76.8%) were asymptomatic while 21 (11.9%) had a penile discharge.
The authors conclude that the majority of male partners of women with T vaginalis were also infected despite a low prevalence of symptoms, and that PCR was sensitive enough to identify infection.
Dr. Schiff has disclosed no financial relationship relevant to this commentary. This commentary does not contain a discussion of a commercial product/device. This commentary does not contain a discussion of an unapproved/investigative use of a commercial product/device.
As emphasized in the concurrent editorial, T vaginalis infection is the most prevalent nonviral sexually transmitted infection in the US and world today — and perhaps the most neglected.11 The mistaken assumptions that, despite the widespread frequency of T vaginalis in women, men are infrequently infected, and that the consequences of infection are usually insignificant, have resulted in persistent, almost universal inattention to this disease. General pediatricians caring for sexually active adolescents need to strongly consider the possibility of this infection, including in asymptomatic males, and use sensitive diagnostic tests such as...