Department of Obstetrics, Gynecology and Reproductive Sciences, Yale School of Medicine, New Haven, CT; Department of Obstetrics and Gynecology, MedStar Washington Hospital Center, Washington, DC.
Division of Infectious Diseases, Department of Pediatrics, Yale School of Medicine, New Haven, CT.
Am J Obstet Gynecol. 2023 Sep;229(3):284.e1-284.e10. doi: 10.1016/j.ajog.2023.06.045. Epub 2023 Jun 29.
Trichomoniasis is the most prevalent nonviral sexually transmitted infection in the United States. Numerous studies have shown disproportionately higher prevalence rates in non-Hispanic Black women. Because of the high rates of reinfection, the Centers for Disease Control and Prevention recommends retesting women treated for trichomoniasis. Despite these national guidelines, there are few studies examining adherence to retesting recommendations for patients with trichomoniasis. Adherence to retesting guidelines has been shown in other infections to be an important determinant of racial disparities.
This study aimed to describe Trichomonas vaginalis infection rates, evaluate adherence to retesting guidelines, and examine characteristics of women who were not retested according to the guidelines in an urban, diverse, hospital-based obstetrics and gynecology clinic population.
We conducted a retrospective cohort study of patients from a single hospital-based obstetrics and gynecology clinic who were tested for Trichomonas vaginalis between January 1, 2015 and December 31, 2019. Descriptive statistics were used to examine guideline-concordant testing for reinfection among patients with trichomoniasis. Multivariable logistic regression was used to identify characteristics associated with testing positive and with appropriate retesting. Subgroup analyses were performed for patients who were pregnant and tested positive for Trichomonas vaginalis.
Among the 8809 patients tested for Trichomonas vaginalis, 799 (9.1%) tested positive at least once during the study. Factors associated with trichomoniasis included identifying as non-Hispanic Black (adjusted odds ratio, 3.13; 95% confidence interval, 2.52-3.89), current or former tobacco smoking (adjusted odds ratio, 2.27; 95% confidence interval, 1.94-2.65), and single marital status (adjusted odds ratio, 1.96; 95% confidence interval, 1.51-2.56). Similar associated factors were found in the pregnant subgroup analysis. For women with trichomoniasis, guideline-concordant retesting rates were low across the entire population, with only 27% (214/799) of patients retested within the recommended time frame; 42% (82/194) of the pregnant subgroup underwent guideline-concordant retesting. Non-Hispanic Black women had significantly lower odds of undergoing guideline-recommended retesting than non-Hispanic White women (adjusted odds ratio, 0.54; 95% confidence interval, 0.31-0.92). Among patients tested according to guideline recommendations, we found a high rate of Trichomonas vaginalis positivity at retesting: 24% in the entire cohort (51/214) and 33% in the pregnant subgroup (27/82).
Trichomonas vaginalis infection was identified at a high frequency in a diverse, urban hospital-based obstetrics and gynecology clinic population. Opportunities exist to improve on equitable and guideline-concordant retesting of patients with trichomoniasis.
滴虫病是美国最常见的非病毒性性传播感染。许多研究表明，非西班牙裔黑人女性的患病率更高。由于再感染率高，疾病控制与预防中心建议对接受滴虫病治疗的女性进行重新检测。尽管有这些国家指南，但很少有研究检查滴虫病患者对重新检测建议的依从性。在其他感染中，对重新检测指南的依从性已被证明是种族差异的一个重要决定因素。
本研究旨在描述阴道毛滴虫感染率，评估对重新检测指南的依从性，并检查根据指南未进行重新检测的女性特征，这些女性来自于一个城市、多样化的基于医院的妇产科诊所人群。
我们对 2015 年 1 月 1 日至 2019 年 12 月 31 日期间在一家基于医院的妇产科诊所接受阴道毛滴虫检测的患者进行了回顾性队列研究。描述性统计用于检查滴虫病患者再感染的符合指南的检测情况。多变量逻辑回归用于确定与检测阳性和适当重新检测相关的特征。对已怀孕且阴道毛滴虫检测呈阳性的患者进行了亚组分析。
在接受阴道毛滴虫检测的 8809 名患者中，有 799 名（9.1%）至少在研究期间的一次检测中呈阳性。与滴虫病相关的因素包括被认定为非西班牙裔黑人（调整后的优势比，3.13；95%置信区间，2.52-3.89）、当前或曾经吸烟（调整后的优势比，2.27；95%置信区间，1.94-2.65）和单身婚姻状况（调整后的优势比，1.96；95%置信区间，1.51-2.56）。在怀孕亚组分析中也发现了类似的相关因素。对于患有滴虫病的女性，整个人群的符合指南的重新检测率都很低，只有 27%（214/799）的患者在推荐的时间范围内进行了重新检测；在怀孕亚组中，42%（82/194）的患者进行了符合指南的重新检测。与非西班牙裔白人女性相比，非西班牙裔黑人女性进行推荐重新检测的可能性显著降低（调整后的优势比，0.54；95%置信区间，0.31-0.92）。在根据指南建议进行检测的患者中，我们发现重新检测时阴道毛滴虫阳性率很高：整个队列中有 24%（51/214），怀孕亚组中有 33%（27/82）。
在一个多样化的城市基于医院的妇产科诊所人群中，阴道毛滴虫感染的发生率很高。有机会改善对滴虫病患者的公平和符合指南的重新检测。
