Trichomonas vaginalis in Pregnancy

Abstract

OBJECTIVE: To identify factors associated with testing for and diagnosis of trichomoniasis in pregnancy and to describe patterns of treatment and tests of reinfection or persistence. METHODS: We conducted a retrospective cohort study of women who delivered from July 2016 to June 2018 at one institution. Testing for Trichomonas vaginalis infection was done by wet mount microscopy or by nucleic acid amplification testing for routine prenatal testing or symptomatic visits. Poisson regression was used to identify factors associated with testing for trichomoniasis and testing positive in pregnancy. Treatment and re-testing patterns also were assessed. RESULTS: Among 3,265 pregnant women, 2,489 (76%) were tested for T vaginalis infection. Of the total sample, 1,808 (55%) were tested by wet mount microscopy, 1,661 (51%) by nucleic acid amplification testing, and 980 (30%) by both modalities. The sensitivity for microscopy compared with nucleic acid amplification testing was 26%, with a specificity of 99%. Factors associated with increased likelihood of being tested included younger age (adjusted risk ratio [aRR] 0.99, 95% CI 0.99–1.00) and bacterial vaginosis (aRR 1.17, 95% CI 1.01–1.37). Prevalence of trichomoniasis was 15% among those tested by any modality (wet mount or nucleic acid amplification testing). Risk factors for trichomoniasis included younger age (aRR 0.97, P<.01), being of black race (aRR 2.62, P<.01), abnormal vaginal discharge (aRR 1.45, P<.01), and chlamydia during the current pregnancy (aRR 1.70, P<.01). Women diagnosed by microscopy had a shorter time to treatment compared with those diagnosed by nucleic acid amplification testing. Most (75%) women with positive infections had a test of reinfection; 29% of these were positive. Bacterial vaginosis was associated with decreased risk of a positive test of reinfection. CONCLUSION: Although testing for and treatment of trichomoniasis during pregnancy is not routinely recommended, the high burden of infection among some pregnant women demonstrates a need to further understand patterns of T vaginalis testing and infection. Opportunities exist for improving timely treatment of trichomoniasis and test of reinfection.

Trichomoniasis and retesting in Durham County, North Carolina, United States, 2021 - 2022

“…Compared to NAAT, the sensitivity of wet mount has been reported between 26%-68%. 23,24 At our institution wet mount missed one of 3 cases of trichomoniasis. NAAT is clearly more sensitive and thus preferable in settings able to offer it.…”

Association of Delayed Treatment of Chlamydial Infection and Gonorrhea in Pregnancy and Preterm Birth

“…Of note, although delayed treatment was not associated with increased odds of preterm birth above that of timely treated cases, it is possible that treatment delays are associated with other adverse pregnancy outcomes not addressed in this analysis. Strategies such as point of care testing and expedited partner therapy should be considered to reduce the frequent treatment delays seen in our cohort 26–28 . Behavioral interventions and specific counseling messages to reduce STI acquisition and increase condom use among pregnant women are urgently needed.…”

“…Strategies such as point of care testing and expedited partner therapy should be considered to reduce the frequent treatment delays seen in our cohort. [26][27][28] Behavioral interventions and specific counseling messages to reduce STI acquisition and increase condom use among pregnant women are urgently needed.…”

Trichomonas vaginalis and Spontaneous Preterm Birth in a High-Risk Obstetric Cohort in Atlanta, GA

“…Because routine testing for TV in pregnancy in the absence of symptoms is not standard of care 10 and not all delivering women were tested during pregnancy, to assess the potential for selection bias, we used logistic regression to model factors associated with having been tested for TV with NAAT and then generated predicted probabilities of testing and estimated inverse probability of testing weights 20 . Variables used to generate the inverse probability of testing weight model were informed by our prior work on TV testing at our institution 13 and included the following: age, race, use of an interpreter for consenting, date of delivery (6-month period), parity, Kotelchuck prenatal care utilization index, number of triage visits, chronic hypertension, past or current intimate partner violence, history of TV infection in a prior pregnancy, diagnosis of CT during the current pregnancy, and BV diagnosis during the current pregnancy. We then used these probabilities in a weighted logistic regression model of sPTB.…”

“…Although routine screening for TV is not recommended by the Centers for Disease Control and Prevention in HIV-negative individuals, 10 our prior work has shown a high proportion of testing among asymptomatic women in this population, likely because of provider preference in the setting of a high population prevalence of TV. 13 To eliminate potential bias from nonindependence of observations, if a woman had more than 1 delivery during the study period, only her first delivery at our facility was included. Because multifetal gestation is an independent risk factor for PTB, only singleton pregnancies were included in the analysis.…”