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Increased risk for T. vaginalis in an urban population of young adults

Increased risk for T. vaginalis in an urban population of young adults. S M Rogers for MSSP Research Team. Monitoring STIs in the Population Research Team. Susan M Rogers, Research Triangle Institute Charles F Turner, City University of New York

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Increased risk for T. vaginalis in an urban population of young adults

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  1. Increased risk for T. vaginalis in an urban population of young adults SM Rogers for MSSP Research Team

  2. Monitoring STIs in the Population Research Team • Susan M Rogers, Research Triangle Institute • Charles F Turner, City University of New York • Bill Miller, University of North Carolina, Chapel Hill • Emily Erbelding, Johns Hopkins Medical Institutions • Marcia Hobbs, University of North Carolina, Chapel Hill • Elizabeth Eggleston, Research Triangle Institute • Anthony Roman, University of Massachusetts • Sylvia Tan, Research Triangle Institute • James Chromy, Research Triangle Institute • Ravikiran Muvva, Baltimore City Health Department

  3. Trichomoniasis • Most common, curable sexually transmitted disease worldwide (WHO 2001, CDC) • Associated with increased risk for HIV, HSV-2, PID • Caused by motile protozoan, T. vaginalis • Variety of diagnostic tools available • MAY 2011: FDA approved PCR (Gen-Probe)

  4. Epidemiology of T. vaginalis • Current understanding largely limited to clinical settings and special populations • U.S. population assessments • 2001-04 NHANES • 2001-02 Add Health • Case reporting data not available in U.S.

  5. In general, epidemiological studies suggest T. vaginalis: • Is more common among women than men • Varies by race/ethnicity, age • Generally asymptomatic • Frequent co-morbidity with other STIs • Among population subgroups, TV prevalence exceeds that of other STIs, i.e., CT and GC

  6. Monitoring STIs in the Population (MSSP) Study Objectives • Assess prevalence of T. vaginalis and C. trachomatis among young adults, Baltimore, MD 2006-09 • Identify characteristics and behaviors associated with TV and CT infection • Compare trends in infection prevalence over time

  7. 2006-09 MSSP: Survey methods • Probability sample of 15-35 year-olds residing in Baltimore with land-line telephone • Telephone-ACASI on sexual behaviors and STI history • Mail-out, mail-back specimen collection, TMA testing for TV and APTIMA (Gen-Probe) for CT • Sampling weights derived

  8. 2006-09 MSSP: Results • 4,996 eligible households identified • Interviews completed with 2,936 (59%) • 1843 women, 1093 men • Mean age, 24.6 yrs. • 62.3% Black, 76.8% never married • 2,120 (73%) provided valid specimens for STI testing • Imputation for specimen non-response

  9. Estimated prevalence of TV and CT Prevalence

  10. Estimated prevalence of TV and CT infection • From bio-specimens alone TV 7.5% (6.0, 9.0) CT 3.9% (2.7, 5.0) • Bio-specimens plus imputations (MI of 5-2-2011) TV 7.6% (6.1, 9.0) CT 4.1% (2.9, 5.3)

  11. Estimated prevalence of T. vaginalis: sex and race

  12. Estimated prevalence of C. trachomatis:sex and race

  13. Estimated prevalence of TV and CT by age

  14. Estimated prevalence of T. vaginalis: age and sex

  15. Other Risk factors for TV and CT *Models control for age, sex, and race/ethnicity

  16. Trends in TV and CT, 2006-09

  17. Methodological considerations/lessons • Challenges of population-based studies • Expensive T-ACASI • Specimen collection Mail-out, mail-back • Representativeness/response rates • Increased use of cell phones, decrease in land-lines

  18. Methodological considerations/lessons • Specimen testing • Use of non-FDA approved test for TV diagnosis • Test performance in low prevalence population • Disclosure of research results

  19. Conclusions: 2006-09 MSSP • Epidemiology of T. vaginalis: • Higher prevalence of TV than CT • TV more common among women than men, particularly high among Black women (16.1%) • Substantial co-infection with CT • Prevalence of TV was consistently high across all age groups • Majority infections asymptomatic • Trend analysis: rates similar over period observed

  20. Implications of these results Routine screening for TV in conjunction with CT in populations at elevated risk of infection should be considered • Expand our understanding of TV epidemiology • Improve detection and enhance treatment to avoid health complications

  21. Research Support • NIH grant R01-HD047163 from the National Institute of Child Health and Human Development

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