High prevalence of trichomoniasis in rural men in Mwanza, Tanzania: results from a population based study

Objectives: To measure the prevalence of urethral infections including tric homoniasis in rural Tanzanian men, to assess the prevalence of symptoms and signs among men with Trichomonas vaginalis, and to analyse the risk factor s for trichomoniasis. Design: A cross sectional study of 1004 men aged 15-54 years in a rural com munity in north west Tanzania. Methods: Participants were interviewed about sexual behaviour and symptoms of sexually transmitted diseases. First fraction urine samples and urethral swabs were collected and used to rest for T vaginalis by wet preparation a nd culture, Neisseria gonorrhoeae by culture, Chlamydia trachomatis by liga se chain reaction and non-specific urethritis by Gram stain. Urine was also tested for the presence of leucocytes using a leucocyte esterase dipstick. Men were re-interviewed 2 weeks later to document new symptoms and signs o f urethritis. Results: Complete laboratory results were available on 980 men. One in four men had laboratory evidence of urethritis. T vaginalis was found in 109 in dividuals (11%), gonorrhoea in eight (0.8%), and chlamydial infection in 15 (1.5%). Over 50% of men with urethritis were asymptomatic. The prevalence of signs and symptoms was similar among men with T vaginalis alone compared with men with other urethral infections. The sensitivity and specificity o f the leucocyte esterase dipstick (LED) test for detecting T vaginalis were 80% and 48% respectively in symptomatic men and 60% and 68% in asymptomati c men. Factors associated with trichomoniasis included religion, type of em ployment, and marital status. Conclusions: A high prevalence of urethritis was found in men in this commu nity based study More than half of the urethral infections detected were as ymptomatic. The most prevalent pathogen was T vaginalis. Studies are needed on the prevalence of trichomoniasis in men presenting to health services w ith complaints suggestive of urethritis since treatment for T vaginalis is not included in the syndromic management of urethritis in most countries. T he performance of the LED test as a screening test for trichomoniasis was u nsatisfactory in both symptomatic and asymptomatic men. Improved screening tests are urgently needed to identify urethral infections that are asymptom atic and which are not covered by current syndromic management algorithms.