The epidemiology of trichomoniasis in women in four African cities

Objectives: To describe the epidemiology of Trichomonas vaginalis infection and its association with HIV infection, in women in four African cities wi th different levels of HIV infection. Design: Cross-sectional study, using standardized methods, including a stan dardized questionnaire and standardized laboratory tests, in four cities in sub-Saharan Africa: two with a high prevalence of HIV infection (Kisumu, K enya and Ndola, Zambia), and two with a relatively low prevalence of HIV (C otonou, Benin and Yaounde, Cameroon). Methods: In each city, a random sample of about 2000 adults aged 15-49 year s was taken. Consenting men and women were interviewed about their socio-de mographic characteristics and their sexual behaviour, and were tested for H IV, syphilis, herpes simplex virus type 2 (HSV-2), gonorrhoea, chlamydial i nfection, and (women only) T vaginalis infection. Risk factor analyses were carried out for trichomoniasis for each city separately. Multivariate anal ysis, however, was only possible for Yaounde, Kisumu and Ndola. Results: The prevalence of trichomoniasis was significantly higher in the h igh HIV prevalence cities (29.3% in Kisumu and 34.3% in Ndola) than in Coto nou (3.2%) and Yaounde (17.6%). Risk of trichomoniasis was increased in wom en who reported more lifetime sex partners. HIV infection was an independen t risk factor for trichomonas infection in Yaounde [adjusted odds ratio (OR ) = 1.8, 95% confidence interval (CI) = 0.9-3.7] and Kisumu (adjusted OR = 1.7, 95% Cl = 1.1-2.7), but not in Ndola. A striking finding was the high p revalence (40%) of trichomonas infection in women in Ndola who denied that they had ever had sex. Conclusion: Trichomoniasis may have played a role in the spread of HIV in s ubSaharan Africa and may be one of the factors explaining the differences i n levels of HIV infection between different regions in Africa. The differen ces in prevalence of trichomoniasis between the four cities remain unexplai ned, but we lack data on the epidemiology of trichomoniasis in men. More re search is required on the interaction between trichomoniasis and HIV infect ion, the epidemiology of trichomoniasis in men, and trichomonas infections in women who deny sexual activity. (C) 2001 Lippincott Williams & Wilkins.