Trichomoniasis in Adolescents: A Marker for the Lack of a Public Health Response to the Epidemic of Sexually Transmitted Diseases in the United States

Despite being a readily diagnosed and treated sexually transmitted disease (STD) trichomoniasis is not reportable in the United States and control of trichomoniasis has received relatively little emphasis from public health STD control programs including that of the Centers for Disease Control and Prevention. More recently however appreciation of high rates of disease and of associations between trichomoniasis in women and both adverse pregnancy outcomes and an increased risk of HIV infection have suggested a need for increased control efforts. Trichomoniasis is caused by the parasite Trichomonas vaginalis. The annual incidence of T. vaginalis infection in the United States has been estimated at 7.4 million cases with 1180 million cases worldwide. The World Health Organization has estimated that this infection accounts for almost one-half of all curable STDs worldwide. The prevalence of trichomoniasis trichomoniasis in women attending inner-city STD clinics in the United States typically approaches 25% and may be higher in certain populations. In Los Angeles California for instance the prevalence in black attendees at a public clinic was found to be 38%. Rates of T. vaginalis infection in men are largely unknown because of the poor sensitivity of the currently available diagnostic techniques for men. Recent studies using more-sensitive polymerase chain reaction (PCR)-based techniques have found that in some populations rates of T. vaginalis infection in men may equal those of chlamydia infection. (excerpt)