背景:阴道毛滴虫是美国最普遍的非病毒性性传播感染。许多研究表明,非西班牙裔黑人女性的患病率更高。由于再感染率高,疾病控制和预防中心建议重新测试治疗毛滴虫的妇女。尽管有这些国家准则,很少有研究检查滴虫患者对重新测试建议的依从性。在其他感染中,遵守重新测试指南已被证明是种族差异的重要决定因素。
目的:本研究的目的是描述阴道毛滴虫的感染率,为了评估对重新测试指南的遵守情况,并检查未根据城市指南重新测试的妇女的特征,多样化,以医院为基础的Ob/Gyn诊所人群。
方法:我们在2015年1月1日至2019年12月31日期间,对一家以医院为基础的Ob/Gyn诊所的患者进行了一项回顾性队列研究,这些患者接受了阴道毛滴虫检测。描述性统计用于检查滴虫患者再感染的指南一致性测试。使用多变量逻辑回归来识别与测试阳性和适当的重新测试相关的特征。对怀孕且阴道毛滴虫检测呈阳性的患者进行亚组分析。
结果:在8,809名阴道毛滴虫患者中,799(9.1%)在研究期间至少一次测试为阳性。与毛滴虫病相关的因素包括确定为非西班牙裔黑人(aOR3.13,95%CI2.52-3.89),当前或以前的烟草吸烟者(AOR2.27,95%CI1.94-2.65),和单身婚姻状况(aOR1.96,95%CI1.51-2.56)。在妊娠亚组分析中发现了类似的相关因素。对于患有毛滴虫病的女性,在整个人群中,指南一致性再检验率很低,只有27%(214/799)的患者在推荐时间内进行了再检验;42%(82/194)的孕妇亚组接受了指南一致性再检验.与非西班牙裔白人女性相比,非西班牙裔黑人女性接受指南推荐的重新测试的几率显着降低(aOR0.54,95%CI0.31-0.92)。在指南建议内测试的患者中,我们发现再次检测时阴道毛滴虫阳性率很高:在整个队列中为24%(51/214),在妊娠亚组中为33%(27/82).
结论:阴道毛滴虫感染在不同的人群中频率很高,城市医院妇产科门诊人群。存在改善滴虫病患者公平和指南一致的重新测试的机会。
Trichomoniasis is the most prevalent nonviral sexually transmitted infection in the United States. Numerous studies have shown disproportionately higher prevalence rates in non-Hispanic Black women. Because of the high rates of reinfection, the Centers for Disease Control and Prevention recommends retesting women treated for trichomoniasis. Despite these national
guidelines, there are few studies examining adherence to retesting recommendations for patients with trichomoniasis. Adherence to retesting
guidelines has been shown in other infections to be an important determinant of racial disparities.
This study aimed to describe Trichomonas vaginalis infection rates, evaluate adherence to retesting
guidelines, and examine characteristics of women who were not retested according to the
guidelines in an urban, diverse, hospital-based obstetrics and gynecology clinic population.
We conducted a retrospective cohort study of patients from a single hospital-based obstetrics and gynecology clinic who were tested for Trichomonas vaginalis between January 1, 2015 and December 31, 2019. Descriptive statistics were used to examine
guideline-concordant testing for reinfection among patients with trichomoniasis. Multivariable logistic regression was used to identify characteristics associated with testing positive and with appropriate retesting. Subgroup analyses were performed for patients who were pregnant and tested positive for Trichomonas vaginalis.
Among the 8809 patients tested for Trichomonas vaginalis, 799 (9.1%) tested positive at least once during the study. Factors associated with trichomoniasis included identifying as non-Hispanic Black (adjusted odds ratio, 3.13; 95% confidence interval, 2.52-3.89), current or former tobacco smoking (adjusted odds ratio, 2.27; 95% confidence interval, 1.94-2.65), and single marital status (adjusted odds ratio, 1.96; 95% confidence interval, 1.51-2.56). Similar associated factors were found in the pregnant subgroup analysis. For women with trichomoniasis, guideline-concordant retesting rates were low across the entire population, with only 27% (214/799) of patients retested within the recommended time frame; 42% (82/194) of the pregnant subgroup underwent guideline-concordant retesting. Non-Hispanic Black women had significantly lower odds of undergoing guideline-recommended retesting than non-Hispanic White women (adjusted odds ratio, 0.54; 95% confidence interval, 0.31-0.92). Among patients tested according to guideline recommendations, we found a high rate of Trichomonas vaginalis positivity at retesting: 24% in the entire cohort (51/214) and 33% in the pregnant subgroup (27/82).
Trichomonas vaginalis infection was identified at a high frequency in a diverse, urban hospital-based obstetrics and gynecology clinic population. Opportunities exist to improve on equitable and guideline-concordant retesting of patients with trichomoniasis.