Trichomoniasis and HIV Interactions
Trichomoniasis and HIV Interactions
Objective To discuss the epidemiology of Trichomonas vaginalis (TV) and HIV co-infections, the role of TV in acquisition and transmission of HIV, special treatment considerations for TV among women with HIV and the prevention of TV among HIV-infected persons.
Design Systematic review.
Data source Review of literature of EMBASE and PubMed databases from January 1990 to February 2013. Search keywords included TV, HIV co-infections, HIV acquisition, HIV transmission, HIV shedding, TV treatment, HIV and couples studies.
Review method We included studies of any design that contained the selected search words and were published during the specified time frame. We then searched the reference lists of included papers for additional papers and included these when relevant.
Results There is strong evidence that TV increases both transmission and acquisition of HIV among women, and that successful treatment for TV can reduce HIV genital shedding. Single dose metronidazole (MTZ) should no longer be used for HIV+ women with TV given the high rates of asymptomatic bacterial vaginosis co-infections and other factors that may render MTZ less effective in HIV+ women. Prevention of TV among HIV+ persons is similar to among HIV, including promotion of condoms as well as regular screening and prompt treatment. There may be a role for expedited partner treatment for the prevention of repeat infections, but most repeat infections are clinical treatment failures. Diligence in screening and treating TV among both HIV- susceptible and HIV+ persons is an important public health strategy.
Trichomonas vaginalis (TV) is the most common non-viral sexually transmitted infection (STI) worldwide and has been associated with pelvic inflammatory disease and adverse pregnancy outcomes. Once thought to be a minor STI, TV is now being given more attention because of its potential role in both the acquisition and transmission of HIV. In this paper, we discuss the epidemiology of HIV and TV co-infections, present evidence that TV plays a role in HIV acquisition and HIV transmission, describe the theories of how TV amplifies HIV transmission, discuss issues of TV treatment among HIV positive women, and present potential prevention measures of TV among HIV+ persons.
Abstract and Introduction
Abstract
Objective To discuss the epidemiology of Trichomonas vaginalis (TV) and HIV co-infections, the role of TV in acquisition and transmission of HIV, special treatment considerations for TV among women with HIV and the prevention of TV among HIV-infected persons.
Design Systematic review.
Data source Review of literature of EMBASE and PubMed databases from January 1990 to February 2013. Search keywords included TV, HIV co-infections, HIV acquisition, HIV transmission, HIV shedding, TV treatment, HIV and couples studies.
Review method We included studies of any design that contained the selected search words and were published during the specified time frame. We then searched the reference lists of included papers for additional papers and included these when relevant.
Results There is strong evidence that TV increases both transmission and acquisition of HIV among women, and that successful treatment for TV can reduce HIV genital shedding. Single dose metronidazole (MTZ) should no longer be used for HIV+ women with TV given the high rates of asymptomatic bacterial vaginosis co-infections and other factors that may render MTZ less effective in HIV+ women. Prevention of TV among HIV+ persons is similar to among HIV, including promotion of condoms as well as regular screening and prompt treatment. There may be a role for expedited partner treatment for the prevention of repeat infections, but most repeat infections are clinical treatment failures. Diligence in screening and treating TV among both HIV- susceptible and HIV+ persons is an important public health strategy.
Introduction
Trichomonas vaginalis (TV) is the most common non-viral sexually transmitted infection (STI) worldwide and has been associated with pelvic inflammatory disease and adverse pregnancy outcomes. Once thought to be a minor STI, TV is now being given more attention because of its potential role in both the acquisition and transmission of HIV. In this paper, we discuss the epidemiology of HIV and TV co-infections, present evidence that TV plays a role in HIV acquisition and HIV transmission, describe the theories of how TV amplifies HIV transmission, discuss issues of TV treatment among HIV positive women, and present potential prevention measures of TV among HIV+ persons.
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