The Prevalence of Trichomonas vaginalis Infection among Reproductive-Age Women in the United

States, 2001–2004

Madeline Sutton1⇑, Maya Sternberg1, Emilia H. Koumans1, Geraldine McQuillan2, Stuart Berman1, and
Lauri Markowitz1

+ Author Affiliations

1National Center for HIV/AIDS, Viral Hepatitis, Sexually Transmitted Disease, and Tuberculosis
Prevention, Centers for Disease Control and Prevention, Atlanta, Georgia

2National Center for Health Statistics, US Department of Health and Human Services, Hyattsville,
Maryland

Reprints or correspondence: Dr. Madeline Sutton, Div. of HIV/AIDS Prevention, National Center for
HIV/AIDS, Viral Hepatitis, Sexually Transmitted Disease, and Tuberculosis Prevention, Centers for Disease
Control and Prevention, 1600 Clifton Rd. NE, Mailstop E-45, Atlanta, GA 30333 (zxa3@cdc.gov).

Presented in part: 54th Annual Clinical Meeting of the American College of Obstetricians and
Gynecologists, Washington, DC, May 2006; and 2006 National STD Prevention Conference, Jacksonville,
Florida, May 2006.

Abstract

Background. Trichomonas vaginalis infection is a common sexually transmitted protozoal infection and is
associated with several adverse health outcomes, such as preterm birth, delivery of a low–birth weight
infant, and facilitation of sexual transmission of human immunodeficiency virus. The annual incidence in
the United States has been estimated to be 3–5 million cases. However, there are no data on the
prevalence of trichomoniasis among all reproductive-age women. We estimated the prevalence of T.
vaginalis infection from a nationally representative sample of women in the United States.

Methods. Women aged 14–49 years who participated in the National Health and Examination Survey
cycles for 2001–2004 provided self-collected vaginal swab specimens. The vaginal fluids extracted from
these swabs were evaluated for the presence of T. vaginalis using polymerase chain reaction.

Results. Overall, 3754 (81%) of 4646 women provided swab specimens. The prevalence of T. vaginalis
infection was 3.1% (95% confidence interval [CI], 2.3%–4.3%); for non-Hispanic white women, it was
1.3% (95% CI, 0.7%–2.3%); for Mexican American women, it was 1.8% (95% CI, 0.9%–3.7%); and for non-
Hispanic black women, it was 13.3% (95% CI, 10.0%–17.7%). Factors that remained associated with
increased likelihood of T. vaginalis infection in multivariable analyses included non-Hispanic black
race/ethnicity, being born in the United States, a greater number of lifetime sex partners, increasing
age, lower educational level, poverty, and douching.

Conclusions. The prevalence of T. vaginalis infection among women in the United States was 3.1%. A
significant racial disparity exists; the prevalence among non-Hispanic black women was 10.3 times
higher than that among non-Hispanic white and Mexican American women. Optimal prevention and
control strategies for T. vaginalis infection should be explored as a means of closing the racial disparity
gaps and decreasing adverse health outcomes due to T. vaginalis infection.

Footnotes

This information is distributed solely for the purpose of predissemination peer review under applicable
information quality guidelines. It has not been formally disseminated by the Centers for Disease Control
and Prevention. It does not represent and should not be construed to represent any agency
determination or policy.

Received April 9, 2007.

Accepted July 21, 2007.

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