Trichomonas vaginalis As a Cause of Urethritis in Malawian Men

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Abstract
Background and Objectives: Trichomonas vaginalisis one of the most common sexually transmitted infections. In Malawi, rates of trichomoniasis in women are high. The prevalence ofT. vaginalisinfection in men is expected to be high but has not previously been documented. Goals: We sought to determine the prevalence of trichomoniasis in Malawian men with and without urethritis, to evaluate a polymerase chain reaction detection assay forT. vaginalisin urethral swabs and to examine the effect ofT. vaginalisinfection on excretion of human immunodeficiency virus (HIV) in semen. Study Design: Men presenting at the Sexually Transmitted Diseases (STD) and Dermatology Clinics in Malawi were enrolled in a cross-sectional study. We compared a polymerase chain reaction-based test forT. vaginalisdetection with wet-mount microscopy and culture of urethral swabs. HIV serology was determined by enzyme-linked immunosorbent assay (ELISA), and HIV-1 RNA concentrations in semen were measured by quantitative nucleic acid sequence-based analysis. Results: T. vaginaliswas detected in 51 of 293 men. The estimated prevalence among symptomatic men was 20.8% and among asymptomatic men, 12.2%. Polymerase chain reaction performed with a sensitivity of 0.82 (95% CI: 0.66-0.92) and specificity of 0.95 (95% CI: 0.91-0.97) compared to wet-mount microscopy and culture. There was no difference in the rate of HIV seropositivity in men with and withoutT. vaginalisinfection. However, in men with symptomatic urethritis, the median HIV RNA concentration in seminal plasma from men withT. vaginaliswas significantly higher that in seminal plasma from HIV-positive men without trichomonas.