Prevalence and predictors of trichomonas infection in newly incarcerated women

Prevalence and Management of Sexually Transmitted Infections in Correctional Settings: A Systematic Review

Admissions to jails and prisons in the United States number 10 million yearly; persons entering locked correctional facilities have high prevalence of sexually transmitted infections (STIs). These individuals come disproportionately from communities of color, with lower access to care and prevention, compared with the United States as a whole. Following PRISMA guidelines, the authors present results of a systematic review of literature published since 2012 on STIs in US jails, prisons, Immigration and Customs Enforcement detention centers, and juvenile facilities. This updates an earlier review of STIs in short-term facilities. This current review contributed to new recommendations in the Centers for Disease Control and Prevention 2021 treatment guidelines for STIs, advising screening for Trichomonas in women entering correctional facilities. The current review also synthesizes recommendations on screening: in particular, opt-out testing is superior to opt-in protocols. Carceral interventions-managing diagnosed cases and preventing new infections from occurring (eg, by initiating human immunodeficiency virus preexposure prophylaxis before release)-can counteract structural racism in healthcare.

Self-Reported Sexually Transmitted Infections After Incarceration in Women with or at Risk for HIV in the United States, 2007-2017

Background: U.S. women who have been incarcerated report high rates of sexual risk behavior and sexually transmitted infections (STIs). Materials and Methods: We estimated the effect of incarceration on the time to first incident STI in a multicenter cohort of U.S. women with or at risk for HIV. We used marginal structural models to compare time to first self-reported gonorrhea, chlamydia, or trichomonas infection for nonincarcerated women and incarcerated women. Covariates included demographic factors, HIV status, sex exchange, drug/alcohol use, and prior incarceration. Results: Three thousand hundred twenty-four women contributed a median of 4 at-risk years and experienced 213 first incident STI events. The crude incidence of STIs was 3.7 per 100 person-years for incarcerated women and 1.9 per 100 person-years for nonincarcerated women. The weighted hazard ratio for incident STIs was 4.05 (95% confidence interval: 1.61-10.19). Conclusion: Women with or at risk for HIV in the United States who have recently experienced incarceration may be at increased STI risk.

Sexually Transmitted Infections Treatment Guidelines, 2021

These guidelines for the treatment of persons who have or are at risk for sexually transmitted infections (STIs) were updated by CDC after consultation with professionals knowledgeable in the field of STIs who met in Atlanta, Georgia, June 11-14, 2019. The information in this report updates the 2015 guidelines. These guidelines discuss 1) updated recommendations for treatment of Neisseria gonorrhoeae, Chlamydia trachomatis, and Trichomonas vaginalis; 2) addition of metronidazole to the recommended treatment regimen for pelvic inflammatory disease; 3) alternative treatment options for bacterial vaginosis; 4) management of Mycoplasma genitalium; 5) human papillomavirus vaccine recommendations and counseling messages; 6) expanded risk factors for syphilis testing among pregnant women; 7) one-time testing for hepatitis C infection; 8) evaluation of men who have sex with men after sexual assault; and 9) two-step testing for serologic diagnosis of genital herpes simplex virus. Physicians and other health care providers can use these guidelines to assist in prevention and treatment of STIs.

Computer-assisted motivational interviewing for contraceptive use in women leaving prison: A randomized controlled trial

OBJECTIVES

Rates of unintended pregnancies in women with a history of incarceration are high and access to contraception before and after arrest can be limited. Individualized counseling can better prepare women for healthy pregnancy or provide an opportunity for contraceptive education and access within correctional facilities. In this study, we assessed the efficacy of motivational interviewing as an individualized intervention to increase the initiation of contraceptive methods while incarcerated and continuation after release in female inmates who wanted to avoid pregnancy for at least one year after release.

STUDY DESIGN

We performed an RCT in a population of incarcerated women who wanted to avoid pregnancy. Women were randomized to either a computer-assisted motivational interviewing intervention group (n = 119) or an educational video with counseling control group. (n = 113). The primary outcome was initiation of a method of birth control prior to release from the correctional facility.

RESULTS

Initiation of contraception was higher in the intervention group (56% vs. 42%, p = 0.03), but this difference was not significant after controlling for number of male partners within the year prior to incarceration. There was no difference between the groups in the rates of pregnancies or STIs or continuation of contraception after release, which was generally low (21%).

CONCLUSION

Computer-assisted motivational interviewing did not improve uptake or continuation of contraception in this study.

IMPLICATIONS

Periods of incarceration provide an opportunity to offer contraceptive services to women who want to avoid a pregnancy. Motivational interviewing may not be an effective method to affect contraceptive behaviors in this population. Future research should explore the family planning values and preferences of women who become involved with the correctional system.

Self-reported sexually-transmitted infections and criminal justice involvement among women who use drugs

Background

Women involved in the criminal justice system in the United States have high rates of sexually transmitted infections (STI). It is unknown whether criminal justice involvement is a marker for other risk behavior, such as sex exchange or drug use, or criminal justice involvement itself increases risk directly.

Methods

This study examines the relationship between STI and the frequency and duration of arrest, probation, and incarceration in a sample of women who use drugs (n = 394) in Oakland, California who reported having been tested for STI in the past six months. Logistic regression models of STI using criminal justice measures as independent variables were used, and subsequent estimates were adjusted for demographics, sex exchange, specific drugs used, and number of sexual partners.

Results

Any time spent in jail in the past year was associated with higher odds of recent STI (UOR = 2.28, 95%CI [1.41–3.51]), and short incarcerations (2–3 weeks) in jail most substantially increased the odds of an STI diagnosis (UOR = 7.65, 95%CI [1.03, 56.68]). Arrest and probation were not significantly associated with STI. After adjusting for the covariates, particularly sex exchange and opioid use, none of the criminal justice-related variables were significantly associated with STI.

Conclusions

A substantial portion of the increased risk of STI that is associated with criminal justice involvement for women who use drugs is likely due to sex exchange. Longitudinal studies are needed to temporally separate criminal justice exposures, drug use, sex exchange, and STI outcomes.

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Criminal justice involvement is common for women who use drugs.

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Short jail incarcerations (2–3 weeks) were associated with an increased odds of STI, largely accounted for by sex exchange and opioid use.

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Qualitative studies that examine why women's sexual partnerships, opioid use, and sex exchange change after incarceration are needed.

Exploring Lifetime Accumulation of Criminal Justice Involvement and Associated Health and Social Outcomes in a Community-Based Sample of Women who Use Drugs

Among people who use illegal drugs, engagement with the criminal justice (CJ) system often involves an ongoing, intermittent series of arrests, incarcerations, and periods of community supervision. The potential associations between the lifetime accumulation of CJ involvement and social and health outcomes is largely unexplored. In a cross-sectional sample of women who use crack, heroin, and/ or methamphetamine recruited from communities in Oakland, CA (N = 624), we developed an approach to characterize CJ accumulation. We used latent class analysis (LCA), a multivariate person-centered method that assumes an unobserved categorical variable that divides a population into a small number of mutually exclusive and exhaustive classes. Using observed measures of incarceration and community supervision as indicator variables, we developed a model of CJ accumulation that elucidates patterns of involvement as lived by the women in the sample. Based on model fit statistics, we selected a three-class model and labeled the classes "low," "medium," and "high." We then explored associations between the classes of CJ accumulation and health and health-related outcomes using logistic regression. The odds of homelessness (p for trend = 0.004), transience (p for trend = 0.017), and recent victimization (p for trend = 0.023) were higher among women in higher accumulation classes. Higher class of CJ accumulation was associated with higher odds of reporting unmet need for physical health care (p for trend < 0.001) and mental health care (p for trend = 0.002). The odds of physical health conditions, such as hepatitis C infection (p for trend < 0.001) and mental health conditions, such as depression (p for trend = 0.003), also increased with higher class of accumulation. While the findings described here are limited by the cross-sectional nature of the study, they suggest that CJ accumulation is a potentially meaningful concept for assessing associations between the CJ system and health-related issues.

Neutrophils kill the parasite Trichomonas vaginalis using trogocytosis

T. vaginalis, a human-infective parasite, causes the most common nonviral sexually transmitted infection (STI) worldwide and contributes to adverse inflammatory disorders. The immune response to T. vaginalis is poorly understood. Neutrophils (polymorphonuclear cells [PMNs]) are the major immune cell present at the T. vaginalis-host interface and are thought to clear T. vaginalis. However, the mechanism of PMN clearance of T. vaginalis has not been characterized. We demonstrate that human PMNs rapidly kill T. vaginalis in a dose-dependent, contact-dependent, and neutrophil extracellular trap (NET)-independent manner. In contrast to phagocytosis, we observed that PMN killing of T. vaginalis involves taking "bites" of T. vaginalis prior to parasite death, using trogocytosis to achieve pathogen killing. Both trogocytosis and parasite killing are dependent on the presence of PMN serine proteases and human serum factors. Our analyses provide the first demonstration, to our knowledge, of a mammalian phagocyte using trogocytosis for pathogen clearance and reveal a novel mechanism used by PMNs to kill a large, highly motile target.

Therapeutic effects of Iranian herbal extracts against Trichomonas vaginalis

Trichomonas vaginalis is a flagellated parasite affecting about 276 million people annually worldwide. Tricomoniasis is associated with different complications in pregnant women and infants. 5'-nitroimidazole derivatives (metronidazole, ornidazole, and tinidazole) are FDA approved drugs recommended for trichomoniasis treatment. Treatment with metronidazole 5'-nitroimidazole derivatives is associated with many side effects, and drug resistance to metronidazole has been reported in some cases. Recently, many attempts have been made to evaluate the effects of plants on causative agents of vaginal infections. In our research, the national and international databases were searched and the effects of various herbal extracts on T. vaginalis in Iran were reviewed from 2006 to 2016. In articles investigated, some plants had favorable antitrichomonal effects and needed to be further investigated. All the plant extracts have only been evaluated in vitro. Surveys of different articles in this review show that the active ingredients present in different parts of plants, including aerial parts, leaves, flowers, stems, and root can be suitable sources for introducing and developing new antitrichomonal compounds.

Vaginal self-sampling as a diagnosis tool in low-income countries and potential applications for exploring the infectious causes of miscarriage

Gynecological health is a challenge in low-income countries. Personal opposition to perineal examination has been overcome by the use of vaginal self-sampling. Here, we review the use of this procedure notably in low-income countries and the main infectious causes of miscarriage. Vaginal self-sampling was mainly used for human papillomavirus detection but also to detect microorganisms causing sexually transmitted infections or bacterial vaginosis. 58 studies have been performed in low-resource countries, mainly studies performed to detect human papillomavirus in urban and peri-urban areas and demonstrating excellent acceptability. Several infectious causes of miscarriage could be tested using self-vaginal samples. In the future, such strategies coupled with a rapid-identification point-of-care method could allow the development of screening and treatment programs in rural areas in low-resource countries.

Investigation of the presence of Trichomonas vaginalis in infertile Turkish women

Background

Trichomoniasis is a sexually transmitted vaginal infection caused by a protozoan called Trichomonas vaginalis. Its prevalence ranges between 3–40% among randomly tested women.

Objectives

To investigate the presence of T. vaginalis in infertile women presenting to a Turkish gynecology outpatient clinic using parasitological methods.

Methods

The study population comprised 51 patient participants who attended the gynecology clinic of Mustafa Kemal University Hospital between March and August 2013. The women were divided into those presenting with infertility (n = 22) and a patient control group (n = 29). Women in the control group had complaints other than infertility. Microscopic examination, Giemsa staining, and cysteine-peptone-liver-maltose culture were performed on samples taken from posterior fornix tested for T. vaginalis.

Results

T. vaginalis was observed in 18% (n = 4) of infertile patients and in none of the control group (P = 0.03).

Conclusions

Asymptomatic infertile women should be examined for T. vaginalis infection, which may play a role as a cause or contributing factor in infertility.

Infectious Diseases and the Criminal Justice System

The United States leads the world in incarceration, which disproportionately affects disadvantaged individuals, including those who are mentally ill, poor, homeless and racial minorities. Incarceration is disruptive to families and communities and contributes to health disparities in sexually transmitted infections (STIs) and human immunodeficiency virus (HIV). The objective of this grand rounds is to review (1) the epidemiology of incarceration in the United States, (2) the social factors which contribute to high rates of STIs in incarcerated individuals and (3) the HIV care cascade in incarcerated and recently released individuals. Routine screening and treatment for STIs and HIV in the criminal justice system can identify many new infections and has the potential to both improve individual outcomes and reduce transmission to others. Increased collaboration between the department of health and department of corrections, as well as partnerships between academic institutions and the criminal justice system, have the potential to improve outcomes in this vulnerable population.

Correlates of incident Trichomonas vaginalis infections among African American female adolescents

BACKGROUND

Trichomonas vaginalis is the most common curable sexually transmitted infection associated with adverse reproductive health and pregnancy outcomes and may amplify HIV transmission. The objective was to identify correlates of incident T. vaginalis infections among African American adolescent girls.

METHODS

Data were collected via audio computer-assisted self-interviews at baseline and every 6 months for 18 months from 701 African American girls (14-20 years) in an HIV prevention trial. At each assessment, self-collected vaginal swabs were assayed for T. vaginalis, Chlamydia trachomatis, and Neisseria gonorrhoeae. Generalized estimating equations assessed associations between incident T. vaginalis infection and sociodemographic characteristics, substance use, partner-level factors, sexual risk behaviors, douching, and other sexually transmitted infections.

RESULTS

Of 605 (86.3%) participants who completed at least 1 follow-up assessment, an incident T. vaginalis infection was detected among 20.0% (n = 121). Factors associated with incident infection in adjusted analysis included the following: cigarette smoking (adjusted odds ratio [AOR], 1.66; 95% confidence interval [CI], 1.04-2.64), using alcohol on an increasing number of days in the past 3 months (AOR, 1.02; 95% CI, 1.00-1.04), acquisition of C. trachomatis (AOR, 2.27; 95% CI, 1.40-3.69) or N. gonorrhoeae (AOR, 5.71; 95% CI, 2.97-11.02), and T. vaginalis infection at the previous assessment (AOR, 3.16; 95% CI, 1.96-5.07).

CONCLUSIONS

Incident T. vaginalis infections were common. Strategies to reduce infection rates among this population may include improving partner notification and treatment services. The benefits of rescreening, screening adolescents screened for or infected with C. trachomatis or N. gonorrhoeae, and associations between substance use and T. vaginalis acquisition warrant further investigation.

Prevalence and factors associated with Trichomonas vaginalis infection among high-risk women in Los Angeles

Remnant specimen from 1215 women screening for chlamydia/gonorrhea at 4 different venue types (sexually transmitted disease clinics, home-test kit users, juvenile and adult detention) in Los Angeles, California, were tested for Trichomonas vaginalis. Prevalence of T. vaginalis varied by screening population, and concurrent chlamydia or gonorrhea was independently associated with T. vaginalis.