Prevalence of Infection and Protozoan Load in South African Women: a Cross-sectional Study

Objectives: is thought to be the most common non-viral sexually transmitted infection worldwide. We investigated the prevalence, risk factors and protozoan load of infection in South African women.

Methods: A cross-sectional study of 604 women was conducted at 25 primary healthcare facilities in rural South Africa (Mopani district). DNA was detected in vaginal and rectal swabs. In univariate and multivariate analyses, the infection was investigated in relation to demographic characteristics, medical history and behavioural factors. The load was determined as the logarithm of DNA copies per microlitre sample solution.

Results: Collected vaginal and rectal swabs were tested for DNA. Prevalence of vaginal was 20% (95% CI 17.0% to 23.4%) and rectal 1.2% (95% CI 0.6% to 2.4%). Most women (66%) with a vaginal infection were asymptomatic. Factors associated with infection were a relationship status of single (OR 2.4; 95% CI 1.5 to 4.0; p<0.001) and HIV positive infection (OR 1.6; 95% CI 1.0 to 2.6; p=0.041). Women with vaginal infection were more likely to have concurrent rectal infection than those without vaginal infection (12%vs3%; p<0.001; OR 4.1). A higher median load was observed among women with observed vaginal discharge compared with those without vaginal discharge (p=0.025).

Conclusions: Vaginal trichomoniasis is highly prevalent in rural South Africa, especially among single women and those with HIV infection, and often presents without symptoms.