Trichomoniasis in adolescents: a marker for the lack of a public health response to the epidemic of sexually transmitted diseases in the United States.

Despite being a readily diagnosed and treated sexually transmitted disease (STD), trichomoniasis is not reportable in the United States, and control of trichomo-niasis has received relatively little emphasis from public health STD control programs, including that of the Centers for Disease Control and Prevention. More recently, however, appreciation of high rates of disease and of associations between tricho-moniasis in women and both adverse pregnancy outcomes and an increased risk of HIV infection have suggested a need for increased control efforts. Trichomoniasis is caused by the parasite Trichomonas vaginalis. The annual incidence of T. vaginalis infection in the United States has been estimated at 7.4 million cases, with 1180 million cases worldwide [1]. The World Health Organization has estimated that this infection accounts for almost one-half of all curable STDs worldwide [2]. The prevalence of tricho-moniasis in women attending inner-city STD clinics in the United States typically approaches 25% and may be higher in certain populations [3, 4]. In Los Angeles, California, for instance, the prevalence in black attendees at a public clinic was found to be 38% [5]. Rates of T. vaginalis infection in men are largely unknown, because of the poor sensitivity of the currently available diagnostic techniques for men. Recent studies using more-sensitive polymerase chain reaction (PCR)–based techniques have found that, in some populations , rates of T. vaginalis infection in men may equal those of chlamydia infection [6]. In this issue of the Journal of Infectious Diseases, Van Der Pol et al. report astoundingly high rates of trichomoniasis in a co-hort of 14–17-year-old adolescent women at high risk for STDs in Indianapolis, In-diana [7]. Women were entered into a longitudinal study and were tested at quarterly intervals using PCR techniques. Of the 268 participants, 6.0% were infected with T. vaginalis at enrollment. More revealing was that, during the course of the study, 123% of the participants had at least 1 episode of T. vaginalis infection, and 131% had multiple episodes. In women, T. vaginalis infection may cause vaginal discharge, irritation, and inflammation. In men, it is usually asymp-tomatic but is becoming increasingly recognized as a cause of nongonococcal ure-thritis. Diagnosis of T. vaginalis infection in women is usually accomplished via direct microscopic examination of vaginal fluid; however, even when performed by skilled microscopists, the sensitivity of this technique is only 60% [8]. Most clinics do not screen asymptomatic women for T. vaginalis infection, even though it is …