Disparities in adherence to retesting guidelines in women with Trichomonas vaginalis infection

Trichomonas vaginalis is the most prevalent nonviral sexually transmitted infection in the United States. Numerous studies have shown disproportionately higher prevalence rates in Non-Hispanic Black women. Due to high rates of reinfection, the Centers for Disease Control and Prevention recommends retesting women treated for trichomoniasis. Despite these national guidelines, there are few studies examining adherence to retesting recommendations for patients with trichomoniasis. Adherence to retesting guidelines has been shown in other infections to be an important determinant for racial disparities. The purpose of this study is to describe Trichomonas vaginalis infection rates, to evaluate adherence to retesting guidelines, and to examine characteristics of women who were not re-tested according to the guidelines in an urban, diverse, hospital-based Ob/Gyn clinic population. We conducted a retrospective cohort study of patients from a single hospital-based Ob/Gyn clinic who were tested for Trichomonas vaginalis between January 1, 2015, and December 31, 2019. Descriptive statistics were used to examine guideline-concordant testing for reinfection amongst patients with trichomoniasis. Multivariable logistic regression was used to identify characteristics associated with testing positive and with appropriate retesting. Sub-group analyses were performed for patients who were pregnant and tested positive for Trichomonas vaginalis. Among the 8,809 patients tested for Trichomonas vaginalis, 799 (9.1%) tested positive at least once during the study. Factors associated with trichomoniasis included identifying as non-Hispanic Black (aOR 3.13, 95% CI 2.52-3.89), current or former tobacco smoker (aOR 2.27, 95% CI 1.94-2.65), and single marital status (aOR 1.96, 95% CI 1.51-2.56). Similar associated factors were found in the pregnant sub-group analysis. For women with trichomoniasis, guideline-concordant retesting rates were low across the entire population with only 27% (214/799) of patients retested within the recommended timeframe; 42% (82/194) of the pregnant sub-group underwent guideline concordant retesting. Non-Hispanic Black women had significantly lower odds of undergoing guideline-recommended retesting than non-Hispanic White women (aOR 0.54, 95% CI 0.31-0.92). Among patients tested within guideline recommendations, we found a high rate of Trichomonas vaginalis positivity at retesting: 24% in the entire cohort (51/214) and 33% in the pregnant sub-group (27/82)