(115) Rates of Reinfection for Trichomonas vaginalis in Adolescents and Young adults: an Assessment Following the CDC STI Treatment Guidelines in 2021

Background: In 2021, the Centers for Disease Control (CDC) revised the treatment recommendation for Trichomonas vaginalis from a single dose to a 7-day course of metronidazole. Given the high risk of Trichomonas infection in adolescents and young adults (AYA), this study evaluated reinfection rates before and after the change in CDC treatment guidelines.

Methods: This is a retrospective cohort study of AYA patients who presented to an academic children’s hospital who were diagnosed with Trichomonas vaginalis genital infection in 2020 or 2022. Patients were identified by ICD codes. Data were collected on demographics, location of visit, provider specialty, lab results, prescriptions, and use of expedited partner therapy (EPT). The study population was split into two cohorts by year of visit. The primary outcome was the rate of reinfection for Trichomonas in the two cohorts. Descriptive statistics, Fisher’s exact test, and chi-square test data are reported. This study was IRB approved.

Results: 110 patients met inclusion criteria and were included in the study, including 62 and 48 patients in the 2020 and 2022 cohorts, respectively. In both cohorts, the majority of patients (66% in 2020 and 75% in 2022) were prescribed the treatment option in line with CDC recommendations at that time (p=0.245). Location of visit did not affect rates of prescribing recommended treatment in either cohort (p=0.285 and 0.635, respectively). Adolescent medicine was more likely to follow CDC guidelines compared to other specialties (p=0.041 in 2020 and p=0.166 in 2022). In 2020, EPT was offered to 39% (accepted by 54%), similar to 35% (accepted by 41%) in 2022 (p=0.723 and 0.412, respectively). There was a difference in use of EPT based on visit location with only 1/34 emergency department/urgent care (ED/UC) visits offering EPT compared to 40/74 outpatient visits (p < 0.001). In 2020, 65% were retested between >4 weeks and < 12 months, similar to 67% in 2022 (p=0.814). Of those who were retested within this time frame, 33% in 2020 and 22% in 2022 were again positive for trichomonas (p=0.317).

Conclusions: The majority of providers in all locations and specialties followed CDC recommendations for treatment of Trichomonas. There was a trend towards lower rates of reinfection with the change in treatment guidelines, though this was not statistically significant and rates of reinfection remain high. Patients seen in outpatient clinics were more likely to be given EPT compared to ED/UC. Given the high rates of recurrence, further research is needed to identify barriers to treatment and prevention of sexually transmitted infections.