Skip to main content
PMC home page
Sexually Transmitted Infections logoLink to Sexually Transmitted Infections
. 2000 Oct;76(5):355–362. doi: 10.1136/sti.76.5.355

High prevalence of trichomoniasis in rural men in Mwanza, Tanzania: results from a population based study

D Watson-Jones 1, K Mugeye 1, P Mayaud 1, L Ndeki 1, J Todd 1, F Mosha 1, B West 1, B Cleophas-Frisch 1, H Grosskurth 1, M Laga 1, R Hayes 1, D Mabey 1, A Buve 1
PMCID: PMC1744211  PMID: 11141851

Abstract

Objectives: To measure the prevalence of urethral infections including trichomoniasis in rural Tanzanian men, to assess the prevalence of symptoms and signs among men with Trichomonas vaginalis, and to analyse the risk factors for trichomoniasis.

Design: A cross sectional study of 1004 men aged 15–54 years in a rural community in north west Tanzania.

Methods: Participants were interviewed about sexual behaviour and symptoms of sexually transmitted diseases. First fraction urine samples and urethral swabs were collected and used to test for T vaginalis by wet preparation and culture, Neisseria gonorrhoeae by culture, Chlamydia trachomatis by ligase chain reaction and non-specific urethritis by Gram stain. Urine was also tested for the presence of leucocytes using a leucocyte esterase dipstick. Men were re-interviewed 2 weeks later to document new symptoms and signs of urethritis.

Results: Complete laboratory results were available on 980 men. One in four men had laboratory evidence of urethritis. T vaginalis was found in 109 individuals (11%), gonorrhoea in eight (0.8%), and chlamydial infection in 15 (1.5%). Over 50% of men with urethritis were asymptomatic. The prevalence of signs and symptoms was similar among men with T vaginalis alone compared with men with other urethral infections. The sensitivity and specificity of the leucocyte esterase dipstick (LED) test for detecting T vaginalis were 80% and 48% respectively in symptomatic men and 60% and 68% in asymptomatic men. Factors associated with trichomoniasis included religion, type of employment, and marital status.

Conclusions: A high prevalence of urethritis was found in men in this community based study. More than half of the urethral infections detected were asymptomatic. The most prevalent pathogen was T vaginalis. Studies are needed on the prevalence of trichomoniasis in men presenting to health services with complaints suggestive of urethritis since treatment for T vaginalis is not included in the syndromic management of urethritis in most countries. The performance of the LED test as a screening test for trichomoniasis was unsatisfactory in both symptomatic and asymptomatic men. Improved screening tests are urgently needed to identify urethral infections that are asymptomatic and which are not covered by current syndromic management algorithms.

Key Words: urethritis; Tanzania; Trichomonas vaginalis

Full Text

The Full Text of this article is available as a PDF (141.5 KB).

Selected References

These references are in PubMed. This may not be the complete list of references from this article.

  1. Alary M., Baganizi E., Guèdèmè A., Padonou F., Davo N., Adjovi C., van Dyck E., Germain M., Joly J., Mahony J. B. Evaluation of clinical algorithms for the diagnosis of gonococcal and chlamydial infections among men with urethral discharge or dysuria and women with vaginal discharge in Benin. Sex Transm Infect. 1998 Jun;74 (Suppl 1):S44–S49. [PubMed] [Google Scholar]
  2. Borchardt K. A., Hernández V., Miller S., Loaiciga K., Cruz L., Naranjo S., Maida N. A clinical evaluation of trichomoniasis in San Jose, Costa Rica using the InPouch TV test. Genitourin Med. 1992 Oct;68(5):328–330. doi: 10.1136/sti.68.5.328. [DOI] [PMC free article] [PubMed] [Google Scholar]
  3. Borchardt K. A., al-Haraci S., Maida N. Prevalence of Trichomonas vaginalis in a male sexually transmitted disease clinic population by interview, wet mount microscopy, and the InPouch TV test. Genitourin Med. 1995 Dec;71(6):405–406. doi: 10.1136/sti.71.6.405. [DOI] [PMC free article] [PubMed] [Google Scholar]
  4. Chernesky M. A. How can industry, academia, public health authorities and the Sexually Transmitted Diseases Diagnostics Initiative (SDI) work together to help control sexually transmitted diseases in developing countries? Genitourin Med. 1997 Feb;73(1):1–2. doi: 10.1136/sti.73.1.1. [DOI] [PMC free article] [PubMed] [Google Scholar]
  5. Cohen M. S. Sexually transmitted diseases enhance HIV transmission: no longer a hypothesis. Lancet. 1998;351 (Suppl 3):5–7. doi: 10.1016/s0140-6736(98)90002-2. [DOI] [PubMed] [Google Scholar]
  6. Cotch M. F., Pastorek J. G., 2nd, Nugent R. P., Hillier S. L., Gibbs R. S., Martin D. H., Eschenbach D. A., Edelman R., Carey J. C., Regan J. A. Trichomonas vaginalis associated with low birth weight and preterm delivery. The Vaginal Infections and Prematurity Study Group. Sex Transm Dis. 1997 Jul;24(6):353–360. doi: 10.1097/00007435-199707000-00008. [DOI] [PubMed] [Google Scholar]
  7. Dallabetta G., Behets F., Lule G., Hoffman I., Hamilton H., Wangel A. M., Moeng S., Cohen M., Liomba G. Specificity of dysuria and discharge complaints and presence of urethritis in male patients attending an STD clinic in Malawi. Sex Transm Infect. 1998 Jun;74 (Suppl 1):S34–S37. [PubMed] [Google Scholar]
  8. Draper D., Parker R., Patterson E., Jones W., Beutz M., French J., Borchardt K., McGregor J. Detection of Trichomonas vaginalis in pregnant women with the InPouch TV culture system. J Clin Microbiol. 1993 Apr;31(4):1016–1018. doi: 10.1128/jcm.31.4.1016-1018.1993. [DOI] [PMC free article] [PubMed] [Google Scholar]
  9. Fleming D. T., Wasserheit J. N. From epidemiological synergy to public health policy and practice: the contribution of other sexually transmitted diseases to sexual transmission of HIV infection. Sex Transm Infect. 1999 Feb;75(1):3–17. doi: 10.1136/sti.75.1.3. [DOI] [PMC free article] [PubMed] [Google Scholar]
  10. Fouts A. C., Kraus S. J. Trichomonas vaginalis: reevaluation of its clinical presentation and laboratory diagnosis. J Infect Dis. 1980 Feb;141(2):137–143. doi: 10.1093/infdis/141.2.137. [DOI] [PubMed] [Google Scholar]
  11. Gerbase A. C., Rowley J. T., Heymann D. H., Berkley S. F., Piot P. Global prevalence and incidence estimates of selected curable STDs. Sex Transm Infect. 1998 Jun;74 (Suppl 1):S12–S16. [PubMed] [Google Scholar]
  12. Grosskurth H., Mayaud P., Mosha F., Todd J., Senkoro K., Newell J., Gabone R., Changalucha J., West B., Hayes R. Asymptomatic gonorrhoea and chlamydial infection in rural Tanzanian men. BMJ. 1996 Feb 3;312(7026):277–280. doi: 10.1136/bmj.312.7026.277. [DOI] [PMC free article] [PubMed] [Google Scholar]
  13. Grosskurth H., Mosha F., Todd J., Mwijarubi E., Klokke A., Senkoro K., Mayaud P., Changalucha J., Nicoll A., ka-Gina G. Impact of improved treatment of sexually transmitted diseases on HIV infection in rural Tanzania: randomised controlled trial. Lancet. 1995 Aug 26;346(8974):530–536. doi: 10.1016/s0140-6736(95)91380-7. [DOI] [PubMed] [Google Scholar]
  14. Hobbs M. M., Kazembe P., Reed A. W., Miller W. C., Nkata E., Zimba D., Daly C. C., Chakraborty H., Cohen M. S., Hoffman I. Trichomonas vaginalis as a cause of urethritis in Malawian men. Sex Transm Dis. 1999 Aug;26(7):381–387. doi: 10.1097/00007435-199908000-00003. [DOI] [PubMed] [Google Scholar]
  15. Jackson D. J., Rakwar J. P., Chohan B., Mandaliya K., Bwayo J. J., Ndinya-Achola J. O., Nagelkerke N. J., Kreiss J. K., Moses S. Urethral infection in a workplace population of East African men: evaluation of strategies for screening and management. J Infect Dis. 1997 Apr;175(4):833–838. doi: 10.1086/513979. [DOI] [PubMed] [Google Scholar]
  16. Klouman E., Masenga E. J., Klepp K. I., Sam N. E., Nkya W., Nkya C. HIV and reproductive tract infections in a total village population in rural Kilimanjaro, Tanzania: women at increased risk. J Acquir Immune Defic Syndr Hum Retrovirol. 1997 Feb 1;14(2):163–168. doi: 10.1097/00042560-199702010-00010. [DOI] [PubMed] [Google Scholar]
  17. Krieger J. N. Trichomoniasis in men: old issues and new data. Sex Transm Dis. 1995 Mar-Apr;22(2):83–96. [PubMed] [Google Scholar]
  18. Krieger J. N., Verdon M., Siegel N., Critchlow C., Holmes K. K. Risk assessment and laboratory diagnosis of trichomoniasis in men. J Infect Dis. 1992 Dec;166(6):1362–1366. doi: 10.1093/infdis/166.6.1362. [DOI] [PubMed] [Google Scholar]
  19. LANCELEY F., MCENTEGART M. G. Trichomonas vaginalis in the male; the experimental infection of a few volunteers. Lancet. 1953 Apr 4;1(6762):668–671. doi: 10.1016/s0140-6736(53)91802-9. [DOI] [PubMed] [Google Scholar]
  20. Laga M., Manoka A., Kivuvu M., Malele B., Tuliza M., Nzila N., Goeman J., Behets F., Batter V., Alary M. Non-ulcerative sexually transmitted diseases as risk factors for HIV-1 transmission in women: results from a cohort study. AIDS. 1993 Jan;7(1):95–102. doi: 10.1097/00002030-199301000-00015. [DOI] [PubMed] [Google Scholar]
  21. Mabey D. The diagnosis and treatment of urethritis in developing countries. Genitourin Med. 1994 Feb;70(1):1–2. doi: 10.1136/sti.70.1.1. [DOI] [PMC free article] [PubMed] [Google Scholar]
  22. Mayaud P., Changalucha J., Grosskurth H., Ka-Gina G., Rugemalila J., Nduba J., Newell J., Hayes R., Mabey D. The value of urine specimens in screening for male urethritis and its microbial aetiologies in Tanzania. Genitourin Med. 1992 Dec;68(6):361–365. doi: 10.1136/sti.68.6.361. [DOI] [PMC free article] [PubMed] [Google Scholar]
  23. Mayaud P., Changalucha J., Grosskurth H., Ka-Gina G., Rugemalila J., Nduba J., Newell J., Hayes R., Mabey D. The value of urine specimens in screening for male urethritis and its microbial aetiologies in Tanzania. Genitourin Med. 1992 Dec;68(6):361–365. doi: 10.1136/sti.68.6.361. [DOI] [PMC free article] [PubMed] [Google Scholar]
  24. Mayaud P., Uledi E., Cornelissen J., ka-Gina G., Todd J., Rwakatare M., West B., Kopwe L., Manoko D., Grosskurth H. Risk scores to detect cervical infections in urban antenatal clinic attenders in Mwanza, Tanzania. Sex Transm Infect. 1998 Jun;74 (Suppl 1):S139–S146. [PubMed] [Google Scholar]
  25. Pastorek J. G., 2nd, Cotch M. F., Martin D. H., Eschenbach D. A. Clinical and microbiological correlates of vaginal trichomoniasis during pregnancy. The Vaginal Infections and Prematurity Study Group. Clin Infect Dis. 1996 Nov;23(5):1075–1080. doi: 10.1093/clinids/23.5.1075. [DOI] [PubMed] [Google Scholar]
  26. Vuylsteke B., Laga M., Alary M., Gerniers M. M., Lebughe J. P., Nzila N., Behets F., Van Dyck E., Piot P. Clinical algorithms for the screening of women for gonococcal and chlamydial infection: evaluation of pregnant women and prostitutes in Zaire. Clin Infect Dis. 1993 Jul;17(1):82–88. doi: 10.1093/clinids/17.1.82. [DOI] [PubMed] [Google Scholar]
  27. WESTON T. E., NICOL C. S. NATURAL HISTORY OF TRICHOMONAL INFECTION IN MALES. Br J Vener Dis. 1963 Dec;39:251–257. doi: 10.1136/sti.39.4.251. [DOI] [PMC free article] [PubMed] [Google Scholar]
  28. WHITTINGTON M. J. Epidemiology of infections with Trichomonas vaginalis in the light of improved diagnostic methods. Br J Vener Dis. 1957 Jun;33(2):80–91. doi: 10.1136/sti.33.2.80. [DOI] [PMC free article] [PubMed] [Google Scholar]
  29. Wawer M. J., Sewankambo N. K., Serwadda D., Quinn T. C., Paxton L. A., Kiwanuka N., Wabwire-Mangen F., Li C., Lutalo T., Nalugoda F. Control of sexually transmitted diseases for AIDS prevention in Uganda: a randomised community trial. Rakai Project Study Group. Lancet. 1999 Feb 13;353(9152):525–535. doi: 10.1016/s0140-6736(98)06439-3. [DOI] [PubMed] [Google Scholar]

Articles from Sexually Transmitted Infections are provided here courtesy of BMJ Publishing Group

RESOURCES