Testing 16739 samples for Trichomonas vaginalis from ten separate online STI testing services across different regions of England

22nd June 2023 by Claire Taylor

Mark Clune1, Lesley Navaratne2, Rachel Marsden2, Tony Proom3, Susan Whalen4, Emma Twydall5, Andrew De Burgh-Thomas5, Jane Scott6, Paula Hill6, Naomi Wareham6, Claudia Krause7, June Agius8, Joelle Turner9, Sharon Nettleford10, John White1

1Preventx, 2Maidstone And Tunbridge Wells NHS Trust, 3East Sussex County Council, 4Sandwell Sexual Health, 5Gloucestershire Health and Care NHS Foundation Trust, 6Somerset-wide Integrated Sexual Health Service, 7iCaSH Cambridgeshire Community Services NHS Trust, 8City Health Care Partnership CIC, 9Luton And Dunstable University Hospital NHS Foundation Trust, 10Walsall Healthcare NHS Trust

Background

The online symptomatic triage within our pan-UK online postal self-sampling services (OPSS) has enabled service users with self-identified symptoms to be tested for Trichomonas vaginalis (TV) according to a tailored local protocol. TV testing in asymptomatic service users is also available according to ethnicity and deprivation parameters, guided by local prevalence.

Methods

Using the Cobas TV PCR assay (Roche), TV testing has been performed in ten different English Local Authority areas through their OPSS (Hull, East Riding of Yorkshire, Maidstone and Tunbridge Wells, East Sussex, Gloucestershire, Walsall, Sandwell, Somerset, iCaSH and Luton).

Results

To date we have analysed 16739 samples, mostly among females (n=16523; 98.7%). The overall TV positivity rate (TV+) across all services was 3.5% (n=590), with 4.5% TV+ (n=489) observed in females (of any ethnicity) with vaginal discharge, 1.1% TV+ (n=15) in asymptomatic White British females and 2.0% TV+ (n=86) for asymptomatic females from racially minoritised communities.

The highest positivity was observed among those of any Caribbean ethnicity (5.9% TV+; n=127). There was a linear association with deprivation, ranging from 7.0% TV+ (n=132) among those from IMD decile 1 (most deprived) to 1.5% TV+ (n=14) among those from IMD decile 10 (least deprived). The age range with the highest positivity was those females aged 45–54 years (5.2% TV+; n=32).

Only 216 (1.3%) of the TV tests were done by men/nonbinary/ trans/other service users (overall TV+ 1.9%).

Discussion

The consistently high TV positivity rates observed among females across ten different regions of England suggests that TV prevalence is underestimated and warrants more widespread use of TV PCR testing, including via OPSS. Further testing and analysis are needed in male populations to determine more accurate prevalence estimates and explore associations with TV positivity.