Patient-delivered partner treatment and Trichomonas vaginalis repeat infection among human immunodeficiency virus-infected women.

Trichomonas vaginalis (TV) is a common parasitic sexually transmitted infection found among human immunodeficiency virus (HIV)-infected women with prevalence rates ranging from 6% to 44% in this population.1–6 TV in women is associated with vaginitis, cervicitis, urethritis, and pelvic inflammatory disease.7 Among HIV-infected women, the presence of TV infection may amplify HIV transmission through increased shedding of HIV in vaginal fluids8,9 implicating TV infection as a source of sexual and perinatal transmission of HIV.10–12 Two studies have shown that treatment for TV can result in a reduction of HIV vaginal shedding.13,14 Therefore, prevention of TV infections, including repeat infections, among HIV-infected women can provide not only a clinical, but also a public health benefit.15 The rates of repeat TV infections among HIV-infected women range from 18% to 36%,4,16,17 which is much higher than the 8% repeat infection rate for non-HIV infected women.18 Repeat TV infections can result from nonadherence to treatment by the index patient, reinfection by an untreated sexual partner, infection by a new sexual partner, or treatment failure.16,19 Expedited partner therapy (EPT) is the practice of treating the sex partners of persons with curable sexually transmitted infections without requiring the partners to first obtain a medical evaluation.20 EPT generally consists of a practice called patient-delivered partner therapy or treatment (PDPT), where the patient is given a medication or prescription to deliver to their sex partner(s). PDPT has been recommended for the prevention of recurrent infections with Chlamydia trachomatis and Neisseria gonorrhoeae among women and heterosexual men. However, the Centers for Disease Control and Prevention has declared that there is insufficient evidence to support recommending PDPT for partner management among patients with TV.21 We found some evidence that PDPT may be helpful among HIV-infected women. In our prior cohort of HIVinfected women with TV who were given PDPT, we found that most repeat infections (55%) were attributed to treatment failure16 suggesting that PDPT does prevent reinfection. The purpose of the current study was to evaluate in more depth adherence to PDPT, and possible causes of repeat TV infection in a different cohort of HIV-infected women to determine whether our prior findings are reproducible.