Trichomoniasis and Adverse Birth Outcomes in Pregnant Women

Trichomoniasis is the most prevalent nonviral sexually transmitted infection (STI) in the United States and is more prevalent than chlamydia and gonorrhea combined. In the US, the southern states share a disproportionate burden of infection, with rates up to 14%. Infection with Trichomonas vaginalis increases risk of human immunodeficiency virus (HIV) acquisition and is associated with adverse perinatal outcomes, including preterm birth, low birth weight, and preterm premature rupture of membranes. Although 80% of infections are asymptomatic, there are no national recommendations for trichomoniasis screening in women who are HIV-negative (including pregnant women who are HIV-negative), except for incarcerated women, where screening is recommended. Plus, there is also perpetual controversy surrounding whether asymptomatic trich should be treated in pregnancy or not. Why is that? Shouldn’t we always treat STIs in pregnancy? The data is a bit confusing for asymptomatic trichomoniasis. We’ll review the data in this episode and we will end with some practical advice for treatment of trich in pregnancy.