2006 STD Prevention Conference - Day 3 Press Release, 10 May 2006

New Research from 2006 National STD Prevention Conference Sheds Light on Prevalence of Lesser Known, Potentially Serious Sexually Transmitted Diseases, Identifies Risk Factors

• First national data on bacterial vaginosis and trichomoniasis show high prevalence
• Researchers release profile of LGV cases in New York City; CDC develops rapid diagnostic test

Jacksonville, Fla. (May 10) – New data presented today at the 2006 National STD Prevention Conference show high prevalence among women of bacterial vaginosis (BV), a condition associated with sexual activity, as well as trichomoniasis, an often asymptomatic but potentially serious sexually transmitted disease (STD). The findings also provide new insight into risk factors for lymphogranuloma venereum (LGV) among men who have sex with men (MSM).

Trichomoniasis, caused by the parasite Trichomonas vaginalis, affects both men and women, although symptoms are more common in women. Bacterial vaginosis is a condition in women where the normal balance of bacteria in the vagina is disrupted and replaced by an overgrowth of certain bacteria. Both conditions carry risks for potentially serious health problems, including premature or low-birth weight babies and an increased risk of acquiring HIV. BV has been associated with pelvic inflammatory disease, which can lead to infertility.

LGV, a sexually transmitted disease prevalent in parts of Africa, Asia, and South America, had been rarely diagnosed in the United States and Europe until recent outbreaks among MSM. New York City data released today provide the most detailed profile to date of LGV cases among MSM, findings that could ultimately help public health officials more effectively prevent, diagnose, and treat the disease. In addition, the Centers for Disease Control and Prevention (CDC) announced the development of a quick and accurate test for the disease, which could eventually aid in rapid identification and treatment of cases.

Bacterial vaginosis and trichomoniasis common among U.S. women

The first national data on the prevalence of bacterial vaginosis in U.S. women show that more than one-quarter of women overall, and half of black women, have the condition. CDC researchers analyzed data from a nationally representative health survey of nearly 2,000 women in 2001 and 2002, finding that 27.4 percent of women overall had BV. Broken down by self-reported race/ethnicity, the condition was found in 50.3 percent of black women, 22.4 percent of white women, and 28.8 percent of Mexican-American women (Oral 211).

Another CDC analysis of the same 2,000 women found that one in eight black women were infected with the parasite that causes trichomoniasis, and that overall prevalence among U.S. women was 3 percent. Prevalence among black women (13.5%) was over nine times higher than that among white and Mexican-American women (1.2% and 1.5%) (Oral 213).

An additional, multi-city CDC study of female patients at STD clinics found that nearly one in seven became infected with the trichomonas parasite over a one year period, with older women and black women at greatest risk. Researchers examined levels of infection among nearly 1,300 women attending STD clinics in Newark, N.J., Long Beach, Calif., and Denver, Colo. between 1999 and 2001. After initial screening and treatment for any existing infections, women were followed for a one year period. Overall, 13 percent became infected. Women aged 35 to 39 were most likely to become infected (22.9%), in contrast to many other STDs, which disproportionately affect younger women. Incidence among black women was more than four times higher than among white women (21.2% vs. 4.9%) (Oral 214).

“The high levels of bacterial vaginosis and trichomoniasis – especially among black women – are of concern because both can go unnoticed and may lead to serious health consequences if left untreated,” said Dr. John M. Douglas Jr., Director of the Division of STD Prevention at CDC’s National Center for HIV, STD and TB Prevention (NCHSTP).

Researchers release most detailed LGV profile; CDC develops quicker diagnostic test

Since initial cases among MSM were identified in several U.S. cities beginning in late 2004, LGV – an STD caused by a particular form of chlamydia bacteria – has become a public health challenge. Diagnosis has been hindered by symptoms that frequently mimic those of other anorectal problems, and the lack of a quick and easily administered diagnostic test has posed additional challenges.

Today, researchers from the New York City Department of Health and Mental Hygiene released an analysis of 249 specimens collected in 2004 and 2005 from suspected LGV cases, finding links between LGV, HIV, and syphilis among MSM in the city. Researchers reported that almost all LGV cases occurred among MSM (97%) and most people diagnosed with the disease reported unprotected receptive anal intercourse within six months (65%). Additionally, 84 percent of those with LGV were co-infected with HIV, and nearly half (48%) had a prior syphilis diagnosis. Comparing data from men diagnosed with LGV to those diagnosed with syphilis, researchers found that LGV and syphilis cases were associated with similar race/ethnicity and behavioral risk profiles (Posters 123 and 124).

Also at the conference, CDC announced that it has developed a new test to quickly and accurately diagnose LGV. Current tests require time-consuming genetic sequencing that takes several days to provide results and can only be performed in relatively sophisticated laboratories. The new test works by identifying the DNA associated with the chlamydial strains that cause LGV, and produces results in just a few hours (Symposium B1 [55] and Poster 120).

“While still in the early stages of development, this new test is a promising step in our efforts to better understand, diagnose, and prevent LGV infection,” said Dr. Douglas. “Ultimately, quicker diagnosis of LGV could help affected communities more effectively combat this disease in conjunction with other STD prevention and treatment efforts for men who have sex with men.”