Epidemiologic differences between candidial andtrichomonal infections as detected in cytologic smears in Taiwan

The epidemiologic differences between cytology-detected candidial and trichomonal infections were assessed in 15,933 women attending the 12 district health centres in the Taipei area and a consecutive 1114 patients, visiting venereal disease clinics, whose smears were screened for cervical cancer between July 1991 and December 1992 in Taipei. The Pap smears were examined for the presence of specific organisms, such as trichomonas vaginalis, vaginal candida, herpes simplex virus, human papillomavirus, actinomyces, leptothrix, aspergillu, gardnerella and others. More emphasis was placed on the candidial and trichomonal infection in inflammatory Pap smears. The overall prevalence of candidial and trichomonal infections was 3.40% and 1.88%, respectively. There were striking differences in the prevalence of trichomoniasis ranging from 1.74% in the district health centre population to 3.77% in the venereal disease clinic patients; however, the prevalence of candidial infection remained the same (3.40%) in these two distinct population groups. Indices of socioeconomic status--education and personal hygiene--showed an inverse association with the prevalence of trichomoniasis but a positive correlation with candidiasis. Among participants, younger age (< 20 years old) was independently associated with candidial (OR = 1.95) and trichomonal (OR = 3.87) infections. No sexual behavioural factors were associated with candidial infection in this study; however, having multiple sexual partners (OR = 5.07) was associated with a significantly elevated risk of trichomoniasis, while using condoms was associated with a diminished risk (OR = 0.38). The presence of candidiasis and trichomoniasis was highly associated with abnormal cytologic findings, particularly those indicative of inflammation. There was little evidence that findings suggestive of cervical cancer could be attributed to either candidial or trichomonal infections. These data suggest that trichomoniasis is consistent with venereal transmission of the disease, but transmission by contaminated objects cannot be ruled out because there is an increased relation between trichomoniasis infection and socioeconomic conditions and personal hygiene. Elucidation of such differences may be helpful in designing different strategies to control these infections. Furthermore, the findings can provide a good baseline of prevalence for investigating the relationship between these two pathogens and cervical dysplasia.During July 1991-December 1992, in Taiwan, health workers collected cervical smears from 15,933 women attending 12 district health centers and from 1114 consecutive patients visiting a sexually transmitted disease (STD) clinic in the Taipei region. Researchers focused on the 320 women with trichomoniasis (1.88%) and the 580 women with candidiasis (3.4%) to examine the epidemiologic differences of the two infections, particularly their socioeconomic and sexual behavior factors. The prevalence of candidiasis was the same for both the district health centers and the STD clinics (3.4%), while trichomoniasis was more prevalent at the STD clinics than the district health centers (3.77% vs. 1.74%; p 0.001). The multivariate logistic regression revealed that adolescence was a significant independent risk factor for both candidiasis (odds ratio [OR] = 1.95) and trichomoniasis (OR = 3.87) (p 0.05 and 0.01, respectively). There were no other significant independent risk factors for candidiasis. Other significant independent risk factors for trichomoniasis were: more than one sexual partner (OR = 5.07; p 0.01); primary education or illiteracy (OR = 1.86; p 0.05); and poor genital hygiene (OR = 1.46; p 0.05). Condom use had a protective effect for trichomoniasis (OR = 3.8; p 0.05). Candidial and trichomonal infections were both greatly associated with cervical inflammation (28.41% and 16.59%, respectively) but not with cervical cancer (0 cases). These findings suggest that sexual transmission contributes to trichomoniasis but not to candidiasis and that socioeconomic conditions and poor personal hygiene also contribute to trichomoniasis.