Trends in and correlates of trichomoniasis diagnoses among people attending sexual health services, England, 2012-2023.

Abstract

Objective: We assessed trends in and correlates of trichomoniasis at sexual health services (SHS) in England since the scale-up of molecular testing and after changes in testing policy.

Methods: We derived gender-stratified trends in trichomoniasis diagnoses at SHS in England from 2012 to 2023 using data from the Genitourinary Medicine Clinic Activity Dataset (GUMCAD) sexually transmitted infection (STI) surveillance system. We determined demographic correlates of trichomoniasis diagnoses in 2023 using gender-stratified univariate and multivariable generalised estimated equations logistic regression models.

Results: Nationally, trichomoniasis diagnoses increased by 38% between 2012 and 2019 (6950 to 9490 diagnoses); after a drop in 2020 due to COVID-19 related disruptions to services, diagnoses increased by 54% between 2021 and 2023 (5907 to 9102 diagnoses). In 2023, there were 9102 trichomoniasis diagnoses (86.8% in women, 9.5% in men). Among women, trichomoniasis diagnoses were associated with older age (aged 45+ years, adjusted OR: 2.75 (95% CI 2.53 to 2.98) vs 15-24 years). Women of most minoritised ethnic groups (Asian, black, mixed or 'Other') had higher odds of trichomoniasis diagnoses than white British women. Trichomoniasis was associated with living in the most deprived areas (vs least deprived; 3.25 (2.91-3.63)), living in the West Midlands (2.12 (1.96-2.28)) and in Yorkshire and the Humber (1.44 (1.31-1.58)) (vs London). Similar associations were found with trichomoniasis diagnoses in men.

Discussion: The introduction of molecular testing and recommendations for targeted screening since 2014 has likely contributed to the increase in diagnoses since then. Our understanding of trichomoniasis trends will be improved with the addition of a testing code for this STI to GUMCAD in 2024. The higher likelihood of trichomoniasis among some racially minoritised groups partly reflects targeted testing patterns, but it also highlights a health inequality that requires tailored, culturally competent interventions.