Treatment of Trichomonas in pregnancy and adverse outcomes of pregnancy: A subanalysis of a randomized trial in Rakai, Uganda

Objective The purpose of this study was to assess the association of presumptive Trichomonas vaginalis treatment during pregnancy and birth outcomes. Study design A community-randomized trial of presumptive sexually transmitted disease treatment during pregnancy was conducted between 1994 and 1999 in Rakai district, Uganda. A subanalysis of a trial of presumptive therapy with azithromycin, cefixime, and metronidazole assessed Trichomonas vaginalis treatment in pregnant women. Results Children of 94 women with Trichomonas who were treated had increased low birth weight (relative risk, 2.49; 95% CI, 1.12-5.50), preterm birth rate (relative risk, 1.28; 95% CI, 0.81-2.02), and 2-year mortality rate (relative risk, 1.58; 95% CI, 0.99-2.52), compared with children of 112 women with Trichomonas who were not treated. Conclusion Treatment of Trichomonas vaginalis during pregnancy may be deleterious, and we infer that this may be due to metronidazole. This is consistent with a National Institute for Child Health and Human Development trial that found an excess of preterm births in children of women with Trichomonas vaginalis infection who were treated with metronidazole.