1. Trichomonas Vaginalis Antimicrobial Resistance Activity— SSuN, 2008–2010 Robert D. Kirkcaldy, MD, MPH Epidemic Intelligence Service (EIS) Officer Division of STD Prevention

2. Objectives Identify prevalence of Trichomonas vaginalis (TV) among STD clinic attendees Describe demographic & clinical characteristics of TV cases, esp. those exhibiting resistance Identify prevalence of in vitro antimicrobial resistance among TV isolates TV = Trichomonas vaginalis

3. Timing of TV Specimen Collection, 2009 AMJJulAugSO ND San Francisco Seattle Philadelphia Denver New York City Birmingham

4. Trichomonas Vaginalis Specimen Update* Outcome n (%) Specimens received at CDC 281 Specimens assayed 246 (88) Non-viable 30 (11) In culture 5 (2) * As of 30 November, 2009

5. Percentage of T. Vaginalis Specimens Assayed at CDC, by site Percentage SSuN Site 76% 93% 69% 90% 94% 88%

6. in vitro Metronidazole Resistance* among TV isolates SSuN Siten (%) NYC1 (2) Philadelphia4 (8) Birmingham0 (0) Denver3 (7) San Francisco2 (4) Seattle3 (6) Total13 (5) * MLC ≥ 50 μg/mL under aerobic conditions

7. Frequencies of Metronidazole MLC* results (n=243) MLC* (μg/mL) Number of specimens Median = 6.3 * MLC = Minimum Lethal Concentration under aerobic conditions In vitro resistance MinimalModHigh

8. Challenges Faced CDC laboratory capacity was less than projected –Needed to cap number of specimens Transient poor survivability at selected sites

9. Looking Ahead to 2010 Each site to collect additional 50 specimens CDC lab planning to increase capacity ‘Cap’ on specimen volume not planned –Except for very high volume site: ~ 10–15/week

10. Timing of TV Specimen Collection, 2010 AMayJunJulAugS San Francisco Seattle Philadelphia Denver New York City Birmingham MarFJ

11. CDC. Public Health Image Library Thank you!

12. Frequencies of MLC categories, NYC Minimum Lethal Concentration (μg/mL) Number of specimens Median=3.1

13. Frequencies of MLC categories, Philadelphia Minimum Lethal Concentration (μg/mL) Number of specimens Median=3.1

14. Frequencies of MLC categories, Birmingham Minimum Lethal Concentration (μg/mL) Number of specimens Median=12.5

15. Frequencies of MLC categories, Denver Minimum Lethal Concentration (μg/mL) Number of specimens Median=3.1

16. Frequencies of MLC categories, San Francisco Minimum Lethal Concentration (μg/mL) Number of specimens Median=3.1

17. Frequencies of MLC categories, Seattle Minimum Lethal Concentration (μg/mL) Number of specimens Median=6.3

18. Prevalence of in vitro Metronidazole Resistance* 8% 7% 6% 4% 2% * MLC ≥ 50 ug/dL 5% Percentage Include confidence intervals? SSuN Site

19. Prevalence of in vitro Metronidazole Resistance* (n=243) Colorado Washington California San Francisco Seattle Denver New York NYC Pennsylvania Philadelphia Alabama Birmingham 2% 8% 7% 4% 6% 0% * MLC ≥ 50 ug/dL Total = 5%

20. Acknowledgements CDC NYC Philadelphia Birmingham Denver San Francisco Seattle The findings and conclusions in this presentation are those of the authors and do not necessarily represent the official position of the Centers for Disease Control and Prevention