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Original Article

Spatiotemporal Clusters and Trend of Trichomonas vaginalis Infection in Korea

Yeong Hoon Kim1orcid, Hye-Jin Ahn2, Dongjae Kim3orcid, Ho-Woo Nam2,*orcid
The Korean Journal of Parasitology 2022;60(2):97-107.
Published online: April 20, 2022

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*Corresponding author (howoo@catholic.ac.kr)
• Received: December 6, 2021   • Revised: February 14, 2022   • Accepted: February 16, 2022

© 2022, Korean Society for Parasitology and Tropical Medicine

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Spatiotemporal Clusters and Trend of Trichomonas vaginalis Infection in Korea
Korean J Parasitol. 2022;60(2):97-107.   Published online April 20, 2022
DOI: https://doi.org/10.3347/kjp.2022.60.2.97
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Spatiotemporal Clusters and Trend of Trichomonas vaginalis Infection in Korea
Korean J Parasitol. 2022;60(2):97-107.   Published online April 20, 2022
DOI: https://doi.org/10.3347/kjp.2022.60.2.97
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Spatiotemporal Clusters and Trend of Trichomonas vaginalis Infection in Korea
Image Image Image
Fig. 1 Regional clusters for T. vaginalis infection from 2012 to 2020. Light to dark blue gradient represents increasing order of log likelihood ratio. Lattice patterns represent a joint cluster. Area codes represent administrative districts of the Korean government. SE, Seoul; BU, Busan; IN, Incheon; DG, Daegu; GW, Gwangju; DJ, Daejeon; UL, Ulsan; GY, Gyeonggi-do; GA, Gangwon-do; CB, Chungcheongbuk-do; CN, Chungcheongnam-do; JB, Jeollabuk-do; JN, Jeollanam-do; GB, Gyeongsangbuk-do; GN, Gyeongsangnam-do; JE, Jeju-do; SJ, Sejong.
Fig. 2 Spatiotemporal trend analysis of trichomoniasis according to districts. Green and red indicate decreasing and increasing rate of infection within the cluster, respectively. Light to dark green gradient represents increasing order of log likelihood ratio. Lattice patterns and dashed lines represent joint clusters in decreasing order of log likelihood ratio. Area codes represent administrative districts of the Korean government. SE, Seoul; BU, Busan; IN, Incheon; DG, Daegu; GW, Gwangju; DJ, Daejeon; UL, Ulsan; GY, Gyeonggi-do; GA, Gangwon-do; CB, Chungcheongbuk-do; CN, Chungcheongnam-do; JB, Jeollabuk-do; JN, Jeollanam-do; GB, Gyeongsangbuk-do; GN, Gyeongsangnam-do; JE, Jeju-do; SJ, Sejong.
Fig. 3 Trend analysis of trichomoniasis according to sex. (A) In women, the 20–59 age groups show sharp increasing rates until 2014 (trend 1), but are not significant. From 2014 on, they show significant decrease (trend 2). Annual Percentage Changes (APC) for the 20–29, 30–39, 40–49, and 50–59 age groups are −9.3, −10.1, −10.6, and −8.2, respectively. The 60–69 age group shows a more gradual rise and decrease (significant trend 2) with APC −9.6. The 70–79 age group shows an even more gradual change, but is significant throughout the whole period, with APC 31.0 and −4.6 in trend 1 and 2, respectively. (B) In men, the 10–39 age groups show significant increasing rates throughout the study period. APC for the 10–19, 20–29, and 30–39 age groups are 10.1, 12.4, and 5.9, respectively. In contrast, the 40–59 age groups show significant decrease during the same period. APC for 40–49 and 50–59 age groups are −3.0 and −4.6, respectively. Only significant trends are shown. Crude rates (adjusted cases per 100,000 population at risk) are calculated by mid-year in Joinpoint, so the program outputs 2014 (B) and 2018 (A) twice on the X axis to reflect multiple trends. aIndicates that the APC is significant at the alpha=0.05 level.

Fig. 1

Fig. 2

Fig. 3

Spatiotemporal Clusters and Trend of Trichomonas vaginalis Infection in Korea

Trichomoniasis cases and adjusted infection rate for 2012–2020 according to administrative districts

Average population Cases
Total 2012 2013 2014 2015 2016 2017 2018 2019 2020 Average
Seoul (SE) 9,935,068 260,892 31,920 39,794 39,697 28,798 28,665 25,362 25,716 22,619 18,321 28,988
Busan (BU) 3,479,524 101,688 10,153 11,995 13,380 14,744 15,865 11,411 11,132 7,139 5,869 11,299
Incheon (IN) 2,922,033 60,760 5,638 6,364 6,246 6,963 7,170 7,928 7,933 8,145 4,373 6,751
Daegu (DG) 2,474,029 80,356 9,022 9,079 10,898 11,191 9,804 9,702 7,716 6,511 6,433 8,928
Gwangju (GW) 1,465,451 37,281 4,126 5,447 6,561 5,694 4,704 2,962 2,812 2,768 2,207 4,142
Daejeon (DJ) 1,505,918 22,801 2,047 3,172 3,444 3,295 3,703 2,783 2,016 1,591 750 2,533
Ulsan (UL) 1,157,860 31,765 3,209 2,946 3,341 4,070 4,707 3,791 3,464 3,549 2,688 3,529
Gyeonggi-do (GY) 12,726,986 270,493 24,131 33,382 35,730 35,062 32,439 32,086 29,050 26,477 22,136 30,055
Gangwon-do (GA) 1,544,798 18,998 2,461 2,553 2,494 2,022 2,234 2,001 2,287 1,868 1,078 2,111
Chungcheongbuk-do (CB) 1,587,489 30,868 3,809 3,966 4,149 4,143 4,874 3,212 2,528 2,440 1,747 3,430
Chungcheongnam-do (CN) 2,088,983 35,073 3,223 5,004 5,240 3,387 3,943 3,636 3,907 3,293 3,440 3,897
Jeollabuk-do (JB) 1,851,870 70,039 6,963 8,283 9,285 9,256 8,637 7,411 7,096 7,523 5,585 7,782
Jeollanam-do (JN) 1,892,796 19,681 2,764 2,695 2,316 1,761 2,634 2,198 1,828 1,999 1,486 2,187
Gyeongsangbuk-do (GB) 2,686,178 37,186 3,893 4,726 6,524 5,452 4,874 4,750 3,043 2,250 1,674 4,132
Gyeongsangnam-do (GN) 3,355,458 73,496 7,654 8,636 9,168 9,473 11,371 8,868 8,423 5,615 4,288 8,166
Jeju-do (JE) 635,639 26,737 2,948 3,466 3,262 2,998 2,921 2,736 2,916 2,881 2,609 2,971
Sejong (SJ) 237,329 391 14 25 13 18 69 42 69 63 78 43
Total 51,547,410 1,178,505 123,735 151,227 161,384 148,012 148,252 130,624 121,716 106,584 84,671 130,689
Adjusted casesa
2012 2013 2014 2015 2016 2017 2018 2019 2020 Average
Seoul (SE) 3,131 3,923 3,929 2,873 2,887 2,573 2,633 2,325 1,895 2,908
Busan (BU) 2,869 3,400 3,802 4,196 4,535 3,288 3,235 2,091 1,730 3,238
Incheon (IN) 3,172 3,153 3,755 3,825 3,331 3,290 2,611 2,202 2,186 3,058
Daegu (DG) 2,250 2,544 2,505 2,799 2,886 3,203 3,222 3,341 1,808 2,729
Gwangju (GW) 2,808 3,698 4,445 3,868 3,202 2,024 1,927 1,900 1,522 2,822
Daejeon (DJ) 1,343 2,069 2,248 2,170 2,445 1,853 1,353 1,079 512 1,675
Ulsan (UL) 2,797 2,547 2,864 3,468 4,015 3,254 2,998 3,091 2,366 3,045
Gyeonggi-do (GY) 1,995 2,728 2,891 2,800 2,551 2,492 2,221 2,000 1,649 2,370
Gangwon-do (GA) 1,599 1,655 1,615 1,305 1,441 1,291 1,482 1,212 699 1,367
Chungcheongbuk-do (CB) 2,433 2,522 2,628 2,616 3,062 2,015 1,581 1,525 1,091 2,164
Chungcheongnam-do (CN) 1,589 2,444 2,541 1,630 1,881 1,718 1,837 1,551 1,622 1,868
Jeollabuk-do (JB) 3,717 4,422 4,961 4,950 4,632 3,996 3,863 4,136 3,096 4,197
Jeollanam-do (JN) 1,447 1,413 1,215 922 1,383 1,159 971 1,070 803 1,154
Gyeongsangbuk-do (GB) 1,443 1,751 2,416 2,017 1,805 1,765 1,137 844 634 1,535
Gyeongsangnam-do (GN) 2,306 2,590 2,737 2,815 3,370 2,623 2,496 1,670 1,284 2,432
Jeju-do (JE) 5,050 5,837 5,371 4,801 4,553 4,164 4,371 4,294 3,867 4,701
Sejong (SJ) 124 205 83 85 284 150 220 185 219 173
Total 2,429 2,957 3,144 2,872 2,868 2,523 2,349 2,056 1,634 2,537

aAdjusted infection rate (cases/1,000,000).

Trichomoniasis and adjusted infection rate for 2012–2020 according to sex and age

Age group Cases Average
2012 2013 2014 2015 2016 2017 2018 2019 2020
Female 0–9 94 104 108 71 102 83 102 69 45 86
10–19 2,923 3,407 3,611 3,063 3,135 2,900 2,722 2,250 1,806 2,869
20–29 25,893 32,105 33,717 29,219 30,250 26,821 25,890 21,939 17,861 27,077
30–39 32,159 39,862 43,634 39,300 38,680 32,364 29,251 24,647 18,712 33,179
40–49 34,625 40,986 43,639 40,146 38,377 33,067 29,426 25,218 18,987 33,830
50–59 18,847 24,284 25,761 24,898 24,551 22,390 21,341 19,282 15,550 21,878
60–69 3,768 5,038 5,753 5,975 6,705 6,562 6,508 6,314 5,557 5,798
70–79 1,000 1,480 1,744 1,762 1,845 1,702 1,737 1,649 1,485 1,600
≥80 143 248 288 287 333 307 340 354 323 291
Male 0–9 4 5 3 7 2 5 2 0 1 3
10–19 40 29 33 52 58 47 42 46 64 46
20–29 540 476 426 553 730 807 932 1,113 1,093 741
30–39 1,159 1,106 1,081 1,052 1,472 1,448 1,371 1,527 1,325 1,282
40–49 1,665 1,476 1,278 1,178 1,396 1,342 1,248 1,236 1,049 1,319
50–59 1,258 1,182 982 932 1,033 1,006 990 1,049 815 1,027
60–69 252 246 183 248 290 314 321 359 345 284
70–79 51 46 34 55 58 69 62 64 65 56
≥80 7 6 7 6 6 11 7 8 19 9
Age group Adjusted casesa Average
2012 2013 2014 2015 2016 2017 2018 2019 2020
Female 0–9 42 46 48 32 46 38 49 34 23 40
10–19 956 1,150 1,263 1,119 1,192 1,139 1,102 941 780 1,072
20–29 8,175 10,233 10,699 9,214 9,458 8,322 8,010 6,798 5,525 8,493
30–39 8,029 10,157 11,404 10,476 10,505 9,001 8,248 7,165 5,617 8,956
40–49 8,004 9,359 9,950 9,222 8,850 7,715 7,053 6,118 4,654 7,881
50–59 4,862 6,095 6,317 6,031 5,895 5,320 4,990 4,483 3,631 5,292
60–69 1,678 2,179 2,375 2,288 2,426 2,264 2,139 1,958 1,613 2,102
70–79 580 835 966 973 1,007 897 892 829 730 857
≥80 182 296 319 295 320 277 288 280 242 278
Male 0–9 2 2 1 3 1 2 1 0 0 1
10–19 12 9 11 17 20 17 16 18 26 16
20–29 156 138 122 157 205 225 259 311 306 209
30–39 278 270 271 268 382 384 368 421 374 335
40–49 369 325 281 261 313 304 289 290 249 298
50–59 321 292 237 222 242 235 228 240 187 245
60–69 121 114 80 101 111 114 110 116 105 108
70–79 41 35 25 40 41 47 40 40 39 39
≥80 22 17 18 14 13 21 12 13 28 17

aAdjusted infection rate (cases/1,000,000).

Regional clusters for T. vaginalis infection from 2012 to 2020

District Cases Expected Relative risk Log likelihood ratioa P-value
2012–2014 Seoul 111,411 86,718 1.38 4113.443 <0.001
Jeollabuk-do 24,531 16,008 1.56 2034.825 <0.001
Jeju-do 9,676 5,093 1.92 1651.701 <0.001
Daegu 28,999 21,371 1.38 1293.497 <0.001
Busan 35,528 30,162 1.19 486.738 <0.001
Gwangju 16,134 12,588 1.29 472.969 <0.001
2015–2017 Busan, Gyeongsangnam-do, Ulsan, Daegu 114,997 87,094 1.44 5231.682 <0.001
Busan 42,020 28,928 1.50 2812.724 <0.001
Jeollabuk-do 25,304 15,422 1.68 2766.880 <0.001
Daegu 30,697 20,555 1.53 2296.591 <0.001
Jeju-do 8,655 5,306 1.64 898.886 <0.001
Ulsan 12,568 9,686 1.31 401.646 <0.001
Gyeongsangnam-do 29,712 27,925 1.07 59.983 <0.001
Gwangju 13,360 12,160 1.10 59.131 <0.001
2018–2020 Jeollabuk-do 20,204 11,009 1.89 3213.317 <0.001
Jeju-do 8,406 4,055 2.10 1808.039 <0.001
Daegu 20,660 14,754 1.43 1108.866 <0.001
Incheon, Seoul 87,107 76,650 1.19 917.320 <0.001
Seoul 66,656 58,804 1.17 624.663 <0.001
Incheon 20,451 17,846 1.16 193.043 <0.001
Total period Jeollabuk-do 70,039 42,337 1.70 7895.184 <0.001
Busan, Gyeongsangnam-do, Ulsan, Daegu 287,305 239,295 1.27 5771.405 <0.001
Jeju-do 26,737 14,533 1.86 4159.725 <0.001
Seoul 260,892 227,134 1.19 2998.914 <0.001
Gwangju 37,281 33,504 1.12 211.612 <0.001

aClusters are shown in decreasing order of log likelihood ratio.

Spatiotemporal trends analysis of trichomoniasis according to administrative districts (2012–2020)

Districts Cases Expected Trend inside clustera Trend outside clustera Relative risk Log likelihood ratiob P-value
Gangwon-do, Gwangju, Seoul 317,171 295,956 −7.34 −4.18 1.10 852.650 <0.001
Incheon 60,760 66,805 0.72 −5.36 0.90 740.745 <0.001
Chungcheongbuk-do, Sejong, Daejeon 54,060 76,151 −8.83 −4.86 0.70 305.845 <0.001
Ulsan 31,765 26,471 0.00c −5.19 1.21 289.338 <0.001
Gyeonggi-do 270,493 290,982 −3.73 −5.42 0.91 216.829 <0.001
Jeollabuk-do 70,039 42,337 −2.52 −5.19 1.70 168.491 <0.001

aTrend inside/outside cluster denotes % increase/decrease over the period of 2012–2020.

bClusters are shown in decreasing order of log likelihood ratio.

cReal value: −0.0024.

Trichomoniasis trends according to sex and age

Age group Trend 1 Trend 2
Period APCa 95% CI P-value Period APCa 95% CI P-value
Female 0–9 2012–2020 −3.6 −9.7~2.8 0.22
10–19 2012–2014 15.5 −17.1~60.8 0.29 2014–2020 −6.0 −11.8~0.1 0.05
20–29 2012–2014 13.8 −13.9~50.4 0.27 2014–2020 −9.3 −13.9~−4.5 0.01
30–39 2012–2014 21.5 −5.2~55.7 0.10 2014–2020 −10.1 −14.2~−5.7 0.00
40–49 2012–2014 13.9 −9.5~43.5 0.19 2014–2020 −10.6 −14.5~−6.5 0.00
50–59 2012–2014 15.6 −6.6~43.0 0.13 2014–2020 −8.2 −11.5~−4.7 0.00
60–69 2012–2016 7.6 −3.3~19.7 0.13 2016–2020 −9.6 −17.7~−0.6 0.04
70–79 2012–2014 31.0 5.6~62.7 0.03 2014–2020 −4.6 −7.5~−1.6 0.01
≥80 2012–2014 27.2 −8.8~77.4 0.12 2014–2020 −4.2 −8.2~0.0 0.05
Male 0–9 2012–2020 −9.9 −26.4~10.4 0.26
10–19 2012–2020 10.1 3.3~17.3 0.01
20–29 2012–2020 12.4 8.2~16.7 0.00
30–39 2012–2020 5.9 2.5~9.5 0.00
40–49 2012–2020 −3.0 −5.7~−0.2 0.04
50–59 2012–2020 −4.6 −7.4~−1.8 0.01
60–69 2012–2020 0.2 −3.2~3.7 0.90
70–79 2012–2020 1.5 −3.0~6.3 0.46
≥80 2012–2020 3.4 −6.2~14.0 0.45

aAPC: annual percentage change.

Table 1 Trichomoniasis cases and adjusted infection rate for 2012–2020 according to administrative districts

Adjusted infection rate (cases/1,000,000).

Table 2 Trichomoniasis and adjusted infection rate for 2012–2020 according to sex and age

Adjusted infection rate (cases/1,000,000).

Table 3 Regional clusters for T. vaginalis infection from 2012 to 2020

Clusters are shown in decreasing order of log likelihood ratio.

Table 4 Spatiotemporal trends analysis of trichomoniasis according to administrative districts (2012–2020)

Trend inside/outside cluster denotes % increase/decrease over the period of 2012–2020.

Clusters are shown in decreasing order of log likelihood ratio.

Real value: −0.0024.

Table 5 Trichomoniasis trends according to sex and age

APC: annual percentage change.

Table 1

Table 2

Table 3

Table 4

Table 5

PHD : Parasites, Hosts and Diseases

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