Trichomonas vaginalis infection in men is an important cause of nongonococcal urethritis. Effective detection of the parasite in men using culture requires examination of multiple specimens. We compared culture and PCR-enzyme-linked immunosorbent assay in urethral swabs, urine, and semen for T. vaginalis detection in male sexual partners of women with trichomoniasis identified by wet mount and culture. Trichomonads were detected by at least one positive test in 205/280 men (73.2%) who submitted at least one specimen for culture and PCR. Whereas InPouch TV culture detected only 46/205 cases (22.5%), PCR detected 201/205 (98.0%). Urethral swab cultures from men with urethritis were more likely to be positive with shorter incubation than specimens from men without urethritis. T. vaginalis was detected more often in men with wet-mount-positive partners. Even with a sensitive PCR assay, reliable detection of T. vaginalis in male partners required multiple specimens. The majority of male sexual partners in this study were infected, emphasizing the importance of partner evaluation and treatment.Infection with the protozoan parasite Trichomonas vaginalis is the most common nonviral sexually transmitted infection (STI), with prevalence estimates frequently surpassing those for gonorrhea and chlamydia (36). Infection of the female genital tract can result in vaginitis, cervicitis, and urethritis, and trichomoniasis has been associated with adverse pregnancy outcomes (4, 23, 26). Though it was once virtually ignored, T. vaginalis infection in men is now recognized as an important cause of nongonococcal urethritis (9,27,29) and is associated with prostatitis (17, 25, 31) and male factor infertility (6, 21). In addition, trichomoniasis is a risk factor for sexual transmission of human immunodeficiency virus (HIV) (1,3,5,19). T. vaginalis disrupts the urogenital epithelia and enhances HIV replication in vitro (7). Increased vaginal and endocervical inflammation in women and urethral inflammation in men with trichomoniasis likely contribute to enhanced HIV transmission. Because trichomoniasis is so widespread, substantial proportions of HIV infections might be attributable to T. vaginalis infection in populations where both are prevalent (2, 32).Few studies have examined concordant trichomoniasis in sexual partners. In studies conducted in the early 1990s using culture for T. vaginalis detection, infection was identified in 22 to 48% of male partners of women with trichomoniasis (14, 18). Since that time, more-sensitive nucleic acid amplification assays have been developed for detection of the parasite (8,10,11,13,20,22,30). T. vaginalis detection in men is also improved when multiple urogenital specimens are tested (12, 15, 16). The current study was designed to examine the concordance of T. vaginalis infection in the male sexual partners of women with trichomoniasis attending 3 sexually transmitted diseases (STD) clinics in the United States. In this report, we focus on the performance of culture and PCR from urethral swabs,...

Vaginal trichomonosis is a highly prevalent infection which has been associated with human immunodeficiency virus acquisition and preterm birth. Culture is the current “gold standard” for diagnosis. As urine-based testing using DNA amplification techniques becomes more widely used for other sexually transmitted diseases (STDs) such as gonorrhea and chlamydia, a similar technique for trichomonosis would be highly desirable. Women attending an STD clinic for a new complaint were screened for Trichomonas vaginalis by wet-preparation (wet-prep) microscopy and culture and for the presence of T. vaginalis DNA by specific PCR of vaginal and urine specimens. The presence of trichomonosis was defined as the detection of T. vaginalis by direct microscopy and/or culture from either vaginal samples or urine. The overall prevalence of trichomonosis in the population was 28% (53 of 190). The sensitivity and specificity of PCR using vaginal samples were 89 and 97%, respectively. Seventy-four percent (38 of 51) of women who had a vaginal wet prep or vaginal culture positive for trichomonads had microscopic and/or culture evidence of the organisms in the urine. Two women were positive for trichomonads by wet prep or culture only in the urine. The sensitivity and specificity of PCR using urine specimens were 64 and 100%, respectively. These results indicate that the exclusive use of urine-based detection of T. vaginalis is not appropriate in women. PCR-based detection of T. vaginalis using vaginal specimens may provide an alternative to culture.

Trichomoniasis is a sexually transmitted infection that is highly prevalent worldwide and has been linked to preterm birth and human immunodeficiency virus acquisition. In females, trichomoniasis causes vaginitis, while in males, it is frequently asymptomatic but can be a cause of urethritis. Control efforts have been hampered by the lack of a sensitive diagnostic technique for this infection in males. Men attending a sexually transmitted disease (STD) clinic for a new complaint were screened for Trichomonas vaginalis by culture and by PCR analysis of urine and urethral-swab specimens. The prevalence of Trichomonas determined by culture was 5% (15 of 300 specimens), compared to 17% (52 of 300) determined by PCR. Urine specimens yielded a greater number of positive results by PCR than did urethral-swab specimens. The sensitivity of PCR analysis of urine specimens in comparison to that of culture was 100%. The use of PCR techniques in urine specimenbased detection of T. vaginalis was highly sensitive and revealed a prevalence of infection more than three times that revealed by culture for men at high risk for STDs.Bacterial sexually transmitted diseases (STDs), such as syphilis, gonorrhea, and chlamydia, are declining in the United States; however, infections caused by Trichomonas vaginalis have not evidenced similar declines. Despite the fact that vaginal trichomoniasis has been linked to preterm birth and the acquisition of human immunodeficiency virus (HIV) (3, 11), increased screening efforts have not been made. For women, the most commonly used diagnostic test for Trichomonas is a direct microscopic examination of the vaginal fluid. Although it is highly specific, the sensitivity of this technique in comparison to that of culture ranges from 50 to 80% (9). Culture of vaginal specimens for the organism is the current "gold standard"; however, the use of PCR techniques for detection in females has been studied, with varied results, and current techniques do not appear to have greater sensitivity than culture does (4,12,13,15). Diagnostic techniques for Trichomonas in males are not routinely used, as the current gold standard (culture of urine and urethral swabs) (10) is cumbersome and likely suboptimal. Few studies have addressed the utility of PCR testing for Trichomonas in males. We compared PCR results for urethral and urine specimens to those of culture techniques for the diagnosis of Trichomonas in men attending an STD clinic. MATERIALS AND METHODSHeterosexual males attending the Jefferson County Health Department STD Clinic in Birmingham, Ala., for STD screening or the treatment of its symptoms, were invited to participate in this diagnostic study. The study was approved by the Institutional Review Boards of the Jefferson County Health Department and the University of Alabama at Birmingham. Men were excluded from participation if they had urinated in the previous hour or had taken antibiotics during the preceding 14 days. Reported symptoms of urethral discharge and dysuria were recorded, as well as the nu...

Mobiluncus is more common in healthy women than previously suspected, with M mulieris as the predominant species. The significant difference in the prevalence of M curtisii between women with bacterial vaginosis and uninfected women suggests that this species could be involved in the pathogenesis of bacterial vaginosis.

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