Trichomonas vaginalisPolymerase Chain Reaction Compared with Standard Diagnostic and Therapeutic Protocols for Detection and Treatment of Vaginal Trichomoniasis

Abstract

Wet preparation has limited sensitivity for diagnosis of Trichomonas vaginalis (TV) infection. An observational study of 337 women was conducted to evaluate a new polymerase chain reaction (PCR) test for TV. The sensitivities of wet preparation and TV culture were 52% (95% confidence interval [CI], 41-62) and 78% (95% CI, 69-86), respectively. TV PCR had a sensitivity of 84% (95% CI, 75-90) and a specificity of 94% (95% CI, 90-97). Metronidazole was provided to 67 (69%) of 97 women with TV because of TV on wet preparation, exposure to TV, or a diagnosis of bacterial vaginosis or pelvic inflammatory disease; however, if TV PCR had been used for diagnosis, 81 (84%) of 97 women with TV would have been treated (P=.02). TV is significantly undertreated using standard algorithms for metronidazole therapy. Given the association of trichomoniasis with perinatal morbidity and HIV transmission, women in high-risk groups may benefit from TV PCR.

Use of culture and immunochromatographic technique for diagnosis of trichomoniasis in Sri Lanka

“…Infection would have been missed in 32% if only microscopy was performed. The sensitivity and specificity of microscopy in our study is comparable with other studies [5][6][7][8]. The manufacturer states 83% sensitivity and 99% specificity of ICT compared to 'culture and PCR combination' and 96% sensitivity and 95% specificity compared to wet mount.…”

Inducing Immune Protection Against Trichomonas vaginalis: A Novel Vaccine Approach to Prevent HIV Transmission

“…Ignoring the latter issue yet another problem arises. Diagnosis of cases investigated from clinical suspicion of trichomoniasis are at mercy of low sensitivity of current diagnostic standards as recent evaluations over the past decade have come to find (Lusk et al, 2010;Roth et al, 2011;Seña et al, 2007;Van Der Pol, 2007;Wendel et al, 2002). The most prevalent and most promising techniques will be reviewed below while a more detailed overview of guidelines for laboratory diagnosis and the methodology can be found in Domeika et al (2010).…”

“…Additionally, this method is expensive and time consuming (Domeika et al, 2010) despite the availability of commercial culture systems (InPouch TV system: BioMed Diagnostics). Studies have found sensitivities ranging between 75-83% and specificity near 100% (Huppert et al, 2007;Nye et al, 2009;Wendel et al, 2002). Wet mount is an attractive diagnostic tool due to its simplicity and cost effectiveness, and is consequently the most widely used (Huppert et al, 2007).…”

“…Moreover, incorrect temperature or too much time elapsing between sampling and assessment results in loss of movement creating difficulty of differentiation from lymphocytes or nuclei of vaginal epithelial cells present in the sample (Garber, 2005). Sensitivities range from 52-61.5% and specificity near 100% (Huppert et al, 2007;Nye et al, 2009;Van Der Pol et al, 2006;Wendel et al, 2002). …”

“…These tests may be conducted years after sample collection depending on proper storage conditions unlike wet mount which results in much less sensitivity unless maintained under strict time and temperature conditions (Van Der Pol et al, 2006). Despite high sensitivity for both male and female samples (Seña et al, 2007), greater than wet mount and culture (Crucitti et al, 2003;Lusk et al, 2010;Roth et al, 2011), in the range of 70-98% and specificity from 94-100% (Huppert et al, 2007;Nye et al, 2009;Seña et al, 2007;Wendel et al, 2002) this method is problematic as it is not point of care and remains unconfirmed for use in clinical settings.…”