Methods for Detection of Trichomonas vaginalis in the Male Partners of Infected Women: Implications for Control of Trichomoniasis

Abstract

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,...

Prevalence of Bacterial Vaginosis and Impact of Genital Hygiene Practices in Non-Pregnant Women in Zanjan, Iran

“…9 Infection of the female genital tract can result in vaginitis, cervicitis, and urethritis, and trichomoniasis has been associated with adverse pregnancy outcomes. 10 Behavioral factors such as vaginal douching or menstrual hygiene practices have been suggested as important factors that might influence vaginal flora composition, but little data is available from Iranian populations. 11 Therefore, the present study was carried out to determine the prevalence of BV, VVC and Trichomoniasis and association of BV with socio-demographic characteristics and sexual and hygiene-related variables in women attending primary health care centers in Zanjan, Iran.…”

Comparison of Aptima Trichomonas vaginalis Transcription-Mediated Amplification Assay and BD Affirm VPIII for Detection of T. vaginalis in Symptomatic Women: Performance Parameters and Epidemiological Implications

“…Recent literature suggests an association between T. vaginalis infection and the sequelae of other sexually transmitted infections (STIs), including low birth weight, premature rupture of membranes, preterm labor, atypical pelvic inflammatory disease, infertility, prolonged carriage of human papillomavirus (HPV), and an increased risk for acquiring HIV (9,10,13,18,21,31,32). Current methods used for the diagnosis of T. vaginalis, including wet mount microscopy, rapid antigen testing, and culture, have been shown to have poor sensitivity compared to molecular amplification methods (6,14,17,19,24,25,27). In addition, variable performance occurs with antigen testing and wet mount microscopy, depending on whether patients are symptomatic or asymptomatic (17,26).…”

United Kingdom National Guideline on the Management of Trichomonas vaginalis 2014

“…The sensitivity is highest in women presenting with vaginal discharge and a visualisation of motile trichomonads in these women indicates the presence of infection. However, the sensitivity is reported to be as low as 45-60% in women 20,21,24,[26][27][28][29] in some studies and lower in men, 29,30 and so a negative result should be interpreted with caution. The specificity with trained personnel is high.…”

“…29,30 The sensitivity and specificity has been reported to be 80-94% and greater than 95%, respectively, depending on the comparator. 27,28,34,35 This test requires no instrumentation and provides a result within 30 min and is a suitable alternative to culture or molecular testing.…”