Systematic review of diagnostic tests for vaginal trichomoniasis

Abstract

Objective: To review critically and to summarize the evidence of diagnostic tests and culture media for the diagnosis of Trichomonas vaginitis.Methods: We performed a systematic review of literature indexed in MEDLINE of studies that used Trichomonas culture as the reference standard (9,882 patients, 35 studies). Level I studies (5,047 patients, 13 studies) fulfilled at least two of three criteria: 1) consecutive patients were evaluated prospectively, 2) decision to culture was not influenced by test results, and 3) there was independent and blind comparison to culture.Results: The sensitivity of the polymerase chain reaction technique (PCR) was 95% (95% CI 91% to 99%), and the specificity was 98% (95% CI 96% to 100%). One study was classified as Level I evidence (52 patients). The sensitivity of the enzyme-linked immunosorbent assay was 82% (95% CI 74% to 90%), and the specificity was 73% (95% CI 35% to 100%). The sensitivity of the direct fluorescence antibody was 85% (95% CI 79% to 90%), and the specificity was 99% (95% CI 98% to 100%). Sensitivities of culture media were 95% for Diamond's, 96% for Hollander, and 95% for CPLM.Conclusions: The sensitivity and specificity of tests to diagnose trichomoniasis vary widely. Infect.

Comparison of latex agglutination, wet preparation, and culture for the detection of Trichomonas vaginalis

“…12 Sensitivity of the latex agglutination test compares favourably with culture and is superior to the wet prep. Moreover, the test is simple to perform, requires no equipment other than a glass slide and mixing stick and gives a result in less than 3 minutes.…”

“…This method, though timely and enabling patients to receive same day treatment, has a poor sensitivity 9-11 and patients could remain infected and untreated. Culture, with a much better sensitivity, 12 does not allow same day treatment, and patients, especially if asymptomatic for infection may continue to transmit infection. In many developing countries where the cost of return to the health facility can be substantial, patients may not bother to return for their culture results, thus prolonging infection, leading to further transmission and the possibility of sequelae.…”

“…8 However, this technique has a low sensitivity of 30-80% [9][10][11] and requires trained and experienced microscopists. The gold standard in T vaginalis diagnosis-culture-has a higher sensitivity of 71-100%, 12 but requires an incubator with a constant electricity supply and relatively expensive culture media, in addition to an experienced microscopist. Further, it can take up to 7 days for results to be obtained, and currently is outside the reach of many health settings.…”

Improving diagnosis of Trichomonas Vaginalis infection in resource limited health care settings in Sri Lanka

“…[16] Unfortunately, culture requires an incubator with a constant electricity supply, relatively expensive culture media, and an experienced microscopist. Furthermore, it can take up to 5–7 days for results to be obtained; these issues limit its use in resource-limited settings.…”

Prevalence ofTrichomonas vaginalisinfection in women attending a major gynaecological hospital in Greece: a cross-sectional study

“…Both the sensitivity and the specificity of wet mount depend greatly on microscopist experience. Culture is considered the gold standard for T vaginalis diagnosis, with an overall sensitivity of up to 95%,12 but requires as long as 7 days for results to be obtained. PCR based assays for the diagnosis of trichomoniasis were introduced in the early 1990s13 and have since aided the diagnosis of the infection, both in women and men, with an overall sensitivity and specificity around 95% and 98%, respectively 12…”