Trichomoniasis: Challenges to Appropriate Management

Abstract

Trichomonas vaginalis infection is a common cause of vaginal irritation in women and is the most common nonviral sexually transmitted disease in the world. It has been associated with serious sequelae, the most notable of which are prematurity, low birth weight, and increases in human immunodeficiency virus transmission. We review advances in diagnosis and treatment and the current controversies regarding management.

Factors associated with low birth weight in a historical series of deliveries in Campinas, Brazil

“…Moreover, they show that morbidities characteristic of pregnancy (hypertension, preeclampsia, history of preterm, infectious diseases, premature rupture of membranes, and hemorrhages during pregnancy) are also risk factors for low birth weight 1,27 . In fact, infections during pregnancy are also considered risk factors, including asymptomatic bacteriuria 28 , bacterial vaginosis 29 , trichomoniasis 30 , malaria 31 and maternal periodontal disease 32,33 .…”

Counterpoint: Screening for Trichomoniasis—Where's the Evidence of Benefit?

“…Conventional Pap tests are considered to have poor diagnostic sensitivity and specificity, although liquid-based tests reportedly perform better, with diagnostic sensitivity and specificity in the range of 60% and 98%, respectively (9,10 ). The results may take several days to become available, however, and it is recommended that positives be confirmed by another means (9,10 ).…”

“…The results may take several days to become available, however, and it is recommended that positives be confirmed by another means (9,10 ). Given that Pap tests are obtained for other reasons, the additional costs for T. vaginalis screening are minimal.…”

“…They have the advantages of being simple to perform, not requiring immediate processing, and having a rapid turnaround. Performance is better than that for wet preparations and comparable to culture, but these point-of-care tests have been evaluated primarily in the diagnosis of symptomatic women, rather than in screening asymptomatic ones (9,10 ). Nucleic acid amplification tests (such as the PCR) have the highest diagnostic sensitivity and specificity and are appropriate for use with both symptomatic and asymptomatic individuals but are expensive.…”

Evaluation of the OSOM Trichomonas Rapid Test versus Wet Preparation Examination for Detection of Trichomonas vaginalis Vaginitis in Specimens from Women with a Low Prevalence of Infection

“…Due to the poor sensitivity of WP (35 to 70%), T. vaginalis cases likely were being missed because of lost flagellate viability during specimen transport (10,14,15). New diagnostic methods for trichomoniasis recently have become commercially available that do not require the presence of viable flagellate, including rapid antigen immunocapillary and nucleic acid amplification tests (2,3,5,6).…”