Use of Spun Urine to Enhance Detection of Trichomonas vaginalis in Adolescent Women

Abstract

Background: Diagnosis of Trichomonas vaginalis infection is traditionally performed by microscopic examination of vaginal fluid. Although this technique is relatively insensitive compared with culture, it is widely used because of its lower cost and immediate results. Objective: To assess the utility of microscopic examination of spun urine as a means of increasing the sensitivity of microscopic diagnosis of T vaginalis. Design and Setting: Retrospective observational study performed in a hospital-based adolescent clinic. Subjects: Female patients enrolled between July 1995 and August 1996 into a larger study evaluating diagnosis of vaginal infections (N = 686). To be included, subjects had to have a positive culture for T vaginalis (n = 97); those who did not have a spun urine examination were excluded (n = 22). Main Outcome Measure: Microscopic examination of vaginal fluid and spun urine for presence of motile trichomonads. Using a positive Trichomonas culture as the reference standard, the sensitivity of vaginal fluid alone was compared with vaginal fluid plus spun urine. The McNemar test for paired samples was used to test the statistical significance of the difference in sensitivities. Results: Ninety-seven subjects had culture results positive for Trichomonas. Of these, 75 (77%) had a spun urine examination performed. Subjects were aged 13 to 22 years and all were African American. Seventy-three percent of the infections were detected by vaginal fluid specimen, 64% by spun urine, and 85% by either vaginal specimen or spun urine. The difference in sensitivity between vaginal specimen alone and vaginal specimen plus spun urine was 12% (95% confidence interval, 3%-21%; PϽ.005). Nine patients who would not have been diagnosed by examination of vaginal fluid alone were diagnosed with the addition of spun urine examination. Conclusion: Microscopic examination of a spun urine specimen performed in conjunction with microscopic examination of a vaginal fluid specimen improves the detection rate of T vaginalis.

Trichomonas vaginalis infection and the diagnostic significance of detection tests among Ghanaian outpatients

“…Such low detection rates are more apt to frequent misdiagnosis and underestimation of the T. vaginalis problem. Second, in the search for less invasive human samples for detection of T. vaginalis , researchers have evaluated the possible use of urine specimens [14, 27]. In this current study, we found no discrimination in PCR test results between vaginal/urethral swabs and urine samples.…”

Increase Trichomonas vaginalis detection based on urine routine analysis through a machine learning approach

“…vaginalis screening in clinical practice. The advantageous features of this test include easy specimen preparation, immediate results, and low cost 46 . Among the methods capable of detecting T .…”

“…Therefore, it may be an acceptable tool for T . vaginalis screening 25,46 . However, it is extremely labor-intensive.…”

Patient and Provider Demographics and the Management of Genitourinary Tract Infections in the Emergency Department

“…ED clinicians do not use the urinalysis to diagnose T. vaginalis because of low sensitivity (but does have high specifcity). Te vaginal wet mount has moderate sensitivity and high specifcity, while the NAAT has high sensitivity and specifcity [30][31][32]. Both the urine microscopy and vaginal wet mount results are available to the clinician during the ED encounter, and to avoid multicollinearity in the multivariable analysis, we combined these T. vaginalis results into a single variable, indicating whether T. vaginalis infection was known during the ED encounter as follows: (1) positive for T. vaginalis during the ED encounter: positive result by urine microscopy, vaginal wet mount, or both; (2) negative for T. vaginalis infection during ED encounter: negative T. vaginalis by vaginal wet mount and negative by urine microscopy if the urinalysis was performed; and (3) vaginal wet mount not performed: vaginal wet mount not performed and urine microscopy negative for T. vaginalis if a urinalysis was performed.…”