Use of urine polymerase chain reaction to define the prevalence and clinical presentation of Trichomonas vaginalis in men attending an STD clinic

Abstract

Objective: To determine the prevalence and clinical features of Trichomonas vaginalis (TV) infection in men. Methods: Men attending a public STD clinic in Baltimore, Maryland, were evaluated between March and July 2000. Clinicians recorded a standardised history and clinical examination. Urethral swab specimens were collected for Gram stain and Neisseria gonorrhoeae culture. First fraction urine samples were evaluated with TV culture and chlamydia and TV polymerase chain reaction (PCR). True positive TV was defined as a positive TV culture or a positive TV PCR confirmed with a second primer set. Results: 355 men were evaluated in 363 visits. The prevalence of gonorrhoea, TV, and chlamydia were 19%, 13%, and 11%, respectively. In men over 28 years, the prevalence of TV was significantly higher than chlamydia. Age and urethritis by Gram stain were associated with a positive result on TV culture (p=0.03 and p=0.02, respectively) but not associated with TV infection as defined by a positive TV culture or a confirmed TV PCR. Discharge or dysuria was reported in 47% and 22% of men with TV, respectively. Conclusions: TV prevalence in an urban STD clinic setting was high. Older age and urethritis were not significantly associated with TV infection as defined by a positive TV culture or a confirmed TV PCR.T richomonas vaginalis (TV) has been associated with complications of pregnancy and an increased risk of HIV acquisition in women.1 2 Some studies have associated TV infection in men with prostatitis, urethral strictures, and elevated seminal HIV RNA in men with HIV infection and symptomatic urethritis.3-5 Yet controversy continues over the prevalence and morbidity of TV infection in men.Studies using TV culture have shown TV prevalence rates from 3-12% in men attending STD clinics in the United States and have associated TV infection with older age, symptoms of urethritis, and diagnostic criteria for non-gonococcal urethritis (NGU). [6][7][8] Recently, polymerase chain reaction (PCR) has emerged as a powerful tool for TV diagnosis, but studies using TV PCR have provided limited information about the prevalence of infection, the epidemiology, or the clinical presentation of disease in men.9 10 This study used urine TV PCR and culture to determine the prevalence and clinical features of TV infection in men in an urban STD clinic in the United States. METHODSThis study was approved by the institutional review boards of the Johns Hopkins Medical Institutions and the Baltimore city health department. Men attending a Baltimore City Health Department STD clinic were evaluated between March and July 2000. A standardised clinical form was used to record the history and directed examination. Laboratory evaluationIntraurethral secretions were collected for Gram stain and Neisseria gonorrhoeae culture using modified Thayer-Martin media. First fraction urine (15 ml) was centrifuged for 10 minutes. The sediment was inoculated into an InPouch TV test (Biomed Diagnostics, Santa Clara, CA, USA) for TV culture and incubated at 37°C in 5...

Comparison between the Gen-Probe Transcription-Mediated Amplification Trichomonas vaginalis Research Assay and Real-Time PCR for Trichomonas vaginalis Detection Using a Roche LightCycler Instrument with Female Self-Obtained Vaginal Swab Samples and Male Urine Samples

“…These data are similar to those for our STD clinic population and those of Miller et al and Wendel et al (18,30,31). Male urine and SOVS have been shown to be acceptable for the detection of T. vaginalis (9,10,16,20,23,31). In our study, these self-obtained samples demonstrated a very high initial sensitivity and specificity for TMA of 96.7% and 97.3%, respectively, and the TMA assay had excellent resolved sensitivity and specificity at 98.6% and 99.1%.…”

“…Females had a higher prevalence (17.8%) of T. vaginalis in our population than men (4.5%). These data are similar to those for our STD clinic population and those of Miller et al and Wendel et al (18,30,31). Male urine and SOVS have been shown to be acceptable for the detection of T. vaginalis (9,10,16,20,23,31).…”

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

“…Not surprisingly, substantially more T. vaginalis infections in men were detected by PCR than by culture. Others have reported similar results in recent studies of T. vaginalis in men attending STD clinics (30,35). The study was designed to examine concordant infection in the partners of women with trichomoniasis, and positive index cases were defined using wet mount microscopy and culture but not PCR.…”

“…Early positive cultures are plausible indicators of infections with higher parasite loads, and urethral inflammation is more likely to accompany such infections. Similarly, Wendel et al observed an association of urethritis in men with trichomoniasis detected by culture but not by PCR (35). The superior sensitivity of nucleic acid amplification tests compared to T. vaginalis culture certainly results in detection of more asymptomatic trichomoniasis in men by PCR, and such infections may have lower organism burdens with less urethral inflammation.…”

Three-Year History of Transcription-Mediated Amplification-Based Trichomonas vaginalis Analyte-Specific Reagent Testing in a Subacute Care Patient Population

“…Other studies have reported that sensitivity of vaginal swabs exceeds those of endocervical swabs or urine for detection of T. vaginalis (20,33). However, past studies used DNA amplification methods that, in a general sense, have been shown clinically (6,26) and in vitro (5,17) to be less sensitive than TMA-based, target capture-supplemented methodology.…”