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Rosales-Rimache J, Inolopú JL, Soncco-Llulluy FC, Medina-Ciprian L. Comparison of Three Methods for Diagnosing Trichomoniasis in Female Patients with Sexual Activity Attended at a Hospital in Peru. J Parasitol Res 2023; 2023:9528942. [PMID: 38028127 PMCID: PMC10665100 DOI: 10.1155/2023/9528942] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/26/2023] [Revised: 08/10/2023] [Accepted: 11/02/2023] [Indexed: 12/01/2023] Open
Abstract
Background Trichomoniasis is a sexually transmitted infection that mainly affects women. The diagnosis is made by different methods that identify the presence of Trichomonas vaginalis; therefore, sensitivity, specificity, and performance are essential to guarantee an adequate diagnosis. Our study is aimed at comparing three methods for diagnosing trichomoniasis in patients treated at a hospital in Peru during the year 2018. Methods We designed a cross-sectional study and enrolled women whose vaginal secretion samples were evaluated by direct examination, Papanicolaou staining, and culture in the Diamond medium. Results We evaluated 134 women with a mean age of 36.6 ± 12.1 years and a beginning of sexual activity of 18.5 ± 3.0 years. We found leukocyte infiltration, fetid odor, and strawberry cervix in 66.4%, 35.1%, and 18.7%. The prevalence of trichomoniasis by the culture method, direct examination, and Papanicolaou was 32.1, 21.6, and 11.2%. The direct examination's sensitivity, specificity, and diagnostic performance (AUC) were 65.1%, 98.9%, and 82.0%, while for the Pap smear, they were 32.6%, 98.9%, and 65.7%%. Conclusion The culture of T. vaginalis is the gold standard for diagnosing trichomoniasis; however, direct examination is a fast, specific alternative with good diagnostic performance. The Pap test has low sensitivity and should not be used in settings where the prevalence and risk factors for trichomoniasis are high.
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Affiliation(s)
- Jaime Rosales-Rimache
- Universidad Privada Norbert Wiener, Vicerrectorado de Investigación, Lima 15046, Peru
| | - Jorge L. Inolopú
- Facultad de Salud Pública y Administración, Universidad Peruana Cayetano Heredia, Lima 15101, Peru
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Bahreini MS, Sedghi S, Badalzadeh Y, Motazedian MH, Shirani M, Jahromi SS, Teimouri A, Agholi M, Asgari Q. Molecular diagnosis of Trichomonas vaginalis in liquid-based Papanicolaou samples in Shiraz, southern Iran. BMC Womens Health 2023; 23:6. [PMID: 36604666 PMCID: PMC9817326 DOI: 10.1186/s12905-022-02141-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/21/2022] [Accepted: 12/20/2022] [Indexed: 01/07/2023] Open
Abstract
BACKGROUND Trichomoniasis is a parasitic infection of the urinary and genital tract, caused by Trichomonas vaginalis. This study aimed to investigate the molecular diagnosis of T. vaginalis infection in liquid-based Papanicolaou samples in Shiraz, southern Iran. MATERIALS AND METHODS In this cross-sectional study, 534 liquid-based Papanicolaou samples were collected from women referring to the laboratory of Motahari Clinic of Shiraz University of Medical Sciences in 2021. Genomic DNA were extracted from the samples and examined for evidence of T. vaginalis using polymerase chain reaction (PCR) using TVK3 and TVK7 specific primers. RESULTS The mean age of participants was 39.28 ± 9.89 with a maximum age of 65 and a minimum age of 19 years. T. vaginalis DNA fragments were detected in 4.86% (26/534) of the cases. There was significantly higher prevalence in the age groups of 21 to 30 and 41 to 50 years (46.15%, p = 0.001 and 38.46%, p = 0.015, respectively). Furthermore, the results showed an association between a history of foamy discharge and Trichomonas positivity (p = 0.001). CONCLUSION T. vaginalis infection is common in liquid-based Papanicolaou samples of women who attended regular health check-ups in the study area. Screening for trichomoniasis in populations, particularly if using highly sensitive methods such as PCR, may lead to increased detection and treatment.
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Affiliation(s)
- Mohammad Saleh Bahreini
- grid.412571.40000 0000 8819 4698Department of Parasitology and Mycology, School of Medicine, Shiraz University of Medical Sciences, Shiraz, Iran
| | - Samaneh Sedghi
- grid.412571.40000 0000 8819 4698Department of Parasitology and Mycology, School of Medicine, Shiraz University of Medical Sciences, Shiraz, Iran
| | - Yalda Badalzadeh
- grid.412571.40000 0000 8819 4698Department of Parasitology and Mycology, School of Medicine, Shiraz University of Medical Sciences, Shiraz, Iran
| | - Mohammad Hossein Motazedian
- grid.412571.40000 0000 8819 4698Department of Parasitology and Mycology, School of Medicine, Shiraz University of Medical Sciences, Shiraz, Iran
| | - Manouchehr Shirani
- grid.412571.40000 0000 8819 4698Department of Parasitology and Mycology, School of Medicine, Shiraz University of Medical Sciences, Shiraz, Iran
| | - Sareh Sami Jahromi
- grid.412571.40000 0000 8819 4698Department of Pathology, School of Medicine, Shiraz University of Medical Sciences, Shiraz, Iran
| | - Aref Teimouri
- grid.412571.40000 0000 8819 4698Department of Parasitology and Mycology, School of Medicine, Shiraz University of Medical Sciences, Shiraz, Iran
| | - Mahmoud Agholi
- grid.411135.30000 0004 0415 3047Department of Parasitology and Mycology, School of Medicine, Fasa University of Medical Sciences, Fasa, Iran
| | - Qasem Asgari
- grid.412571.40000 0000 8819 4698Department of Parasitology and Mycology, School of Medicine, Shiraz University of Medical Sciences, Shiraz, Iran
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Abraham E, Fairley CK, Denham I, Bradshaw CS, Farquharson RM, Vodstrcil LA, Plummer EL, Ong JJ, Chen MY, Phillips TR, Chow EP. Positivity and Risk Factors for Trichomonas vaginalis Among Women Attending a Sexual Health Clinic in Melbourne, 2006 to 2019. Sex Transm Dis 2022; 49:762-768. [PMID: 35948300 PMCID: PMC9553257 DOI: 10.1097/olq.0000000000001690] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/08/2022] [Accepted: 07/29/2022] [Indexed: 11/25/2022]
Abstract
BACKGROUND Trichomonas vaginalis is not a notifiable disease in Australia in most states, resulting in limited Australian epidemiological studies. This study aimed to examine the positivity of T. vaginalis in women attending the Melbourne Sexual Health Centre (MSHC) and identify associated factors. METHODS All women 16 years or older who were tested for T. vaginalis at MSHC from 2006 to 2019 were included. The diagnostic method changed from culture to nucleic acid amplification test in August 2018. The annual positivity of T. vaginalis was calculated. Because of the data completeness, we performed a generalized estimating equations multivariable logistic regression using data from 2011 to 2019 to examine factors associated with T. vaginalis positivity. RESULTS From 2006 to 2019, 69,739 tests for T. vaginalis were conducted, and 294 tested positive (0.42%; 95% confidence interval [CI], 0.37%-0.47%). Approximately 60% of women tested reported symptoms. After adjusting for potential confounders including the change in diagnostic method, there was a 21% (95% CI, 12%-31%) annual increase in T. vaginalis positivity between 2011 and 2019. Women with concurrent syphilis had the highest odds of testing positive for T. vaginalis (adjusted odds ratio [aOR], 21.55; 95% CI, 6.96-66.78), followed by women who had injected drugs in the last 12 months (aOR, 6.99; 95% CI, 4.11-11.87), were 35 years or older (aOR, 3.47; 95% CI, 2.26-5.35), or had concurrent chlamydia (aOR, 1.77; 95% CI, 1.05-2.99). CONCLUSIONS The rising positivity of T. vaginalis at MSHC irrespective of change in diagnostic method suggests a concurrent community-wide rise in Melbourne. Given the rising positivity, testing informed by risk factors should be considered.
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Affiliation(s)
- Esha Abraham
- From the Melbourne Sexual Health Centre, Alfred Health
- Central Clinical School, Faculty of Medicine, Nursing and Health Sciences, Monash University
| | - Christopher K. Fairley
- From the Melbourne Sexual Health Centre, Alfred Health
- Central Clinical School, Faculty of Medicine, Nursing and Health Sciences, Monash University
| | - Ian Denham
- From the Melbourne Sexual Health Centre, Alfred Health
| | - Catriona S. Bradshaw
- From the Melbourne Sexual Health Centre, Alfred Health
- Central Clinical School, Faculty of Medicine, Nursing and Health Sciences, Monash University
- Centre for Epidemiology and Biostatistics, Melbourne School of Population and Global Health, The University of Melbourne, Melbourne, Victoria, Australia
| | - Rebecca M. Farquharson
- From the Melbourne Sexual Health Centre, Alfred Health
- Central Clinical School, Faculty of Medicine, Nursing and Health Sciences, Monash University
| | - Lenka A. Vodstrcil
- From the Melbourne Sexual Health Centre, Alfred Health
- Central Clinical School, Faculty of Medicine, Nursing and Health Sciences, Monash University
- Centre for Epidemiology and Biostatistics, Melbourne School of Population and Global Health, The University of Melbourne, Melbourne, Victoria, Australia
| | - Erica L. Plummer
- From the Melbourne Sexual Health Centre, Alfred Health
- Central Clinical School, Faculty of Medicine, Nursing and Health Sciences, Monash University
| | - Jason J. Ong
- From the Melbourne Sexual Health Centre, Alfred Health
- Central Clinical School, Faculty of Medicine, Nursing and Health Sciences, Monash University
| | - Marcus Y. Chen
- From the Melbourne Sexual Health Centre, Alfred Health
- Central Clinical School, Faculty of Medicine, Nursing and Health Sciences, Monash University
| | - Tiffany R. Phillips
- From the Melbourne Sexual Health Centre, Alfred Health
- Central Clinical School, Faculty of Medicine, Nursing and Health Sciences, Monash University
| | - Eric P.F. Chow
- From the Melbourne Sexual Health Centre, Alfred Health
- Central Clinical School, Faculty of Medicine, Nursing and Health Sciences, Monash University
- Centre for Epidemiology and Biostatistics, Melbourne School of Population and Global Health, The University of Melbourne, Melbourne, Victoria, Australia
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INVESTIGATION OF SOME MICROBIAL AGENTS IN VAGINAL AND ENDOSERVIX SWAP SAMPLES OF 18 – 50 AGED WOMEN WITH VAGINAL DISCHARGE. INTERNATIONAL JOURNAL OF HEALTH SERVICES RESEARCH AND POLICY 2022. [DOI: 10.33457/ijhsrp.1000855] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022] Open
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Abraham E, Fairley CK, Aung ET, Bradshaw CS, Chen MY, Phillips TR, Chow EPF. Trichomoniasis among men presenting to a sexual health clinic in Melbourne, Australia. Sex Health 2022; 19:70-73. [DOI: 10.1071/sh21240] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/03/2021] [Accepted: 01/29/2022] [Indexed: 11/23/2022]
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Yasin J, Ayalew G, Dagnaw M, Shiferaw G, Mekonnen F. Vulvovaginitis Prevalence Among Women in Gondar, Northwest Ethiopia: Special Emphasis on Aerobic Vaginitis Causing Bacterial Profile, Antimicrobial Susceptibility Pattern, and Associated Factors. Infect Drug Resist 2021; 14:4567-4580. [PMID: 34754204 PMCID: PMC8572045 DOI: 10.2147/idr.s337205] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/01/2021] [Accepted: 10/20/2021] [Indexed: 01/13/2023] Open
Abstract
Background Genital tract infections are posing a series of public health challenges for women in both developed and developing countries. Microbial infections of the vagina can lead to serious medical complications such as preterm labor, amniotic fluid infection, premature rupture of the fetal membranes, and low birth weight of the neonate, leading to high perinatal morbidity and mortality. In Ethiopia, limited information is found on the burden, antimicrobial susceptibility profile and associated factors for aerobic vaginitis. Thus, this study was aimed to determine the burden of AV, antimicrobial susceptibility profile of aerobic bacterial isolates and associated factors among women attending Gondar town health facilities, northwest Ethiopia. Methods A health facility-based cross-sectional study was conducted on 214 study participants from February 1 to May 31, 2019. For all consecutive women, demographic variables were collected using a structured questionnaire and two vaginal swabs for each were collected. The diagnosis of AV and BV was based on the composite score of Donders and Nugent criteria, respectively. All bacteria were isolated and characterized by conventional culture techniques. The antimicrobial susceptibility pattern was performed using the disc diffusion technique. Logistic regression, univariate and multivariate analysis were carried out. A p-value ≤ 0.05 at 95% CI was considered as statistically significant. Results The overall prevalence of vulvovaginitis among women was 50%. The identified aetiologies of vulvovaginitis were bacterial vaginosis (35.5%), candidiasis (23.8%), aerobic vaginitis (22.9%) and trichomoniasis (3.3%). Aerobic bacteria, especially Enterococcus faecalis and Escherichia coli, were predominantly isolated in the vaginal samples. The prevalence of the multidrug resistance rate was 38.98%. The isolated Gram positive bacteria were sensitive to antibiotics like vancomycin, cefoxitin, ciprofloxacin, clindamycin, and gentamicin, whereas the Gram negative bacteria isolates were sensitive to ciprofloxacin, gentamicin and meropenem. Conclusion The high burden of bacterial vaginosis and aerobic vaginitis was reported. Therefore, regular screening of women using microbiological diagnosis should be promoted. The common bacteria isolated were Enterococcus faecalis and Escherichia coli. Additionally, antibiotics like vancomycin, cefoxitin, ciprofloxacin, clindamycin, gentamicin, and meropenem were shown to have good action against the majority of bacteria isolates.
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Affiliation(s)
- Jemal Yasin
- Department of Medical Microbiology, School of Biomedical and Laboratory Sciences, University of Gondar, Gondar, Ethiopia
| | - Getnet Ayalew
- Department of Medical Microbiology, School of Biomedical and Laboratory Sciences, University of Gondar, Gondar, Ethiopia
| | - Mulat Dagnaw
- Department of Medical Microbiology, School of Biomedical and Laboratory Sciences, University of Gondar, Gondar, Ethiopia
| | - Getachew Shiferaw
- Department of Gynecology and Obstetrics, School of Medicine, University of Gondar, Gondar, Ethiopia
| | - Feleke Mekonnen
- Department of Medical Laboratory Sciences, School of Health Sciences, College of Medicine and Health Sciences, Bahir Dar University, Bahir Dar, Ethiopia
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Abstract
Vaginitis is defined as inflammation or infection of the vagina and is associated with a spectrum of symptoms, including vulvovaginal itching, burning, irritation, dyspareunia, "fishy" vaginal odor, and abnormal vaginal discharge. Vaginal symptoms are some of the most frequent reasons for patient visits to obstetrician-gynecologists () and may have important consequences in terms of discomfort and pain, days lost from school or work, sexual functioning, and self-image (). Distinguishing vaginal from vulvar symptoms is important to direct evaluation and treatment. The purpose of this document is to provide updated evidence-based guidance for the diagnosis and treatment of the common causes of vaginitis in nonpregnant patients. Information on the treatment of vaginitis in patients with human immunodeficiency virus (HIV) is covered elsewhere (). Guidelines are subject to change. For the most up-to-date information on vaginitis diagnosis and treatment, see the Centers for Disease Control and Prevention (CDC) Sexually Transmitted Diseases webpage, which is available at https://www.cdc.gov/std/.
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TÜRKMEN ALBAYRAK H, ALBAYRAK AM, BAKIR A, ŞAHİN İ. Vulvovajinal Enfeksiyon Tanı Yöntemlerinin Karşılaştırılması ve Predispozan Faktörlerin Etkilerinin İncelenmesi. DÜZCE ÜNIVERSITESI SAĞLIK BILIMLERI ENSTITÜSÜ DERGISI 2020. [DOI: 10.33631/duzcesbed.558836] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
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Sonkar SC, Wasnik K, Kumar A, Mittal P, Saluja D. Comparative analysis of syndromic and PCR-based diagnostic assay reveals misdiagnosis/ overtreatment for trichomoniasis based on subjective judgment in symptomatic patients. Infect Dis Poverty 2016; 5:42. [PMID: 27146362 PMCID: PMC4857337 DOI: 10.1186/s40249-016-0133-x] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/16/2015] [Accepted: 04/18/2016] [Indexed: 12/11/2022] Open
Abstract
Background Trichomoniasis, a sexually transmitted disease (STD), is caused by Trichomonas vaginalis in both men and women. Screening of trichomoniasis is problematic in resource challenged settings as currently available, inexpensive diagnostic methods are of low sensitivity and/or specificity. In India, National AIDS Control organization (NACO) recommended syndromic case management (SCM) for treatment. The objective of the present study was to compare the utility of the NACO-NACP III Algorithms for STI/RTI treatment used by clinicians with PCR based diagnosis. Methods Patients visiting Department of Obstetrics & Gynecology, Vardhman Mahavir Medical College and Safdarjung Hospital, New Delhi from January 2011 to June 2014 were enrolled in the study to compare the diagnostic efficiency of PCR-based assays against SCM. Based on SCM, patients (n = 820) were treated with antibiotics using pre-packed STI/RTI kits (sexually transmitted infection/reproductive tract infection; procured by National AIDS Control/State AIDS Control Society (NACO/SACS), Ministry of Health and Family Welfare, Govt of India.) under National AIDS Control Programme (NACP III) for syndromic case management (SCM). Ectocervical dry swab samples were also obtained from these patients and out of that 634 samples were tested by PCR. Total genomic DNA was extracted from these samples and used as template for PCR amplification using pfoB, gyrA and orf1 gene specific primers for diagnosis of T. vaginalis (TV), Chlamydia trachomatis (CT) and Neisseria gonorrhoeae (NG) respectively. Results Out of 6000 patients who visited OPD, 820 (14 %) female patients reported vaginal discharge and were recommended antibiotic treatment for one or more pathogens namely, TV, CT, NG and Candida or for co-infection. On the basis of signs & symptoms and NACO guidelines, the following distribution of various infections was observed: TV (46 %), CT (20 %), coinfection with TV and CT (12 %), coinfection with CT and NG (11 %), coinfection with TV, CT and Candida (7 %) and coinfection with TV and NG (2 %). Others were infected with NG alone (1 %), coinfected with TV and Candida (0.4 %) and 0.3 % were coinfected with CT, NG and Candida. Based on PCR method, 110 (17 %) women tested positive for one or more of these three pathogens while 524 (83 %) women were negative for any of these three pathogens but could be positive for other STIs not tested in this study. Since all the patients (634) were given antibiotics, we estimate that the over-treatment was 85 % while 524 (83 %) patients were also misdiagnosed by SCM. Conclusions The over-treatment and inaccurate diagnosis of pathogens due to subjective judgment based on syndromic approach in symptomatic women is a large economic wastage and may also contribute towards increased resistance. The misdiagnosed patients will also serve as a reservoir for transmission of pathogens to their sexual partner. Electronic supplementary material The online version of this article (doi:10.1186/s40249-016-0133-x) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- Subash Chandra Sonkar
- Dr. B. R. Ambedkar Center for Biomedical Research, University of Delhi, Delhi, 110007, India
| | - Kirti Wasnik
- Dr. B. R. Ambedkar Center for Biomedical Research, University of Delhi, Delhi, 110007, India
| | - Anita Kumar
- Department of Obstetrics & Gynecology, Vardhman Mahavir Medical College and Safdarjung Hospital, New Delhi, 110029, India
| | - Pratima Mittal
- Department of Obstetrics & Gynecology, Vardhman Mahavir Medical College and Safdarjung Hospital, New Delhi, 110029, India
| | - Daman Saluja
- Dr. B. R. Ambedkar Center for Biomedical Research, University of Delhi, Delhi, 110007, India.
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Menezes CB, Mello MDS, Tasca T. COMPARISON OF PERMANENT STAINING METHODS FOR THE LABORATORY DIAGNOSIS OF TRICHOMONIASIS. Rev Inst Med Trop Sao Paulo 2016; 58:5. [PMID: 26910452 PMCID: PMC4793946 DOI: 10.1590/s1678-994620160005] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/21/2015] [Accepted: 04/17/2015] [Indexed: 02/01/2023] Open
Abstract
Trichomonas vaginalis is the etiologic agent of trichomoniasis, the most common
non-viral sexually transmitted disease (STD) in the world. The diagnosis is based on
wet mount preparation and direct microscopy on fixed and stained clinical specimens.
The aim of this study was to compare the performance of different fixing and staining
techniques used in the detection of T. vaginalis in urine. The smears were fixed and
submitted to different methods of permanent staining and then, the morphological
aspects of the parasites were analyzed and compared. The Papanicolaou staining with
ethanol as the fixative solution showed to be the best method of permanent staining.
Our data suggest that staining techniques in association with wet mount examination
of fresh specimens contribute to increase the sensitivity in the diagnosis of
trichomoniasis.
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Affiliation(s)
- Camila Braz Menezes
- Faculdade de Farmácia, Universidade Federal do Rio Grande do Sul, Porto Alegre, RS, Brasil
| | | | - Tiana Tasca
- Faculdade de Farmácia, Universidade Federal do Rio Grande do Sul, Porto Alegre, RS, Brasil
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Oliveira AS, Ferrão AR, Pereira FM, Martinez-de-Oliveira J, Palmeira-de-Oliveira A. Trichomonas vaginalis: An Updated Overview Towards Diagnostic Improvement. Acta Parasitol 2016; 61:10-21. [PMID: 26751868 DOI: 10.1515/ap-2016-0002] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/01/2015] [Accepted: 09/15/2015] [Indexed: 11/15/2022]
Abstract
The protozoan Trichomonas vaginalis (TV) is responsible for trichomonosis, a sexually transmitted disease (STD) with a significant incidence worldwide. This infection is one of the most common non-viral STDs, representing almost 50% of all curable STDs. Trichomonosis has an incidence of 180 million new cases worldwide. Nowadays, the 'gold standard' for TV diagnosis remains the use of in vitro cultures combined with daily visual microscopic evaluations, which is a time-consuming and low sensitive method. Recent diagnostic methodologies include imunocromatographic assays and molecular biology techniques. The use of the latter has improved enormously the sensitivity and specificity of TV diagnosis, despite, however, none being unable to identify the presence of live parasites. By understanding the biology, the pathogenesis, the proteomic profile and its relation with the parasite's virulence mechanisms, new possibilities towards diagnostic techniques can arise. This review covers various important aspects of vaginal trichomonosis from the parasite's biology and virulence to recent improvements in diagnostic techniques and also metabolic and protein discoveries.
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Abstract
Trichomonas vaginalis is the most common nonviral sexually transmitted infection (STI) in the world. It was once thought to be a nuisance STI, but it is now being recognized as an important source of reproductive morbidity and a facilitator of HIV transmission and acquisition, and thus it is an important public health problem. The prevalence of T. vaginalis varies greatly by geography and risk group, but is more common among persons of African descent and appears to increase with age, though this may be a screening phenomenon. Wet mount and culture are simple diagnostics, but have lower sensitivity than nucleic acid amplification techniques presently approved for women only. Single dose (2 g) metronidazole (MTZ) for both the index patient and their sexual partners is the preferred treatment. High rates of retest positivity are found after single-dose treatment which are likely due to clinical resistance rather than re-infection and/or drug resistance.
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Affiliation(s)
- Patricia Kissinger
- School of Public Health and Tropical Medicine, Tulane University, 1440 Canal Street SL-18, New Orleans, LA, 70112, USA,
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Nazari N, Zangeneh M, Moradi F, Bozorgomid A. Prevalence of trichomoniasis among women in kermanshah, iran. IRANIAN RED CRESCENT MEDICAL JOURNAL 2015; 17:e23617. [PMID: 26019904 PMCID: PMC4441789 DOI: 10.5812/ircmj.23617] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 09/14/2014] [Revised: 11/24/2014] [Accepted: 12/16/2014] [Indexed: 11/16/2022]
Abstract
BACKGROUND Trichomoniasis, caused by Trichomonas vaginalis, is the most common sexually transmitted disease (STD) in the world with estimates of 7-8 million infections annually in the United States and 180 million globally. OBJECTIVES This study aimed to determine the prevalence and risk factors for T. vaginalis infection in women who attended the Clinic of Obstetrics and Gynecology in Kermanshah, Iran. PATIENTS AND METHODS This cross-sectional study was performed on all women aged 15 to 65 years who attended the clinic of obstetrics and gynecology, Imam Reza Hospital, Kermanshah, west of Iran, between September 2011 and July 2012. Vaginal secretion samples were examined by the Dorset culture medium and wet-mount methods. Demographic and personal information were also collected via questionnaires and the data were analyzed using chi-square and Fisher exact tests. RESULTS A total of 600 women were screened for T. vaginalis infection and this infection was diagnosed in 9 (1.5%) and 13 cases (2.1%) using the wet mount and culture methods, respectively. The age and husband occupation were significantly associated with an increased risk of trichomoniasis in the infected cases (P < 0.05 and P < 0.001, respectively); other variables, including the patients' occupation and education level appeared to be positively (but not significantly) correlated with infection (P > 0.05). CONCLUSIONS The prevalence of T. vaginalis infection in the study population was low. Diagnosis of trichomoniasis based on only clinical symptoms is not efficient for treatment decision. Based on our results, we suggest using the culture method on all the suspected cases even if the wet smear is negative.
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Affiliation(s)
- Naser Nazari
- Department of Parasitology and Mycology, Medical School, Kermanshah University of Medical Sciences, Kermanshah, IR Iran
| | - Maryam Zangeneh
- Department of Obstetrics and Gynecology, High Risk Pregnancy Research Center, Imam Reza Hospital, Kermanshah University of Medical Sciences, Kermanshah, IR Iran
- Corresponding Author: Maryam Zangeneh, Department of Obstetrics and Gynecology, High Risk Pregnancy Research Center, Imam Reza Hospital, Kermanshah University of Medical Sciences, Kermanshah, IR Iran. Tel: +98-9188323419, E-mail:
| | - Fatemeh Moradi
- Medical School, Kermanshah University of Medical Sciences, Kermanshah, IR Iran
| | - Arezoo Bozorgomid
- Medical School, Kermanshah University of Medical Sciences, Kermanshah, IR Iran
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Munson E, Napierala M, Schell RF. Insights into trichomoniasis as a result of highly sensitive molecular diagnostics screening in a high-prevalence sexually transmitted infection community. Expert Rev Anti Infect Ther 2014; 11:845-63. [DOI: 10.1586/14787210.2013.814429] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/16/2023]
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Donders GGG, Depuydt CE, Bogers JP, Vereecken AJ. Association of Trichomonas vaginalis and cytological abnormalities of the cervix in low risk women. PLoS One 2013; 8:e86266. [PMID: 24386492 PMCID: PMC3875579 DOI: 10.1371/journal.pone.0086266] [Citation(s) in RCA: 36] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/12/2013] [Accepted: 12/12/2013] [Indexed: 11/18/2022] Open
Abstract
Objective Is Trichomonas vaginalis (TV) an inducing factor for the development of (pre-)cancerous lesions of the cervix? Design Cross sectional study. Setting Screening healthy Belgian women with low infection risk. Sample 63,251 consecutive liquid based cervical samples. Methods Real time quantitative PCR for presence of TV, 18 HPV types and Pap smear analysis of cytologic abnormalities. Main Outcome Measures Association of TV and HPV with cervix dysplasia Results The overall prevalence of TV DNA was 0.37%, of low risk HPV 2%, of high risk HPV 13.2%, and 8.8 % had cytological abnormalities. Both LR-HPV and HR-HPV were significantly associated with all cytological abnormalities. Presence of TV was associated with LR- and HR-HPV, ASC-US and HSIL, but not with other abnormalities. All women with TV and HSIL also had HR-HPV, while the latter was present in only 59% of women with TV and ASC-US. Amongst HPV negative women, TV was found in 1.3% of women with ASC-US, but only in 0.03% of women with normal cytology (OR 4.2, CL95% 2.1-8.6). In HR-HPV positive women, presence of TV increased the likelihood of cytological abnormalities somewhat (P=0.05), mainly due to an increase in ASC-US and LSIL, but not HSIL. Conclusions We conclude that TV infection is associated with both LR and HR-HPV infection of the cervix, as well as with ASC-US and HSIL. TV is a concomitant STI, but is not thought to be a co-factor in the causation of HSIL and cervical cancer. However, TV may cause false positive diagnoses of ASC-US.
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Affiliation(s)
- Gilbert G. G. Donders
- Departments of Obstetrics and Gynecology, University Hospital Antwerpen, Antwerpen, Belgium
- Department of Obstetrics and Gynecology, Heilig Hart Regional Hospital, Tienen, Belgium
- Department Clinical Research for Women, Tienen, Belgium
- * E-mail:
| | - Christophe E. Depuydt
- Laboratory for Molecular and Clinical Pathology (RIATOL), AML Laboratory Sonic Healthcare Benelux, Antwerp, Belgium
| | - John-Paul Bogers
- Laboratory for Molecular and Clinical Pathology (RIATOL), AML Laboratory Sonic Healthcare Benelux, Antwerp, Belgium
| | - Annie J. Vereecken
- Laboratory for Molecular and Clinical Pathology (RIATOL), AML Laboratory Sonic Healthcare Benelux, Antwerp, Belgium
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Diagnostic rates differ on the basis of the number of read days with the use of the InPouch culture system for Trichomonas vaginalis screening. J Clin Microbiol 2013; 51:3875-6. [PMID: 24006006 DOI: 10.1128/jcm.02006-13] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
The InPouch Trichomonas vaginalis test is the gold standard for clinical culture for Trichomonas vaginalis screening. The current package insert recommends an examination period of 3 days. After review of 2,499 InPouch tests spanning 13 years, we observed that examination up to 3 days will detect only 82.8% (95% confidence interval [CI], 79.0% to 86.2%) of positive specimens.
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Howell LP, Darragh TM, Souers RJ, Thomas N, Moriarty AT. Identification of Trichomonas vaginalis in different Papanicolaou test preparations: trends over time in the College of American Pathologists educational Interlaboratory Comparison Program. Arch Pathol Lab Med 2013; 137:1043-6. [PMID: 23899059 DOI: 10.5858/arpa.2012-0036-cp] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
CONTEXT The College of American Pathologists' Interlaboratory Comparison Program in Gynecologic Cytology has seen an increase in enrollment in liquid-based Papanicolaou test challenges with a decrease for conventional Papanicolaou tests. Trichomonas vaginalis can be difficult to identify in all preparation types. OBJECTIVES To evaluate 20 years of participant results from the College of American Pathologists Interlaboratory Comparison Program in Gynecologic Cytology for Trichomonas to ascertain whether performance has changed because of the introduction of liquid-based Papanicolaou and proficiency testing. DESIGN Concordance rates for the target diagnosis of Trichomonas vaginalis were evaluated for 167,956 participant responses (1990-2010). A nonlinear mixed model was fit with participant type, preparation type, and a 2-level program year (1990-2005 and 2006-2010) reflecting before and after proficiency testing began. A repeated-measures component allowed modeling of the slide-specific performance to ensure that the overall results were not based on the performance of a few slides. RESULTS Cytotechnologists had higher concordance with the target diagnosis than did pathologists (89.8% [72,992 of 81,319] versus 83.4% [72,271 of 86,637], P < .001) and better performance for each preparation type (P = .003). Concordance initially dropped after the introduction of proficiency testing (P < .001) for conventional and liquid-based (SurePath) preparations by both participant types, followed by quick, parallel improvement. CONCLUSIONS Performance is high in the detection of Trichomonas vaginalis in the College of American Pathologists Interlaboratory Comparison Program in Gynecologic Cytology. Liquid-based Papanicolaou and proficiency testing minimally affected participant performance. Cytotechnologists performed better over time and across preparation types than did pathologists, although pathologists showed performance results parallel to that of the cytotechnologists. Awareness of the performance differences by pathologists and cytotechnologists, as well as their difference in proficiency among liquid-based techniques, may help ensure accurate results in clinical practice.
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Affiliation(s)
- Lydia Pleotis Howell
- Department of Pathology and Laboratory Medicine, University of California, Davis Medical Center, Sacramento, CA 95817, USA.
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19
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Leeflang MMG, Rutjes AWS, Reitsma JB, Hooft L, Bossuyt PMM. Variation of a test's sensitivity and specificity with disease prevalence. CMAJ 2013; 185:E537-44. [PMID: 23798453 DOI: 10.1503/cmaj.121286] [Citation(s) in RCA: 347] [Impact Index Per Article: 31.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/28/2022] Open
Abstract
BACKGROUND Anecdotal evidence suggests that the sensitivity and specificity of a diagnostic test may vary with disease prevalence. Our objective was to investigate the associations between disease prevalence and test sensitivity and specificity using studies of diagnostic accuracy. METHODS We used data from 23 meta-analyses, each of which included 10-39 studies (416 total). The median prevalence per review ranged from 1% to 77%. We evaluated the effects of prevalence on sensitivity and specificity using a bivariate random-effects model for each meta-analysis, with prevalence as a covariate. We estimated the overall effect of prevalence by pooling the effects using the inverse variance method. RESULTS Within a given review, a change in prevalence from the lowest to highest value resulted in a corresponding change in sensitivity or specificity from 0 to 40 percentage points. This effect was statistically significant (p < 0.05) for either sensitivity or specificity in 8 meta-analyses (35%). Overall, specificity tended to be lower with higher disease prevalence; there was no such systematic effect for sensitivity. INTERPRETATION The sensitivity and specificity of a test often vary with disease prevalence; this effect is likely to be the result of mechanisms, such as patient spectrum, that affect prevalence, sensitivity and specificity. Because it may be difficult to identify such mechanisms, clinicians should use prevalence as a guide when selecting studies that most closely match their situation.
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Affiliation(s)
- Mariska M G Leeflang
- Department of Clinical Epidemiology, Biostatistics and Bioinformatics, Academic Medical Center, University of Amsterdam, Amsterdam, The Netherlands.
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20
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Bygott JM, Robson JM. The rarity ofTrichomonas vaginalisin urban Australia. Sex Transm Infect 2013; 89:509-13. [DOI: 10.1136/sextrans-2012-050826] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022] Open
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Huppert JS, Huang B, Chen C, Dawood HY, Fichorova RN. Clinical evidence for the role of Trichomonas vaginalis in regulation of secretory leukocyte protease inhibitor in the female genital tract. J Infect Dis 2013; 207:1462-70. [PMID: 23355743 DOI: 10.1093/infdis/jit039] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/16/2022] Open
Abstract
BACKGROUND Secretory leukocyte protease inhibitor (SLPI) is responsible for regulating inflammatory damage to and innate and adaptive immune responses in the vaginal mucosa. Depressed cervicovaginal SLPI levels have been correlated with both Trichomonas vaginalis infection and poor reproductive health outcomes. METHODS We measured levels of SLPI in 215 vaginal specimens collected from adolescent and young adult females aged 14-22 years. Log-transformed SLPI values were compared by analysis of variance or by an unpaired t test before and after adjustment for confounding effects through the propensity score method. RESULTS Females receiving hormonal contraceptives and those with an abnormal vaginal pH had lower SLPI levels as compared to their peers. After propensity score adjustment for race, behavioral factors, hormonal use, and other sexually transmitted infections (STIs), SLPI levels were lower in females with a positive T. vaginalis antigen test result, a vaginal pH >4.5, vaginal leukocytosis, and recurrent (vs initial) T. vaginalis infection, with the lowest levels observed in those with the highest T. vaginalis loads. CONCLUSIONS The SLPI level was reduced by >50% in a T. vaginalis load-dependent manner. Future research should consider whether identifying and treating females with low levels of T. vaginalis infection (before they become wet mount positive) would prevent the loss of SLPI and impaired vaginal immunity. The SLPI level could be used as a vaginal-health marker to evaluate interventions and vaginal products.
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Affiliation(s)
- Jill S Huppert
- Division of Gynecology, Cincinnati Children’s Hospital Medical Center, Ohio 45229-3039, USA.
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22
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Performance of a rapid self-test for detection of Trichomonas vaginalis in South Africa and Brazil. J Clin Microbiol 2013; 51:1037-9. [PMID: 23325818 DOI: 10.1128/jcm.01547-12] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
Women participating in studies in Brazil (n = 695) and South Africa (n = 230) performed rapid point-of-care tests for Trichomonas vaginalis on self-collected vaginal swabs. Using PCR as the gold standard, rapid self-testing achieved high specificity (99.1%; 95% confidence interval [CI], 98.2 to 99.6%) and moderate sensitivity (76.7%; 95% CI, 61.4 to 88.2%). These tests may be considered an alternative to syndromic management in resource-poor settings.
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23
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Fule SR, Fule RP, Tankhiwale NS. Clinical and laboratory evidence of Trichomonas vaginalis infection among women of reproductive age in rural area. Indian J Med Microbiol 2013; 30:314-6. [PMID: 22885198 DOI: 10.4103/0255-0857.99493] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
Abstract
BACKGROUND Vaginitis is a commonly encountered complaint and one of the most frequent reasons for patient visit to obstetrician-gynaecologists. Three vaginal infections are frequent causes of a vaginal discharge: (1) bacterial vaginosis, (2) vulvovaginal candidiasis and (3) trichomonas vaginitis. Differences in the clinical presentation are helpful in diagnosis. Characteristic signs and symptoms for these three vaginal infections are distinct, but on many occasions, they are overlapping. The aim of the present study was to find the prevalence and correlation between the clinical spectrum and laboratory evidence of Trichomonas vaginalis infection by simple, reliable, confirmatory and specific method, i.e. microscopic examination of wet mount preparation and acridine stain of vaginal fluid. MATERIALS AND METHODS Irrespective of HIV status, a total of 156 women with vaginal discharge were studied for establishing diagnosis of genital tract infection. The cases of bacterial vaginosis and vulvovaginal candidiasis were excluded from the study. Vaginal speculum assisted high vaginal swabs were collected from women with discharge, during collection vagina was inspected for obvious signs. RESULTS Of the 156 women with vaginal discharge, 19 (12.06 %) showed T. vaginalis infection. All the women belonged to active reproductive age group, i.e. 20-40 years. Itching dysuria, and offensive, malodorous, thin, yellowish vaginal discharge were the main and consistent complaints. Only in 2 (1.52%) cases, vaginal speculum examination revealed erythema and punctuate haemorrhage, the so-called "strawberry' vagina. The pH was recorded to be >4.5. CONCLUSION Clinical differentiation of various forms of infectious vaginitis is unreliable. The prevalence of T. vaginalis infection at 12.06% was found among rural young women of reproductive age using simple and reliable screening wet mount microscopy.
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Affiliation(s)
- S R Fule
- Department of Microbiology, Jawaharlal Nehru Medical College, Sawangi, Wardha, Maharashtra, India
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24
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Kwon I, McNulty A, Read P. The prevalence of Trichomonas vaginalis detected by wet mount and polymerase chain reaction in Sydney women. Sex Health 2013; 10:385-6. [DOI: 10.1071/sh12201] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/29/2012] [Accepted: 01/13/2013] [Indexed: 11/23/2022]
Abstract
Objectives
Although Trichomonas vaginalis (TV) has a low profile in urban Australia, local data has estimated the prevalence in women to be 10 times higher when using polymerase chain reaction (PCR) versus wet mount microscopy (4.8% v. 0.4%). Our aim was to determine the prevalence of TV in Sydney women using both wet mount and PCR. Methods: A cross-sectional study was conducted of women requiring sexually transmissible infection screening at the Sydney Sexual Health Centre. Vaginal swabs were examined for TV using PCR and wet mount microscopy. Results: In total, 781 of 1263 eligible women were tested; 3 out of 781 tested positive by PCR and 1 out of 781 by wet mount, giving a prevalence of 0.38% (95% confidence interval (CI): 0.14–1.12%) and 0.13% (95% CI: 0.03–0.71%) respectively. There was not enough power to compare PCR and wet mount. Conclusions: The results of this analysis indicate that in our female urban population, TV is a very rare sexually transmissible infection,with 0.38% prevalence, and routine screening by PCR is not indicated.
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25
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Trichomonas vaginalis Prevalence Increases With Remoteness in Rural and Remote New South Wales, Australia. Sex Transm Dis 2012. [DOI: 10.1097/olq.0b013e31826ae875] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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26
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Bivariate meta-analysis of predictive values of diagnostic tests can be an alternative to bivariate meta-analysis of sensitivity and specificity. J Clin Epidemiol 2012; 65:1088-97. [DOI: 10.1016/j.jclinepi.2012.03.006] [Citation(s) in RCA: 60] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/26/2011] [Revised: 02/20/2012] [Accepted: 03/26/2012] [Indexed: 01/05/2023]
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27
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Hegazy MM, El-Tantawy NL, Soliman MM, El-Sadeek ES, El-Nagar HS. Performance of rapid immunochromatographic assay in the diagnosis of Trichomoniasis vaginalis. Diagn Microbiol Infect Dis 2012; 74:49-53. [PMID: 22727836 DOI: 10.1016/j.diagmicrobio.2012.05.003] [Citation(s) in RCA: 23] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/31/2012] [Revised: 05/01/2012] [Accepted: 05/07/2012] [Indexed: 11/30/2022]
Abstract
Trichomonas vaginalis accounts for nearly half of all curable sexually transmitted diseases worldwide with serious health consequences. Effort to increase the sensitivity of its diagnosis is critical to both control measures and epidemiologic studies. This study was conducted to evaluate the OSOM® Trichomonas Rapid Test (Sekisui Diagnostics, Framingham, MA, USA), a qualitative antigen-detection immunochromatographic (IC) assay in the diagnosis of vaginal trichomoniasis comparable to the conventional methods. The study enrolled 258 females aged 18-50 years classified into symptomatic (185) and asymptomatic (73) groups. Vaginal swab specimens were obtained for wet mount, stained preparation (Giemsa, acridine-orange), culture (InPouch TV™, modified Diamond's), and for rapid OSOM testing. Trichomonas vaginalis was detected in 67, 66, 71, 99, 96, and 97 using wet mount, acridine-orange stain, Giemsa stain, modified Diamond's, InPouch media, and OSOM test, respectively. In comparison to a composite reference standard (CRS) of wet mount microscopy and culture, OSOM test reported 97.98%, 99.37%, 98.98%, 98.75%, and 98.84% for sensitivity, specificity, positive predictive value, negative predictive value, and diagnostic accuracy, respectively. The OSOM test proved to be a simple and objective test. This rapid point-of-care-test will contribute significantly in the diagnosis of vaginal trichomoniasis and will increase the understanding of its still vague epidemiology.
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Affiliation(s)
- Mamdouh M Hegazy
- Department of Medical Parasitology, Faculty of Medicine, Mansoura University, Egypt
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28
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Hussey J, Mitchell L. Untreated Trichomonas vaginalis for 20 years: lessons to be learnt? Int J STD AIDS 2012; 23:223-4. [DOI: 10.1258/ijsa.2011.011278] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
Affiliation(s)
- J Hussey
- Sunderland Royal Hospital, Kayll Road, Sunderland SR4 7TP, UK
| | - L Mitchell
- Sunderland Royal Hospital, Kayll Road, Sunderland SR4 7TP, UK
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Diagnosis of vaginal discharge by wet mount microscopy: a simple and underrated method. Obstet Gynecol Surv 2012; 66:359-68. [PMID: 21851750 DOI: 10.1097/ogx.0b013e31822bdf31] [Citation(s) in RCA: 39] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
UNLABELLED Vaginal discharge is highly variable in quality and quantity among different individuals, and even in the same individual during different periods of life. Vaginal discharge is most commonly caused by infection with sexually transmitted organisms or increased colonization by different facultative pathogenic microorganisms (i.e., Gardnerella vaginalis). Noninfectious causes of vaginal discharge are quite rare (10% noninfectious as compared to 90% infectious causes). Most common in women with a vaginal infection is bacterial vaginosis (40%-50% of cases), followed by vulvovaginal candidosis (20%-25%), and then trichomoniasis (15%-20%). If infection is suspected as the primary cause, a sample of the vaginal discharge should be taken and examined microscopically. When evaluating vaginal secretions by phase-contrast wet mount microscopy, knowledge of what is normal versus abnormal is very important. Knowledge of the sensitivity and specificity of wet mount microscopy in different clinical settings is also important. TARGET AUDIENCE Obstetricians & Gynecologists, Family Physicians LEARNING OBJECTIVES After completing this CME activity, physicians should be better able to evaluate lifetime changes in vaginal secretions, characterize the physiological and pathological appearance of vaginal discharge, assess the clinical practicality and usefulness of wet mount microscopy and use wet mount microscopy to diagnose bacterial vaginosis and other common vaginal infections.
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Sherrard J, Donders G, White D, Jensen JS. European (IUSTI/WHO) guideline on the management of vaginal discharge, 2011. Int J STD AIDS 2012; 22:421-9. [PMID: 21795415 DOI: 10.1258/ijsa.2011.011012] [Citation(s) in RCA: 39] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
Abstract
Three common infections are associated with vaginal discharge: bacterial vaginosis, trichomoniasis and candidiasis, of which trichomoniasis is a sexually transmitted infection (STI). This guideline covers the presentation and clinical findings of these infections and outlines the differential diagnoses. Recommendations for investigation and management based on currently available evidence are made, including the management of persistent and recurrent infections.
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Affiliation(s)
- J Sherrard
- Department of Genitourinary Medicine, Churchill Hospital, Oxford, UK.
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Abstract
We report a case of Trichomonas vaginalis (TV) presenting as vulval ulceration in a 41-year-old woman. There was complete resolution of her symptoms only after oral tinidazole. The delayed diagnosis and importance of using the correct tests for the diagnosis of TV are discussed.
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Affiliation(s)
- L Mitchell
- New Croft Centre, Sexual Health Clinic, Newcastle-upon-Tyne, UK.
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Munson E, Napierala M, Basile J, Miller C, Burtch J, Hryciuk JE, Schell RF. Trichomonas vaginalis transcription-mediated amplification-based analyte-specific reagent and alternative target testing of primary clinical vaginal saline suspensions. Diagn Microbiol Infect Dis 2010; 68:66-72. [PMID: 20727473 DOI: 10.1016/j.diagmicrobio.2010.05.002] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/08/2010] [Revised: 04/23/2010] [Accepted: 05/03/2010] [Indexed: 11/18/2022]
Abstract
Following wet mount analysis, 255 vaginal saline suspensions were aliquoted to lysis medium for transcription-mediated amplification (TMA)-based Trichomonas vaginalis analyte-specific reagent testing (ASR) (Gen-Probe, San Diego, CA). Specimens with visible T. vaginalis were then refrigerated, with additional aliquoting at later intervals. Twenty-four wet mount-positive specimens (9.4%) yielded a median luminescent value (x1000, relative light unit [RLU]) of 4736. In contrast, RLU ranged from 1 to 21 following ASR of 204 wet mount-negative specimens. Twenty-seven wet mount-negative specimens (10.5%) were positive by ASR and subsequently positive via T. vaginalis alternative target TMA (Gen-Probe). Discrepancies were additionally resolved by demonstration of T. vaginalis nucleic acid from a separate endocervical collection. T. vaginalis nucleic acid was detectable following prolonged storage, following minimal incubation in lysis medium, and from low-volume aliquots of sparsely populated specimens. T. vaginalis ASR adequately detects T. vaginalis from vaginal saline suspension aliquots, providing a simple specimen alternative for a highly sensitive laboratory diagnosis of trichomoniasis.
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Affiliation(s)
- Erik Munson
- Wheaton Franciscan Laboratory, Wauwatosa, WI 53226, USA.
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Screening for Trichomonas vaginalis in high-risk adolescent females with a new transcription-mediated nucleic acid amplification test (NAAT): associations with ethnicity, symptoms, and prior and current STIs. J Pediatr Adolesc Gynecol 2010; 23:312-6. [PMID: 20493735 DOI: 10.1016/j.jpag.2010.03.004] [Citation(s) in RCA: 34] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/23/2009] [Revised: 03/10/2010] [Accepted: 03/11/2010] [Indexed: 11/23/2022]
Abstract
PURPOSE The importance of diagnosing trichomoniasis is highlighted by its strong association with HIV acquisition and viral shedding. The low sensitivity of wet preparation and often asymptomatic nature of trichomoniasis results in failure to recognize and treat this sexually transmitted infection. The purpose of this study was to evaluate the feasibility of screening high-risk adolescent females using a new highly sensitive and specific NAAT assay. METHODS We enrolled a consecutive, clinical sample of 144 sexually active females, aged 13 through 21. Subjects completed a questionnaire on sexual history and current vaginal symptoms, and provided two self- or physician-collected vaginal swabs and urine. A wet preparation test was performed with one swab and the APTIMA Trichomonas vaginalis (ATV) assay (Gen-Probe, Inc.) was performed with the other and with urine. RESULTS Mean age was 18 +/- 1.6 years; 55% Hispanic and 35% black. A three-fold higher prevalence of trichomoniasis (6.3%) was detected by ATV than by wet preparation (2.1%) with 100% concordance between vaginal swab and urine. Prevalence of chlamydia by APTIMA was 11%; no gonorrhea was detected. Subjects with trichomoniasis were more likely than those without to be black (P < 0.01), and to report past gonorrhea (P < 0.01) and past PID (P < 0.001). No vaginal symptom distinguished those with trichomoniasis. CONCLUSION Three times as many cases of trichomoniasis were identified with ATV compared to wet preparation and identical results were obtained with vaginal swabs and urine. No symptoms were associated with trichomoniasis. These findings highlight the imperative and feasibility of screening and treating at-risk populations.
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Huppert JS, Hesse E, Kim G, Kim M, Agreda P, Quinn N, Gaydos C. Adolescent women can perform a point-of-care test for trichomoniasis as accurately as clinicians. Sex Transm Infect 2010; 86:514-9. [PMID: 20595142 DOI: 10.1136/sti.2009.042168] [Citation(s) in RCA: 30] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022] Open
Abstract
OBJECTIVES To compare the accuracy (ie, correlation, sensitivity, specificity) of self-performed point-of-care (POC) tests with clinician-performed tests for trichomoniasis in adolescent women. METHODS Sexually experienced women aged 14-22 years (n=209) collected a vaginal swab and performed a POC test for trichomoniasis. Using a speculum, the clinician obtained vaginal swabs that were tested for trichomoniasis using the POC test, wet mount, culture and transcription-mediated amplification (TMA) using standard and alternative primers. Self and clinician results were compared with true positives, defined as either culture-positive or TMA-positive with both sets of primers. RESULTS Participants' mean age was 17.8 years; 87% were African-American; 74% reported vaginal itching or discharge and 51 (24%) had trichomoniasis. Over 99% correctly performed and interpreted her self-test. Self and clinician POC tests were highly correlated (95.7% agreement, κ 0.87). Compared with true positives, the sensitivity of the self-POC test was 78% (CI 65% to 89%), similar to that of the clinician-POC test (84%, CI 71% to 93%) and culture (82%, CI 69% to 92%), and significantly better than wet mount (39%, CI 26% to 54%). The specificity of the self-POC test was 99% (CI 96% to 100%), similar to that of the clinician-POC test (100%, CI 98% to 100%). The sensitivity of the self-POC test was not affected by vaginal symptoms or other variables. CONCLUSIONS Young women performing a self-POC test detected as many trichomoniasis infections as clinician-POC tests or culture, twice as many as wet mount and slightly fewer than an amplified test. Incorporating self-obtained or self-performed POC tests into routine practice could effectively increase the identification and treatment of trichomoniasis in this vulnerable population.
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Affiliation(s)
- Jill S Huppert
- Division of Adolescent Medicine, Cincinnati Children's Hospital Medical Center, 3333 Burnet Avenue, MLC 4000, Cincinnati, OH 45229-3039, USA.
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Evaluation of cervical screening results in a population at normal risk. Int J Gynaecol Obstet 2010; 110:40-2. [DOI: 10.1016/j.ijgo.2010.02.011] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/24/2009] [Revised: 02/16/2010] [Accepted: 03/09/2010] [Indexed: 11/20/2022]
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Lemos PAP, Garcia-Zap MTA. The Prevalence of Trichomonas vaginalis in HIV-Positive and Negative Patients in Referral Hospitals in Goiania, Goias, Brazil. ACTA ACUST UNITED AC 2010. [DOI: 10.3923/ijtmed.2010.24.27] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
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Abstract
PURPOSE OF REVIEW Trichomoniasis, caused by the protozoa Trichomonas vaginalis, is one of the oldest sexually transmitted infections. Since the advent of more accurate diagnostic tests, the epidemiology and consequences of infection with T. vaginalis can be described more precisely. This review will highlight new diagnostic methods, the epidemiology of trichomoniasis, and discuss the merits of improved screening for this pathogen in adolescent women. RECENT FINDINGS Interest in trichomoniasis has renewed due to evidence that trichomoniasis is more common than gonorrhea in adolescent women, is often asymptomatic, may persist for several months, and may be confused with bacterial vaginosis. In addition, trichomoniasis is linked to pelvic inflammatory disease and can increase one's susceptibility to viruses such as herpes, human papillomavirus, andHIV. SUMMARY Clinicians who use better diagnostic methods and offer more widespread testing will identify more infections and reduce the epidemic of this easily treated infection. Early diagnosis provides the opportunity to reduce transmission and potentially prevent future complications.
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Abstract
Many women seek care for vulvar, vaginal, or pelvic complaints. Primary care providers should possess a solid understanding of the differential diagnosis and treatment of gynecologic infections. Many infections in the reproductive tract are sexually transmitted, whereas other common infections are attributable to an overgrowth of the normally present bacteria or yeast in the vagina. Presenting symptoms and signs are helpful in determining the source of infection, but often a battery of tests must be performed to make a definitive diagnosis.
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MESH Headings
- Anti-Bacterial Agents/therapeutic use
- Antifungal Agents/therapeutic use
- Antiviral Agents/therapeutic use
- Candidiasis, Vulvovaginal/diagnosis
- Candidiasis, Vulvovaginal/drug therapy
- Candidiasis, Vulvovaginal/microbiology
- Chlamydia Infections/diagnosis
- Chlamydia Infections/drug therapy
- Diagnosis, Differential
- Female
- Genital Diseases, Female/diagnosis
- Genital Diseases, Female/drug therapy
- Genital Diseases, Female/microbiology
- Gonorrhea/diagnosis
- Gonorrhea/drug therapy
- Herpes Genitalis/diagnosis
- Herpes Genitalis/drug therapy
- Humans
- Pelvic Inflammatory Disease/diagnosis
- Pelvic Inflammatory Disease/drug therapy
- Pelvic Inflammatory Disease/microbiology
- Pregnancy
- Pregnancy Complications, Infectious/diagnosis
- Pregnancy Complications, Infectious/drug therapy
- Syphilis/diagnosis
- Syphilis/drug therapy
- Trichomonas Vaginitis/diagnosis
- Trichomonas Vaginitis/drug therapy
- Vaginosis, Bacterial/diagnosis
- Vaginosis, Bacterial/drug therapy
- Vaginosis, Bacterial/microbiology
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Affiliation(s)
- Wendy S Biggs
- Department of Family Medicine, Michigan State University College of Human Medicine, East Lansing, MI, USA.
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Johnson LF, Alkema L, Dorrington RE. A Bayesian approach to uncertainty analysis of sexually transmitted infection models. Sex Transm Infect 2009; 86:169-74. [PMID: 19880971 DOI: 10.1136/sti.2009.037341] [Citation(s) in RCA: 25] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022] Open
Abstract
OBJECTIVES To propose a Bayesian approach to uncertainty analysis of sexually transmitted infection (STI) models, which can be used to quantify uncertainty in model assessments of policy options, estimate regional STI prevalence from sentinel surveillance data and make inferences about STI transmission and natural history parameters. METHODS Prior distributions are specified to represent uncertainty regarding STI parameters. A likelihood function is defined using a hierarchical approach that takes account of variation between study populations, variation in diagnostic accuracy as well as random binomial variation. The method is illustrated using a model of syphilis, gonorrhoea, chlamydial infection and trichomoniasis in South Africa. RESULTS Model estimates of STI prevalence are in good agreement with observations. Out-of-sample projections and cross-validations also show that the model is reasonably well calibrated. Model predictions of the impact of interventions are subject to significant uncertainty: the predicted reductions in the prevalence of syphilis by 2020, as a result of doubling the rate of health seeking, increasing the proportion of private practitioners using syndromic management protocols and screening all pregnant women for syphilis, are 43% (95% CI 3% to 77%), 9% (95% CI 1% to 19%) and 6% (95% CI 4% to 7%), respectively. CONCLUSIONS This study extends uncertainty analysis techniques for fitted HIV/AIDS models to models that are fitted to other STI prevalence data. There is significant uncertainty regarding the relative effectiveness of different STI control strategies. The proposed technique is reasonable for estimating uncertainty in past STI prevalence levels and for projections of future STI prevalence.
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Affiliation(s)
- Leigh F Johnson
- Centre for Actuarial Research, University of Cape Town, Rondebosch, Cape Town, South Africa.
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Hay P, Ugwumadu A. Detecting and treating common sexually transmitted diseases. Best Pract Res Clin Obstet Gynaecol 2009; 23:647-60. [PMID: 19646929 DOI: 10.1016/j.bpobgyn.2009.06.008] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/15/2009] [Accepted: 06/16/2009] [Indexed: 10/20/2022]
Abstract
In the UK, many sexually transmitted infections (STIs) are best managed in conjunction with an appropriate specialist, for example, a genitourinary medicine practitioner or a Microbiologist. In most of the world, however, gynaecologists routinely manage STIs in women. This article focuses on the most important infections in women, and those in which management is changing. It also addresses the current status, and new developments around the syndrome of pelvic inflammatory disease (PID), which essentially is an STI.
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Affiliation(s)
- Phillip Hay
- Department of Genitourinary Medicine, St George's University of London, London, UK
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41
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An Overview of Meta-analyses of Diagnostic Tests in Infectious Diseases. Infect Dis Clin North Am 2009; 23:225-67, Table of Contents. [DOI: 10.1016/j.idc.2009.01.010] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
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Current issues and considerations regarding trichomoniasis and human immunodeficiency virus in African-Americans. Clin Microbiol Rev 2009; 22:37-45, Table of Contents. [PMID: 19136432 DOI: 10.1128/cmr.00002-08] [Citation(s) in RCA: 68] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
Trichomonas vaginalis has long been recognized as one of the most prevalent sexually transmitted infections. However, it is only in recent years that it has been appreciated that Trichomonas may play a critical role in amplifying human immunodeficiency virus (HIV) transmission. Given the evidence that T. vaginalis likely promotes HIV infection, the apparent high level of Trichomonas infection in the African-American community is cause for concern. Even if T. vaginalis increases the risk of HIV transmission by a small or modest amount, it translates into a sizable population effect since Trichomonas is so common in this community. Therefore, control of trichomoniasis may represent an important avenue of control for the prevention of HIV transmission, particularly among African-Americans.
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Hollier LM, Workowski K. Treatment of Sexually Transmitted Infections in Women. Infect Dis Clin North Am 2008; 22:665-691. [DOI: 10.1016/j.idc.2008.05.009] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
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Abstract
The objective of this study was to examine the effects of clinical factors and of the type and timing of a secondary test in improving the sensitivity of Trichomonas vaginalis detection in young women over that of a wet mount alone. For this purpose, sexually active adolescent women (n = 345) were recruited from a hospital teen clinic or emergency department. Following an interview and a pelvic exam, four primary T. vaginalis tests (wet mount, culture, a rapid test, and a nucleic acid amplification test [NAAT]) were performed on vaginal swabs. If the wet-mount result was negative, two secondary tests (culture and a rapid test) were performed on the used wet-mount swab and saline. A positive result by any of the four primary tests was considered a true T. vaginalis-positive result. The prevalence of T. vaginalis was 18.8% overall and 8.8% in the 307 wet-mount-negative women. There was 100% concordance between primary and secondary rapid tests. Secondary culture was 80% sensitive compared to primary culture. The likelihood of a positive rapid test increased with increasing time between specimen collection and testing. A wet mount followed by a rapid test was the most sensitive strategy using two tests (86.4%; confidence interval [CI], 75.3 to 93.4%). Limiting secondary testing to those with multiple partners resulted in a lower sensitivity (73.9%; CI, 61.5 to 84%) that was not significantly better than that of the wet mount alone (58.5%; CI, 45.6 to 70.6%). We conclude that a rapid test can be delayed or performed on a used swab with no loss of sensitivity. Until a NAAT for T. vaginalis is commercially available, a stepwise approach using an additional rapid test for wet-mount-negative women is recommended for adolescent women regardless of clinical factors.
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Trigg BG, Kerndt PR, Aynalem G. Sexually transmitted infections and pelvic inflammatory disease in women. Med Clin North Am 2008; 92:1083-113, x. [PMID: 18721654 DOI: 10.1016/j.mcna.2008.04.011] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/09/2023]
Abstract
Sexually transmitted infections (STIs) are an important public health challenge in the United States. Primary care clinicians can contribute to decreasing these largely preventable causes of morbidity and mortality by integrating routine screening, testing, counseling, treatment, and partner management of STIs into their practice. Newer tests for chlamydia and gonorrhea that can be performed on urine specimens allow screening without a pelvic examination. The most recent edition of the Centers for Disease Control and Prevention sexually transmitted disease treatment guidelines provides an evidence-based, reliable, and convenient set of recommendations for treating and caring for patients who have STIs.
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Affiliation(s)
- Bruce G Trigg
- Sexually Transmitted Disease Program, Regions 1 and 3, New Mexico Department of Health, 1111 Stanford Drive NE, Albuquerque, NM 87106, USA.
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Impact of Trichomonas vaginalis transcription-mediated amplification-based analyte-specific-reagent testing in a metropolitan setting of high sexually transmitted disease prevalence. J Clin Microbiol 2008; 46:3368-74. [PMID: 18753347 DOI: 10.1128/jcm.00564-08] [Citation(s) in RCA: 35] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
Trichomoniasis is a significant sexually transmitted disease (STD) in the spectrum of public health and primary care because of its association with agents such as human immunodeficiency virus and Neisseria gonorrhoeae. However, its true significance may be underestimated due to diagnostic modalities that exhibit poor sensitivity. A total of 1,086 genital specimens from two urban emergency departments, a suburban urgent-care facility, and a metropolitan outpatient physician group were subjected to transcription-mediated amplification-based Trichomonas vaginalis analyte-specific-reagent (ASR) testing (Gen-Probe, Inc.). The rate of positive molecular ASR results (14.5%) doubled that of direct saline preparation (7.0%; P < 0.0002). Analogous increases were observed at one emergency department and within the outpatient physician group (P < 0.0002). No significant increase in the rate of positive molecular ASR results was observed from the facilities that encountered a lower frequency of black/African American patients. While positive T. vaginalis findings via direct saline preparation did not have a significant association with concomitant Chlamydia trachomatis or N. gonorrhoeae infection overall, a positive T. vaginalis ASR result was a better predictor of concomitant C. trachomatis or N. gonorrhoeae infection (odds ratios of 2.34 and 4.46, respectively; P < 0.0001). The increased rate of positive T. vaginalis ASR results was observed in both point-of-care (P = 0.02 versus direct saline preparation) and laboratory (P = 0.003) testing. Highly sensitive T. vaginalis molecular ASR not only transcends issues of specimen integrity and microscopic acumen but also has an increased ability to predict the likelihood of additional STDs in defined populations.
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Incidence of sexually transmitted infections among HIV-infected women using depot medroxyprogesterone acetate contraception. Contraception 2008; 78:125-30. [DOI: 10.1016/j.contraception.2008.03.015] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/06/2008] [Revised: 03/30/2008] [Accepted: 03/31/2008] [Indexed: 11/24/2022]
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Analysis of standard methods for diagnosing vaginitis: HIV infection does not complicate the diagnosis of vaginitis. J Low Genit Tract Dis 2007; 11:240-50. [PMID: 17917568 DOI: 10.1097/lgt.0b013e318033dfed] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
OBJECTIVE We sought to determine whether the standard diagnostic methods for vaginitis behave similarly among HIV-infected and at-risk seronegative women. MATERIALS AND METHODS We performed pairwise comparisons over time (1994-2003) for the different diagnostic methods for bacterial vaginosis (BV) (Nugent score and Amsel criteria), vulvovaginal candidiasis (potassium hydroxide smear and Pap smear), and trichomoniasis (culture, wet mount, and Pap smear) among HIV-infected and at-risk HIV seronegative women in the Women's Interagency HIV Study cohort. We stratified subjects by HIV status and among the HIV-infected women by CD4+ cell count strata. RESULTS For BV and trichomoniasis, kappa statistics comparing clinical diagnostic methods to laboratory-based methods improved after the first year. Significant differences in overall kappa statistics between HIV-infected and at-risk HIV-seronegative women were found only for vulvovaginal candidiasis where potassium hydroxide smear and Pap smear findings were more tightly correlated among HIV-infected women than among at-risk HIV-seronegative women; among these HIV-infected women, concordance was highest at lower CD4 cell counts. No significant differences in kappa statistics were found for the diagnostic methods of BV or trichomoniasis neither by HIV status nor CD4 cell count strata. CONCLUSIONS The standard diagnostic tests for BV, vulvovaginal candidiasis, and trichomoniasis behave similarly in HIV-infected and at-risk seronegative women. Training and experience are critical for the accurate performance of the diagnostic methods that require clinician interpretation.
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Huppert JS, Mortensen JE, Reed JL, Kahn JA, Rich KD, Miller WC, Hobbs MM. Rapid antigen testing compares favorably with transcription-mediated amplification assay for the detection of Trichomonas vaginalis in young women. Clin Infect Dis 2007; 45:194-8. [PMID: 17578778 DOI: 10.1086/518851] [Citation(s) in RCA: 146] [Impact Index Per Article: 8.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/27/2007] [Accepted: 04/06/2007] [Indexed: 11/04/2022] Open
Abstract
BACKGROUND Diagnosis of Trichomonas vaginalis (TV) infection is limited by imperfect testing methods. Newer tests, such as rapid antigen and nucleic acid amplification tests, are often compared with culture, which is not widely used but is more sensitive than wet mount. We assessed the sensitivity and specificity of 4 tests for the identification of TV using 3 statistical approaches. METHODS Sexually active adolescent women aged 14-21 years (n=330) were recruited from a teen health center and emergency department. Vaginal swabs were tested for TV using wet mount, culture (InPouch TV; Biomed Diagnostics), rapid antigen testing (OSOM TV; Genzyme Diagnostics), and transcription-mediated amplification testing (TMA; APTIMA TV analyte specific reagents; Gen-Probe). RESULTS TV was detected in 61 participants (18.5%). Compared with a composite reference standard (i.e., any TV test with positive results), the sensitivities of wet mount, culture, rapid antigen testing, and TMA were 50.8%, 75.4%, 82%, and 98.4%, respectively. Using latent class analysis, the sensitivity of wet mount (56%) was significantly lower than that of other tests, and the sensitivities of culture and rapid antigen testing were similar (83% and 90%, respectively); specificity was 100% for each of these 3 methods. TMA had a sensitivity of 98.2% and a specificity of 98%. Tests performed equally well regardless of whether the participant had bleeding or other infections. The sensitivities of the rapid antigen test and TMA were comparable (92.5% and 97.5%, respectively) in women who had vaginal symptoms. CONCLUSIONS Wet mount alone is insufficient for the reliable diagnosis of TV infection in women. TMA and rapid antigen tests are highly sensitive and specific, and both are superior to wet mount. Rapid antigen testing is equivalent to culture, and it compares favorably with the sensitivity of TMA for the detection of TV.
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Affiliation(s)
- Jill S Huppert
- Division of Adoeslecent Medicine, Cincinnati Children's Hospital Medical Center, and University of Cincinnati College of Medicine, Cincinnati, OH 45229-3039, USA.
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