A2b Adolescent Women Can Perform A Point-of-Care Test for Trichomoniasis as Accurately as Clinicians

Tuesday, March 9, 2010: 10:30 AM
Cottonwood (M1) (Omni Hotel)
Jill Huppert, MD, MPH1, Elizabeth Hesse, BA1, Hye-Kyong Kim, BA1, Mary Jett-Goheen, BS2, Nicole Quinn, BS2 and Charlotte Gaydos, DrPH2, 1Division of Adolescent Medicine, Cincinnati Children's Hospital Medical Center, Cincinnati, OH, 2School of Medicine, Division of Infectious Diseases, STD Laboratory, Johns Hopkins University, Baltimore, MD

Background: Trichomoniasis is a common sexually transmitted infection in adolescent women. Barriers to diagnosis are that testing requires a pelvic exam and wet mount. If women could accurately perform a point-of-care (POC) test for trichomoniasis on a self-obtained vaginal swab, these barriers would be removed and diagnosis would increase.

Objectives: To compare the accuracy (i.e., correlation, sensitivity, specificity) of self- and clinician-performed POC tests for trichomoniasis in adolescent women.

Methods: Sexually experienced women age 14-22 (n=218) collected a vaginal swab and performed a POC test for trichomoniasis. Using a speculum, the clinician obtained vaginal swabs which 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 to true positives, defined as either culture positive or TMA positive with both sets of primers. Estimates and 95% confidence intervals (CI) were calculated.

Results: Participantsí mean age was 17.8 years; 74% reported vaginal itching or discharge and 60 (28%) had trichomoniasis. Overall, 99% correctly performed and interpreted their self-test. Self- and clinician-POC tests were highly correlated (96% agreement, Kappa 0.88). Compared to true positives, the sensitivity of self-POC was 80% (CI: 68-89%), similar to that of clinician-POC (85%, CI: 73-93%) and culture (85%, CI: 73-93%), and significantly better than wet mount (38%, CI: 26-52%). Specificity of self-POC was 99 % (CI: 96-100%), similar to that of clinician-POC (100%, CI: 98-100%). Sensitivity of 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 test or culture and twice as many as wet mount.

Implications for Programs, Policy, and/or Research: In the future, incorporating self-performed POC tests into routine practice could increase identification and treatment of trichomoniasis in vulnerable women such as adolescents.