Prevalence of Trichomonas Vaginalis in Symptomatic Adolescent Females Presenting to An Urban Pediatric Emergency Department

Background: The prevalence of sexually transmitted infections in adolescent females is a significant public health concern.  Trichomonas vaginalis (TV) infection confers significant morbidity, including increasing risk for pelvic inflammatory disease, cervical cancer, and facilitation of HIV transmission.  Despite these negative health consequences, the prevalence of TV among symptomatic adolescent females remains incompletely understood. 

Objectives: To determine the prevalence of TV among symptomatic adolescent females presenting to an urban pediatric emergency department (PED).

Methods: We enrolled a prospective, consecutive sample of female patients aged 14-19 years presenting to a PED with lower abdominal, pelvic, or flank pain and/or genitourinary complaints such as dysuria or vaginal discharge.  Patients who had been treated with metronidazole in the prior 2 weeks or who were critically ill were excluded from the study.  The presence of TV was assessed through TV rapid antigen testing, and demographic data were collected.

Results: 101 patients met inclusion criteria.  Seventy-seven (76%) of these patients underwent TV testing, with a mean age of 16.4 years.  Eighty percent of the patients reported a history of sexual activity to the treating physician.   The TV prevalence rate was 7.8%. The prevalence rate of Chlamydia was 21.0% and Gonorrhea 2.8%.  Just over 1% of patients were co-infected with TV and Chlamydia.   Furthermore, if all 24 patients who were not tested for TV were presumed to have negative TV tests, the prevalence rate of TV in this sample would still approach 6%. 

Conclusions: A considerable number of adolescent patients who presented to a PED with lower abdominal or genitourinary symptoms were found to have TV infection. 

Implications for Programs, Policy, and/or Research:  Given the high prevalence of TV in this population of adolescents and potential morbidity associated with TV infection, patients presenting to the ED with these symptoms should undergo TV testing.