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Background:
Trichomonas vaginalis is the most common curable STD; however, many infections are missed due to insensitive tests or lack of screening.Objectives: To measure the prevalence of trichomonas in multiple high risk populations; to determine how many trichomonas diagnoses were missed in STD clinic females using provider performed microscopy compared with nucleic acid amplification tests (NAATs).
Methods: Sept-Dec 2010, de-identified remnant genital chlamydia/gonorrhea samples were tested for trichomonas with a Research Use Only APTIMA Trichomonas Vaginalis Assay (Gen-Probe, Incorporated). Specimens were from several screening populations: urine from females entering jail and juvenile hall, vaginal swabs from females and urine from males attending public STD clinics and vaginal swabs from young females participating in an internet screening program. Demographics and genital chlamydia/gonorrhea results were available from all participants as well as risk behavior, clinical and microscopy data from STD clinic patients.
Results: The prevalence of trichomonas in females overall was 14.9% (180/1206); womens’ jail 22% (78/358), juvenile hall 8.4% (29/349), home test kit 7.3% (10/137), female STD clinic 17.4% (63/362). The prevalence in male STD clinic patients was 6.1% (6/99). Overall, in females, trichomonas prevalence was higher in African Americans 25% (128/521), compared to Whites 13% (19/144), and Hispanics 7% (30/455). For females, the prevalence was above 10% in all age groups from 11-64 years of age. For the STD clinic females who had microscopy, only 47.0% (22/47) of those with a positive trichomonas NAAT were diagnosed by microscopy. In addition 12.6% (16/127) of patients who did not have microcopy also had a positive NAAT.
Conclusions: There was a high prevalence of trichomonas across all chlamydia/gonorrhea screening populations. Microscopy was inadequate for identifying the majority of trichomonas cases in STD clinic females.
Implications for Programs, Policy, and Research: Programs should consider using more sensitive diagnostic tools to identify trichomonas and to determine populations appropriate for screening.