Trichomonas Vaginalis Michael Addidle

Trichomonas vaginalis

Anatomy No cyst form Replicates by binary fission

Basic Facts Almost exclusively sexually transmitted Prevalence approx 1% (max) in NZ pop. Humans are the only natural host Incubation period 4-28 days. 30% women asymptomatic. Can be carried asymptomatically for prolonged periods of time. Also trichomonas tenax And trichomonas foetus

Clinical Features Pruritis, dyspareunia Dysuria and frequency Malodourous thin discharge (70% of cases) Men are usually asymptomatic

Colpitis macularis, or “strawberry cervix.” (Courtesy, CDC.). Swygard H et al. Sex Transm Infect 2004;80:91-95 ©2004 by BMJ Publishing Group Ltd

Diagnostic Methods Which method is best? Wet film Acridine Orange Stain Culture (microtitre plate or full test tube culture) Rapid Antigen test (OSOM® Trichomonas Rapid Test) Nucleic Acid probe (BD Affirm™ VPIII Assay) PCR- expensive, good for males, ?incorporate into NG/chlamydia PCR Which method is best? Cost v speed v performance (Think about culture v PCR for Bordetella)

Comparison of Diagnostics for Trichomoniasis in Women Test Sensitivity Specificity Cost Ease of Use Time to Results Wet mount 45-60% >90% low easy minutes Culture 75-85% >95% medium days In-Pouch™ 80-90% minutes to days Pap smear 57% 97% PCR 100% 99.9% high difficult Affirm™ 92% 98% OSOM® >83% >99%

Comparison of Diagnostics for Trichomoniasis in Men Test Sensitivity Specificity Cost Ease of Use Time to Results Culture 20-30% high medium days PCR 100% 99.9% difficult Wet mount ≈ 30% low easy minutes

Complications Recently been implicated as a cause of low birth weight, premature rupture of membranes and pre-term delivery. Hypothesis is that cytokine release from infection triggers labour. However no evidence as yet that treating trichmoniasis during pregnancy reduces this risk. Trichomonas infection also enhances HIV transmission.

Colpitis macularis, or “strawberry cervix.” (Courtesy, CDC.). Swygard H et al. Sex Transm Infect 2004;80:91-95 ©2004 by BMJ Publishing Group Ltd

Guidelines for treating metronidazole resistant trichomoniasis. Treatment of Trichomoniasis Infection Metronidazole Guidelines for treating metronidazole resistant trichomoniasis. ©2004 by BMJ Publishing Group Ltd

This presentation will be available on the Clinical Intranet for review Any suggestions as to how we can do things better/more efficiently in the lab are very welcome.