Trichomonas vaginalis: underdiagnosis in urban Australia could facilitate re-emergence
- M Josephine Lusk1,
- Zin Naing2,
- Ben Rayner2,
- Nikolas Rismanto2,
- Christopher J McIver2,3,
- Robert G Cumming4,
- Kevin McGeechan4,
- William D Rawlinson2,3,
- Pam Konecny1,3
- 1St George Hospital, Kogarah, New South Wales, Australia
- 2Prince of Wales Hospital, Randwick, New South Wales, Australia
- 3University of New South Wales, Randwick, New South Wales, Australia
- 4University of Sydney, Camperdown, New South Wales, Australia
- Correspondence to Dr M Josephine Lusk, Short Street Clinic, St George Hospital, Kogarah NSW 2217, Australia;
Contributors MJL and PK: designed and implemented the clinical research project, collected clinical samples and clinical data and supervised designated clinicians in sample and data collection, undertook data entry and statistical analysis and wrote most of the manuscript (excluding lab methods section). ZN, NR, B Rayner, CJM and WDR: assisted with design of the study, processing and storage of samples and undertook the PCR testing of the clinical samples and contributed to writing the manuscript (lab methods). RGC: assisted with the design of the study, choice of statistical methods, and contributed to reviewing the manuscript. KM: Assisted with the database management and statistical analysis and reviewed manuscript.
- Accepted 20 October 2009
- Published Online First 1 November 2009
Objectives Trichomonas vaginalis (TV) has a low profile in urban sexually transmitted infection (STI) clinics in many developed countries. The objective of this study was to determine the true prevalence of TV in an Australian urban sexual health setting using sensitive molecular diagnostic techniques.
Methods A cross-sectional study investigating the aetiology of cervicitis in women attending two urban sexual health clinics in Sydney, Australia, enrolled 356 consecutive eligible women from 2006 to 2008. The diagnostic yield from the standard clinical practice of discretionary high vaginal wet preparation microscopy in women with suspicious vaginal discharge was compared with universal use of nested PCR for TV of cervical samples.
Results TV was detected by PCR in 17/356 women (4.8%, 95% CI 2.8 to 7.5%), whereas only four cases (1.1%, 95% CI 0.3 to 2.8%) were detected by discretionary wet preparation microscopy. Eleven of the 17 women (p=0.003) were of culturally and linguistically diverse background. Additionally, cervicitis was found to be significantly associated with TV, RR 1.66 (1.14 to 2.42), p=0.034.
Conclusions Traditional TV-detection methods underestimate TV prevalence in urban Australia. The TV prevalence of 4.8% by PCR testing in this study exceeds previously reported urban Australian TV rates of <1%. An increase in trichomoniasis-associated adverse reproductive outcomes and enhanced HIV transmission poses a salient public health threat. Accordingly, TV warrants a higher profile in urban STI clinic settings in developed countries, and we suggest that priority be given to development of standardised molecular TV detection techniques and that these become part of routine STI testing.
- Trichomonas vaginalis
- sexual networks
The information in this manuscript is not being considered elsewhere for publication. Some of the interim findings of the parent cervicitis study were recently presented by MJL at the Australasian Sexual Health Conference, Brisbane, 3 September 2009.
Funding Financial support was provided in part by the HIV and AIDS Related Funding Program (HARP) South Eastern Sydney and Illawarra Area Health Service, and MJL was supported in part by a Novartis Research Scholarship.
Competing interests None.
Patient consent Obtained.
Ethics approval Ethics approval was provided by the South Eastern Sydney and Illawarra Area Health Service Human Research Ethics Committee and the Sydney South West Area Heath Service Ethics Review Committee (Royal Prince Alfred Hospital Zone).
Provenance and peer review Not commissioned; externally peer reviewed.