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P22 Are we using the best tests to diagnose TV in gum clinics in the UK?
  1. Jane Nicholls1,
  2. Peter Muir2,
  3. Katy Turner3,
  4. Margaret May3,
  5. Paul North2,
  6. John Macleod3,
  7. Paddy Horner3
  1. 1Bristol Sexual Health Centre, Bristol, UK
  2. 2Public Health England, Bristol Laboratory, Bristol, UK
  3. 3Department of Social and Community Medicine, University of Bristol, Bristol, UK

Abstract

Background The Aptima TV NAAT test has been approved for use for the detection of Trichomonas vaginalis (TV) and is more sensitive (˜100%) than wet mount microscopy (50%) or culture (75%). Asymptomatic women attending GUM clinics are often not tested for TV as the prevalence is assumed to be too low for testing to be cost effective.

Aims To determine

  • TV positivity rate among GUM attendees with and without symptoms

  • How many additional cases are identified with the new test

  • Whether self-taken vaginal swabs are of equivalent sensitivity in symptomatic GUM patients.

Methods Patients were tested using the Aptima TV NAAT alongside existing testing methods. Test performance was compared using the McNemar test.

Results The positivity of TV determined by TV NAAT was 4.2% (22/519) in symptomatic and 1.8% (28/1599) in asymptomatic women. 9/20 NAAT positive patients, where all test were performed, would not have been identified on wet prep or culture. Overall TV NAAT outperformed currently used methods (p = 0.004), clinic wet prep vs NAAT (p = 0.038), culture vs NAAT (p = 0.002). Self-taken vaginal swabs were equivalent in sensitivity to clinician taken swabs; of patients who tested positive on either NAAT test, 19 tested positive on self-taken swab and 17 tested positive on clinician taken swab (p = 0.625).

Conclusions Testing all women attending GUM clinics with the APTIMA TV NAAT test will identify additional cases and is therefore likely to be cost-effective, and should be considered to replace conventional microbiological testing methods.

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