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  • Cross-sectional study to evaluate Trichomonas vaginalis positivity in women tested for Neisseria gonorrhoeae and Chlamydia trachomatis, attending genitourinary medicine and primary care clinics in Bristol, South West England

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Epidemiology
Original article
Cross-sectional study to evaluate Trichomonas vaginalis positivity in women tested for Neisseria gonorrhoeae and Chlamydia trachomatis, attending genitourinary medicine and primary care clinics in Bristol, South West England
  1. Jane E Nicholls1,
  2. Katy M E Turner2,3,
  3. Paul North4,
  4. Ralph Ferguson4,
  5. Margaret T May3,5,
  6. Karen Gough4,
  7. John Macleod3,5,
  8. Peter Muir3,4,
  9. Patrick J Horner1,3,5
  1. 1Bristol Sexual Health Centre, University Hospitals NHS Foundation Trust, Tower Hill, Bristol, UK
  2. 2School of Veterinary Sciences, University of Bristol, Bristol, UK
  3. 3National Institute for Health Research Health Protection Research Unit (NIHR HPRU) in Evaluation of Interventions in partnership with Public Health England, University of Bristol, Bristol, UK
  4. 4Public Health Laboratory Bristol, National Infection Service, Public Health England, Bristol, UK
  5. 5School of Social & Community Medicine, University of Bristol, Bristol, UK
  1. Correspondence to Dr Patrick Horner, School of Social and Community Medicine, Oakfield House, University of Bristol, UK; Paddy.Horner{at}bristol.ac.uk

Abstract

Background Highly sensitive, commercial nucleic acid amplification tests (NAAT) for Trichomonas vaginalis have only recently been recommended for use in the UK. While testing for T. vaginalis is routine in symptomatic women attending genitourinary medicine (GUM) clinics, it is rare in asymptomatic women or those attending primary care. The aim of this study was to evaluate the positivity of T. vaginalis using a commercial NAAT, in symptomatic and asymptomatic women undergoing testing for chlamydia and gonorrhoea in GUM and primary care settings.

Methods Samples from 9186 women undergoing chlamydia and gonorrhoea testing in South West England between May 2013 and Jan 2015 were also tested for T. vaginalis by NAAT alongside existing tests.

Results T. vaginalis positivity using NAAT was as follows: in GUM 4.5% (24/530, symptomatic) and 1.7% (27/1584, asymptomatic); in primary care 2.7% (94/3499, symptomatic) and 1.2% (41/3573, asymptomatic). Multivariable regression found that in GUM older age, black ethnicity and deprivation were independent risk factors for T. vaginalis infection. Older age and deprivation were also risk factors in primary care. Testing women presenting with symptoms in GUM and primary care using TV NAATs is estimated to cost £260 per positive case diagnosed compared with £716 using current microbiological tests.

Conclusions Aptima TV outperforms existing testing methods used to identify T. vaginalis infection in this population. An NAAT should be used when testing for T. vaginalis in women who present for testing with symptoms in primary care and GUM, based on test performance and cost.

  • TRICHOMONAS
  • DIAGNOSIS
  • MOLECULAR TECHNIQUES
  • PRIMARY CARE

This is an Open Access article distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: http://creativecommons.org/licenses/by-nc/4.0/

https://doi.org/10.1136/sextrans-2016-052942

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    Footnotes

    • Handling editor Jackie A Cassell

    • Twitter Follow Jane Nicholls @drjanenicholls

    • Contributors JEN, PJH and PM conceived the study idea; wrote the protocol with input from KMET, MTM and JM. MTM calculated sample sizes based on data from KG and had overview of the statistical analysis. JEN, KG and PM ran the study in the lab and in primary care. JEN and PJH ran the study in the GUM clinic. RF wrote the ICE programme to offer Aptima TV testing and record consent in primary care. PN was responsible for extracting and summarising the data from LIMS throughout the study. KT performed the data linkage and data analysis on data from PN and MTM provided statistical support. KMET undertook the economic evaluation. JN wrote the first draft with input from KMET, PJH and PM. Subsequent drafts followed critical review by all authors. All authors approved the final version.

    • Funding Hologic provided the test kits free of charge during the study.

      The study was adopted onto the NIHR Portfolio (co adopted by primary care) UKCRN ID 13827.

    • Competing interests Hologic provided test kits free of charge during the study. In addition, PJH, JEN and KMET received expenses (travel, conference fee and accommodation) to attend ISSTDR 2015 (Brisbane). JEN received expenses to attend ECCMID 2016 (Amsterdam) and RICAI 2017 (Paris). No other consultancy fees or payments were received for this study and Hologic was not involved in the study design or analysis.

    • All authors provided ICJME from to generate the following statement: JEN reports personal fees and non financial support from Hologic during the conduct of the study. PJH reports non-financial support from Hologic, during the conduct of the study; personal fees from Crown Prosecution service, personal fees from British Association for Sexual Health and HIV, grants from Mast Group, outside the submitted work. In addition, PJH has a patent A sialidase spot test to diagnose bacterial vaginosis issued to University of Bristol. PM reports non-financial support from Hologic, during the conduct of the study; grants, personal fees, non-financial support from Hologic, grants from Innovate UK, grants and non-financial support from Mast Group and Elitech UK outside the submitted work. KMET reports personal fees from Hologic, during the conduct of the study; personal fees from Aquarius Population Health, outside the submitted work. MTM reports non-financial support from Hologic, during the conduct of the study. Statement provided (KG) confirmed by email to JEN (RF and PN). The views expressed are those of the authors and not those of the NHS, NIHR, PHE or Hologic.

    • Ethics approval NRES Committee South West Cornwall and Plymouth.

    • Provenance and peer review Not commissioned; externally peer reviewed.