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Trichomonas vaginalis: under-diagnosis in urban Australia could facilitate re-emergence
  1. (margaret) Josephine Lusk1,*,
  2. Zin Naing2,
  3. Nickolas Rismanto2,
  4. Ben Rayner2,
  5. Christopher McIver3,
  6. Robert Cumming4,
  7. Kevin McGeechan4,
  8. William Rawlinson3,
  9. Pam Konecny3
  1. 1 Short Street Sexual Health,St George Hospital, Australia;
  2. 2 Prince of Wales Hospital, Randwick, NSW, Australia;
  3. 3 University of New South Wales, Randwick, NSW, Australia;
  4. 4 University of Sydney, Australia
  1. Correspondence to: margaret josephine lusk, Sexual Health, Short Street Sexual Health Centre, St George Hospital, Short Street Clinic,Ground Floor Prichard Wing,St George Hospital, Kogarah, Sydney, NSW 2217, Australia, sydney, 2217, Australia; josephine.lusk{at}sesiahs.health.nsw.gov.au

Abstract

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 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 2006-2008. 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 polymerase chain reaction (PCR) for TV of cervical samples.

Results: TV was detected by PCR in 17/356 women (4.8%, 95% Confidence Interval (CI) 2.8-7.5%), whereas only 4 cases (1.1%, 95% CI 0.3-2.8%) were detected by discretionary wet preparation microscopy. Eleven of the 17 women (p=0.003) were of culturally and linguistically diverse (CALD) background. Additionally, cervicitis was found to be significantly associated with TV, RR 1.66(1.14-2.42), 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 priority be given to development of standardised molecular TV detection techniques and that these become part of routine STI testing.

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