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{{Trichomoniasis}}
{{Trichomoniasis}}


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==Overview==
==Overview==
Laboratory tests used in the diagnosis of trichomoniasis include saline microscopy, culture, and nucleic acid amplification tests (NAATs).<ref name=ggg> Trichomonasias . Wikipedia.https://en.wikipedia.org/wiki/Trichomoniasis Accessed on February 4, 2016</ref>
Laboratory tests used in the diagnosis of trichomoniasis include saline microscopy, culture, and nucleic acid amplification tests (NAATs).<ref name="CDT">http://www.cdc.gov/std/tg2015/trichomoniasis.htm Accessed on September 14, 2016</ref>


==Laboratory Findings==  
==Laboratory Findings==  
===Microscopy===
===Microscopy===
Trichomoniasis is diagnosed by visually observing the trichomonads via a [[microscope]]. In women, the examiner collects the specimen during a [[pelvic examination]] by inserting a [[Speculum (medical)|speculum]] into the vagina and then using a cotton-tipped applicator to collect the sample. The sample is then placed onto a microscopic slide and sent to a laboratory to be analyzed. Trichomoniasis has been difficult to diagnose due to the poor [[Sensitivity|sensitivity]] of the tests.<ref name=Andrea&Chapin2011>{{cite journal| author=Andrea SB, Chapin KC| title=Comparison of Aptima Trichomonas vaginalis Transcription-Mediated Amplification Assay and BD Affirm VPIII for Detection of T. vaginalis in Symptomatic Women: Performance Parameters and Epidemiological Implications. | journal=J Clin Microbiol | year= 2011 | volume= 49 | issue= 3 | pages= 866–9 | pmid=21248097 | doi=10.1128/JCM.02367-10 | pmc= | url= | laysummary = http://www.eurekalert.org/pub_releases/2011-03/l-amd030811.php}}</ref>
Wet-mount [[microscopy]]: has been used as the preferred [[diagnostic]] test, however it has low [[sensitivity]] (44%–68%) compared with culture. To improve detection, [[clinicians]] using wet mounts should attempt to evaluate slides immediately after specimen collection because [[sensitivity]] decreases quickly to 20% within 1 hour after collection.<ref name="urlTrichomoniasis - STI Treatment Guidelines2">{{cite web |url=https://www.cdc.gov/std/treatment-guidelines/trichomoniasis.htm |title=Trichomoniasis - STI Treatment Guidelines |format= |work= |accessdate=}}</ref>


In men, wet preparation is insensitive, and culture testing of [[urethral]] swab, urine, and [[semen]] is required for optimal sensitivity. No FDA-cleared [[PCR]] test for T. vaginalis is available in the United States, but such testing might be available from commercial laboratories that have developed their own PCR tests.<ref name="urlSTD Facts - Trichomoniasis">{{cite web |url=http://www.cdc.gov/std/trichomonas/STDFact-Trichomoniasis.htm |title=STD Facts - Trichomoniasis |format= |work= |accessdate=2012-12-27}}</ref><ref name="urlVaginal Discharge-STD Treatment Guidelines 2006">{{cite web |url=http://www.cdc.gov/std/treatment/2006/vaginal-discharge.htm#vagdis3 |title=Vaginal Discharge-STD Treatment Guidelines 2006 |format= |work= |accessdate=2012-12-27}}</ref>
Trichomoniasis is diagnosed by visually observing the trichomonads via a [[microscope]]. In women, the examiner collects the specimen during a [[pelvic examination]] by inserting a [[Speculum (medical)|speculum]] into the vagina and then using a cotton-tipped applicator to collect the sample. The sample is then placed onto a microscopic slide and sent to a laboratory to be analyzed. Trichomoniasis has been difficult to diagnose due to the poor [[Sensitivity|sensitivity]] of the tests.<ref name="Andrea&Chapin2011">{{cite journal| author=Andrea SB, Chapin KC| title=Comparison of Aptima Trichomonas vaginalis Transcription-Mediated Amplification Assay and BD Affirm VPIII for Detection of T. vaginalis in Symptomatic Women: Performance Parameters and Epidemiological Implications. | journal=J Clin Microbiol | year= 2011 | volume= 49 | issue= 3 | pages= 866–9 | pmid=21248097 | doi=10.1128/JCM.02367-10 | pmc= | url= | laysummary = http://www.eurekalert.org/pub_releases/2011-03/l-amd030811.php}}</ref><ref name="CDT">http://www.cdc.gov/std/tg2015/trichomoniasis.htm Accessed on September 14, 2016</ref>
<ref>Nye, Melinda B., Jane R. Schwebke, and Barbara A. Body. "Comparison of APTIMA Trichomonas vaginalis transcription-mediated amplification to wet mount microscopy, culture, and polymerase chain reaction for diagnosis of trichomoniasis in men and women." American journal of obstetrics and gynecology 200.2 (2009): 188-e1.</ref><ref>Stoner, Kevin A., et al. "Survival of Trichomonas vaginalis in wet preparation and on wet mount." Sexually transmitted infections (2013): sextrans-2012.</ref>
 
Findings on microscopy suggestive of trichomoniasis include:<ref name="pmid23633669">{{cite journal| author=Hobbs MM, Seña AC| title=Modern diagnosis of Trichomonas vaginalis infection. | journal=Sex Transm Infect | year= 2013 | volume= 89 | issue= 6 | pages= 434-8 | pmid=23633669 | doi=10.1136/sextrans-2013-051057 | pmc=PMC3787709 | url=http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=23633669  }} </ref><ref name="pmid15489349">{{cite journal| author=Schwebke JR, Burgess D| title=Trichomoniasis. | journal=Clin Microbiol Rev | year= 2004 | volume= 17 | issue= 4 | pages= 794-803, table of contents | pmid=15489349 | doi=10.1128/CMR.17.4.794-803.2004 | pmc=PMC523559 | url=http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=15489349  }} </ref>
 
*Characteristic "tumbling" motility of [[protozoa]]
*[[Leukocytes]]


<br>
<br>
{|
{|
|-
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! Trichomonas vaginalis !! Pap smear
!Trichomonas vaginalis!!Pap smear
|-
|-
| [[Image:Trichomonas vaginalis.jpg|300px|]] || [[image:Trichomonas_pap_test.jpg|300px]]
|[[Image:Trichomonas vaginalis.jpg|300px|]]||[[image:Trichomonas_pap_test.jpg|300px]]
|}
|}


Two trophozoites of Trichomonas vaginalis obtained from in vitro culture.  Smear was stained with [[Giemsa]].<ref name="urlDPDx - Trichomoniasis">{{cite web |url=http://www.dpd.cdc.gov/dpdx/HTML/Trichomoniasis.htm |title=DPDx - Trichomoniasis |format= |work= |accessdate=2012-12-27}}</ref>
Two trophozoites of Trichomonas vaginalis obtained from in vitro culture.  Smear was stained with [[Giemsa]].<ref name="urlDPDx - Trichomoniasis">{{cite web |url=http://www.dpd.cdc.gov/dpdx/HTML/Trichomoniasis.htm |title=DPDx - Trichomoniasis |format= |work= |accessdate=2012-12-27}}</ref>
===Culture===
Historically, culture has been the gold standard for diagnosis of trichomoniasis. However, [[sensitivity]] is somewhat low (70-89%).<ref name="ggg"> Trichomoniasis . Wikipedia.https://en.wikipedia.org/wiki/Trichomoniasis Accessed on February 4, 2016</ref>
===Nucleic Acid Amplification Tests===
Nucleic acid probe techniques, the most sensitive tests, are moderately priced and fast, but they require instrumentation and thus are not considered point-of-care. The APTIMA ''Trichomonas vaginalis'' Assay (Hologic Gen-Probe, San Diego, CA) was [[FDA]]-cleared in 2011 for use with urine, endocervical, and vaginal swabs, and endocervical specimens collected in the Hologic PreserveCyt solution (ThinPrep) from females only. [[Sensitivity]] is 95–100% and [[specificity]] is also 95–100%.<ref name="pmid26242185">{{cite journal| author=Kissinger P| title=Trichomonas vaginalis: a review of epidemiologic, clinical and treatment issues. | journal=BMC Infect Dis | year= 2015 | volume= 15 | issue=  | pages= 307 | pmid=26242185 | doi=10.1186/s12879-015-1055-0 | pmc=PMC4525749 | url=http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=26242185  }} </ref><ref>Nye, Melinda B., Jane R. Schwebke, and Barbara A. Body. "Comparison of APTIMA Trichomonas vaginalis transcription-mediated amplification to wet mount microscopy, culture, and polymerase chain reaction for diagnosis of trichomoniasis in men and women." American journal of obstetrics and gynecology 200.2 (2009): 188-e1.</ref><ref>Kingston, M. A., D. Bansal, and E. M. Carlin. "'Shelf life'of Trichomonas vaginalis." International journal of STD & AIDS 14.1 (2003): 28.</ref>


==References==
==References==
{{Reflist|2}}
{{Reflist|2}}


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Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]; Associate Editor(s)-in-Chief: Maliha Shakil, M.D. [2], Aysha Anwar, M.B.B.S[3]

Overview

Laboratory tests used in the diagnosis of trichomoniasis include saline microscopy, culture, and nucleic acid amplification tests (NAATs).[1]

Laboratory Findings

Microscopy

Wet-mount microscopy: has been used as the preferred diagnostic test, however it has low sensitivity (44%–68%) compared with culture. To improve detection, clinicians using wet mounts should attempt to evaluate slides immediately after specimen collection because sensitivity decreases quickly to 20% within 1 hour after collection.[2]

Trichomoniasis is diagnosed by visually observing the trichomonads via a microscope. In women, the examiner collects the specimen during a pelvic examination by inserting a speculum into the vagina and then using a cotton-tipped applicator to collect the sample. The sample is then placed onto a microscopic slide and sent to a laboratory to be analyzed. Trichomoniasis has been difficult to diagnose due to the poor sensitivity of the tests.[3][1] [4][5]

Findings on microscopy suggestive of trichomoniasis include:[6][7]


Trichomonas vaginalis Pap smear

Two trophozoites of Trichomonas vaginalis obtained from in vitro culture. Smear was stained with Giemsa.[8]

Culture

Historically, culture has been the gold standard for diagnosis of trichomoniasis. However, sensitivity is somewhat low (70-89%).[9]

Nucleic Acid Amplification Tests

Nucleic acid probe techniques, the most sensitive tests, are moderately priced and fast, but they require instrumentation and thus are not considered point-of-care. The APTIMA Trichomonas vaginalis Assay (Hologic Gen-Probe, San Diego, CA) was FDA-cleared in 2011 for use with urine, endocervical, and vaginal swabs, and endocervical specimens collected in the Hologic PreserveCyt solution (ThinPrep) from females only. Sensitivity is 95–100% and specificity is also 95–100%.[10][11][12]

References

  1. ↑ 1.0 1.1 http://www.cdc.gov/std/tg2015/trichomoniasis.htm Accessed on September 14, 2016
  2. ↑ "Trichomoniasis - STI Treatment Guidelines".
  3. ↑ Andrea SB, Chapin KC (2011). "Comparison of Aptima Trichomonas vaginalis Transcription-Mediated Amplification Assay and BD Affirm VPIII for Detection of T. vaginalis in Symptomatic Women: Performance Parameters and Epidemiological Implications". J Clin Microbiol. 49 (3): 866–9. doi:10.1128/JCM.02367-10. PMID 21248097. Lay summary.
  4. ↑ Nye, Melinda B., Jane R. Schwebke, and Barbara A. Body. "Comparison of APTIMA Trichomonas vaginalis transcription-mediated amplification to wet mount microscopy, culture, and polymerase chain reaction for diagnosis of trichomoniasis in men and women." American journal of obstetrics and gynecology 200.2 (2009): 188-e1.
  5. ↑ Stoner, Kevin A., et al. "Survival of Trichomonas vaginalis in wet preparation and on wet mount." Sexually transmitted infections (2013): sextrans-2012.
  6. ↑ Hobbs MM, Seña AC (2013). "Modern diagnosis of Trichomonas vaginalis infection". Sex Transm Infect. 89 (6): 434–8. doi:10.1136/sextrans-2013-051057. PMC 3787709. PMID 23633669.
  7. ↑ Schwebke JR, Burgess D (2004). "Trichomoniasis". Clin Microbiol Rev. 17 (4): 794–803, table of contents. doi:10.1128/CMR.17.4.794-803.2004. PMC 523559. PMID 15489349.
  8. ↑ "DPDx - Trichomoniasis". Retrieved 2012-12-27.
  9. ↑ Trichomoniasis . Wikipedia.https://en.wikipedia.org/wiki/Trichomoniasis Accessed on February 4, 2016
  10. ↑ Kissinger P (2015). "Trichomonas vaginalis: a review of epidemiologic, clinical and treatment issues". BMC Infect Dis. 15: 307. doi:10.1186/s12879-015-1055-0. PMC 4525749. PMID 26242185.
  11. ↑ Nye, Melinda B., Jane R. Schwebke, and Barbara A. Body. "Comparison of APTIMA Trichomonas vaginalis transcription-mediated amplification to wet mount microscopy, culture, and polymerase chain reaction for diagnosis of trichomoniasis in men and women." American journal of obstetrics and gynecology 200.2 (2009): 188-e1.
  12. ↑ Kingston, M. A., D. Bansal, and E. M. Carlin. "'Shelf life'of Trichomonas vaginalis." International journal of STD & AIDS 14.1 (2003): 28.


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