Trichomoniasis laboratory findings

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]

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

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]

• Characteristic “tumbling” motility of protozoa
• Leukocytes

Trichomonas vaginalis	Pap smear

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

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

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]

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