STRUCTURE

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STRUCTURE
Typically pyriform
9- x 7-mm protozoan trophozoite
Non-dividing organisms have four anterior flagella
Clin. Microbiol. Rev. 17 794-803 2004
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• Broth culture
• Epithelial surface
• C. Ameboid morphology

Clin. Microbiol. Rev. 11 300-317 1998
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TRANSMISSION
Clin. Microbiol. Rev. 17 794-803 2004
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Dangerfield
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Age Distribution of STI
Age
van der Pol et al. 2002 National STD Prevention
Conference
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DISEASE PREVALENCE
Perspect. Sex. Reprod. Health. 36 6-10 2004
Sex. Transm. Dis. 26 52-57 1999
Emerg. Infect. Dis. 7 927-932 2001
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CLINICAL MANIFESTATIONS
Vaginal discharge (42) Pruritis Odor
(50) Irritation Edema or erythema
(22-37) Dysuria
Clin. Microbiol. Rev. 17 794-803 2004
50 asymptomatic ? 33 convert to symptomatic
within six months
Clin. Obstet. Gynecol. 36 137-144 1993
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Trichomonas vaginalis IN MALES
Largely asymptomatic
Non-gonococcal urethritis
Prevalence varies by method
Limited studies
J. Urol. 149 1455-1458 1993
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COMPLICATIONS
HIV co-infection
Am. J. Trop. Med. Hyg. 58 495-500 1998
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COMPLICATIONS
HIV co-infection
Genitourin. Med. 71 207-211 1995
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COMPLICATIONS
HIV co-infection
Zaire prostitutes (HIV-negative) followed for two
years
Odds ratio for HIV seroconversion was 1.9 for T.
vaginalis infection
AIDS. 7 95-102 1993
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COMPLICATIONS
HIV co-infection
HIV transmission
Sex. Transm. Dis. 26 381-387 1999
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COMPLICATIONS
HIV co-infection
HIV transmission
Pregnancy
Sex. Transm. Dis. 24 353-360 1997
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COMPLICATIONS
HIV co-infection
HIV transmission
Pregnancy
Link to PID and cervical cancer
Infertility
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DIRECT MEDICAL COT
Calif. J. Health. Promot. 5 80-91 2007
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DIAGNOSTIC SENSITIVITY
Sitay et al. 103th Gen. Meet. Am. Soc.
Microbiol., abstr. C-120
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ANALYTE-SPECIFIC REAGENT
Target capture
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TARGET CAPTURE
T. vaginalis RNA
Mucus
BLOOD
Epithelial cell RNA
BLOOD
Mucus
Bacterial RNA
Bacterial RNA
BLOOD
Mucus
T. vaginalis RNA
Epithelial cell RNA
Mucus
BLOOD
Mucus
Bacterial RNA
Bacterial RNA
BLOOD
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TARGET CAPTURE
T. vaginalis RNA
Mucus
BLOOD
Epithelial cell RNA
BLOOD
Mucus
Bacterial RNA
Bacterial RNA
BLOOD
Mucus
T. vaginalis RNA
Epithelial cell RNA
Mucus
BLOOD
Mucus
Bacterial RNA
Bacterial RNA
BLOOD
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TARGET CAPTURE
Vacuum pump
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TARGET CAPTURE
T. vaginalis RNA
T. vaginalis RNA
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ANALYTE-SPECIFIC REAGENT
Target capture
Transcription-mediated amplification
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STEPS INVOLVED IN TMA
J. Clin. Virol. 25 S23-S29 2002
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STEPS INVOLVED IN TMA
POL
TARGET
ds cDNA
TARGET
POL
J. Clin. Virol. 25 S23-S29 2002
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STEPS INVOLVED IN TMA
ds cDNA
J. Clin. Virol. 25 S23-S29 2002
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STEPS INVOLVED IN TMA
TARGET
J. Clin. Virol. 25 S23-S29 2002
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STEPS INVOLVED IN TMA
J. Clin. Virol. 25 S23-S29 2002
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ANALYTE-SPECIFIC REAGENT
Target capture
Transcription-mediated amplification
Hybridization protection assay
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HYBRIDIZATION PROTECTION ASSAY
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RATES OF INHIBITION
J. Clin. Microbiol. 44 400-405 2006
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ANALYTICAL SENSITIVITY
10-4
10-9
10-4
10-9
J. Clin. Microbiol. 44 400-405 2006
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SIX-MONTH WET MOUNT AUDIT
97.1 of testing within four entities
43.5 Outpatient Physician Group (OP MD) 41.8
Urban Emergency Department 1 8.0 Suburban
Urgent-care Facility 6.6 Urban Emergency
Department 2
76.4 Laboratory testing 23.6 Point-of-care
testing
7.0 rate of positive result
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SPECIMENS TESTED
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Trichomonas vaginalis WET MOUNT
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AMPLIFIED TESTING
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VENN DIAGRAM
Positive for T. vaginalis C. trachomatis
Positive for C. trachomatis N. gonorrhoeae
Positive for N. gonorrhoeae T. vaginalis
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VENN DIAGRAM
Positive for ALL THREE
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EVALUATION RESULTS
n 1086
78 (7.2) wet mount-positive
82 wet mount-negative specimens found to be
positive by molecular assay
14.7 rate of positive result
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DISTRIBUTION BY FACILITY
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AFRICAN AMERICAN ALONE
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CAUCASIAN ALONE
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LATINO ALONE
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Race Distribution in Rank Order ZIP Codes
Constituting 70th Percentile of Healthcare
Encounters
ED 1 (6 ZIP codes)
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Race Distribution in Rank Order ZIP Codes
Constituting 70th Percentile of Healthcare
Encounters
ED 2 (5 ZIP codes)
Urgent-care (17 ZIP codes)
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CONCOMITANT CHLAMYDIA
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CONCOMITANT GONORRHEA
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PERFORMANCE SITE
a 3.8 positive rate in audit laboratory-performed
testing P 0.60 versus evaluation b 24.6 of
overall evaluation specimens were point-of-care
P 0.49 versus audit c 52.6 of OP MD evaluation
specimens were point-of-care P 0.52 versus
audit d 5.2 positive rate in audit point-of-care
testing P 0.66 versus evaluation
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IS THIS REAL??
Morb. Mortal. Wkly. Rep. 51(No. RR-15) 1-37
2002
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ALTERNATIVE TARGET
Positive reaction in 100 of wet mount-negative
specimens that tested positive in the
T.vaginalis molecular assay
Positive reaction in 5.6 of specimens that
tested negative in the T. vaginalis molecular
assay
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WET MOUNT PERFORMANCE INDICES
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SUMMARY OF FINDINGS
Wet mount failed to diagnose nearly 50 of
trichomoniasis cases
Molecular assay reliable as stand-alone assay or
reflex test
Molecular assay can be predictive for other
agents of STD
Can be performed on same N. gonorrhoeae/C.
trachomatis tube
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Final Thoughts
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STD PREVALENCE--2006
Centers for Disease Control and Prevention 2007
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STD PREVALENCE--2006
Centers for Disease Control and Prevention 2007