Testing Guidelines for Trichomoniasis in Men
Men should be tested for trichomoniasis using nucleic acid amplification tests (NAATs) on urine specimens or urethral swabs, with testing recommended for symptomatic men and those in high-prevalence settings, though routine screening of asymptomatic men is not currently recommended. 1
Who to Test
Symptomatic Men
- Test any man presenting with urethritis symptoms (dysuria, urethral discharge, penile irritation)
- Most men with trichomoniasis are asymptomatic, but symptomatic cases warrant immediate testing 1
High-Risk Asymptomatic Men
Consider testing in:
- Sexual partners of women diagnosed with trichomoniasis (high transmission rates support this) 1
- Men attending STI clinics
- Men with HIV infection
- Men in correctional facilities
- Men with multiple sexual partners
Important caveat: Unlike women, there is no formal recommendation for routine screening of asymptomatic men in the general population, even though men serve as important reservoirs for transmission 1.
Diagnostic Testing Methods
Preferred: NAATs (Most Sensitive)
- Urine specimens: Sensitivity 97.2-100% 2, 3
- Urethral/meatal swabs: Sensitivity 100% 2
- NAATs are significantly more sensitive than traditional methods and should be the first-line diagnostic approach
Alternative: Point-of-Care Tests
The GeneXpert TV test is the only POC test validated for men:
- Sensitivity 97.2% for male urine 3
- Results in <1 hour
- Requires small platform (moderately complex test)
- Useful when immediate diagnosis and treatment are priorities
Not Recommended for Men
- Wet mount microscopy (insensitive, requires immediate examination)
- Culture (not readily available, less sensitive than NAATs)
- Antigen tests (limited validation in men; primarily studied in women) 4
Specimen Collection
First-void urine is the preferred non-invasive specimen for men:
- Collect first 20-30 mL of urine stream
- No urethral swab needed in most cases
- Urethral swabs can be used but are more invasive with similar sensitivity 2
For men who engage in receptive anal intercourse:
- Consider rectal swab testing if available (though most NAATs are not FDA-cleared for rectal specimens) 5
Testing Algorithm
- Symptomatic men: Test immediately with NAAT on urine
- Partners of infected women: Test with NAAT on urine (consider expedited partner treatment while awaiting results) 1
- High-risk asymptomatic men in STI clinics: Consider NAAT testing on urine
- Test for co-infections: Always test for gonorrhea, chlamydia, HIV, and syphilis when testing for trichomoniasis 5
Follow-Up Testing
- Test-of-cure is NOT routinely recommended for men after treatment (unlike some other STIs)
- Rescreening at 3 months should be considered due to high reinfection rates, particularly if partner treatment is uncertain 1
Common Pitfalls
- Don't rely on symptoms alone: Most infected men are asymptomatic but still transmit infection 1
- Don't use wet mount in men: This is insensitive and impractical for male specimens
- Don't forget partner notification: High transmission rates (up to 80%) mean partners need testing and treatment 1
- Don't overlook urine cytology findings: Trichomonas may be incidentally detected on urine cytology; this warrants treatment even without formal STI testing 6
Key Differences from Women
Unlike women (who have annual screening recommendations for those <25 years or with risk factors), men have no routine screening guidelines. Testing in men is primarily symptom-driven or partner-based rather than screening-based, reflecting the current evidence gap on cost-effectiveness and feasibility of male screening programs 1.