Additional Testing and Imaging for Vaginal Trichomoniasis
For a patient with confirmed vaginal trichomoniasis, you should test for concurrent sexually transmitted infections (HIV, chlamydia, and gonorrhea) and evaluate sexual partners, but no additional imaging is indicated. 1
Mandatory Concurrent STI Testing
All patients with suspected or confirmed pelvic inflammatory disease should be tested for Chlamydia trachomatis, Neisseria gonorrhoeae, Trichomonas vaginalis, and HIV. 1
The presence of trichomoniasis increases susceptibility to other sexually transmitted infections, making concurrent testing essential rather than optional. 2
Testing should include NAAT for chlamydia and gonorrhea from the same specimen types already collected (vaginal swab, endocervical swab, or urine). 1
HIV testing is specifically recommended as trichomoniasis increases the risk of HIV transmission and acquisition. 3
Partner Evaluation and Testing
Asymptomatic sexual partners of treated patients must be treated simultaneously, even if testing is negative or unavailable, to prevent reinfection. 4
Male partners are typically asymptomatic carriers, and negative smears and cultures cannot be relied upon to exclude infection in men. 4
In cases of reinfection, the sexual partner should be treated regardless of testing results. 4
When to Consider Additional Diagnostic Testing
If the initial wet mount was negative but clinical suspicion remains high (vaginal pH >4.5, symptoms consistent with trichomoniasis), confirm with NAAT testing, which has 95-100% sensitivity compared to wet mount's 40-80%. 5, 6
For recurrent cases after treatment, consider culture or repeat NAAT to assess for treatment failure or reinfection. 1
When repeat courses of treatment are required, obtain total and differential leukocyte counts before and after retreatment to monitor for metronidazole-associated blood dyscrasias. 4
Imaging Considerations
No imaging studies are indicated for uncomplicated vaginal trichomoniasis.
Imaging (ultrasound or CT) should only be considered if clinical examination suggests complications such as tubo-ovarian abscess or pelvic inflammatory disease with severe symptoms requiring hospitalization. 1
Critical Pitfalls to Avoid
Do not rely solely on wet mount results—negative microscopy does not exclude trichomoniasis, and NAAT should be used when available. 5, 6
Do not forget to screen asymptomatic women with multiple sexual partners, as up to 50% of infections are asymptomatic. 5
Do not delay partner treatment while awaiting test results, as this is the primary cause of treatment failure and reinfection. 4
Do not order imaging studies routinely—they add no value in uncomplicated trichomoniasis and should be reserved for suspected upper genital tract complications. 1