What test should be ordered to diagnose trichomoniasis (Trich) in a male patient when Nucleic Acid Amplification Test (NAAT) is not available?

Testing for Trichomoniasis in Males Without NAAT

When NAAT is unavailable, order culture using the InPouch TV system on a urethral swab specimen, which has approximately 70% sensitivity—significantly better than wet mount alone (60% sensitivity) but still inferior to NAAT. 1

Recommended Testing Algorithm Without NAAT

First-Line Alternative: Culture

• Order InPouch TV culture system using a urethral swab specimen with direct inoculation at the bedside 1
• This system allows both immediate wet mount review and subsequent culture over 2-5 days 1
• Sensitivity is approximately 70% compared to NAAT methods, meaning 30% of infections will still be missed 1
• Culture from urethral swabs in symptomatic men (those with urethritis) are more likely to be positive with shorter incubation times 2

Adjunctive Testing: Wet Mount Microscopy

• Perform saline wet mount on urethral swab submitted in 0.5 mL saline, but examine within 30 minutes to 2 hours maximum 1
• Wet mount requires live organisms with visible motility and has only 60% sensitivity in males 1
• This test should never be used alone as it will miss 40% of infections 1, 3
• Acute inflammation may be observed in positive cases 4

Consider Rapid Antigen Testing (If Available)

• The OSOM Trichomonas Rapid Test can be performed on urethral specimens 1
• Sensitivity ranges from 62-95% compared to culture and NAAT, with best results in symptomatic patients 1
• Does not require live organisms for optimal test performance 1

Critical Specimen Collection Details

Urethral Swab Technique

• Collect urethral swab specimens and either directly inoculate into InPouch TV culture system or submit in appropriate transport medium 1
• For wet mount: submit swab in 0.5 mL saline and examine immediately (within 30 minutes to 2 hours) 1
• Transport culture specimens at room temperature; do NOT refrigerate 1

Multiple Specimen Strategy

• Collect multiple specimens when possible (urethral swab, first-void urine if culture available) as this significantly improves detection rates 2
• Research shows that even with sensitive testing, reliable detection in male partners often requires multiple specimens 2
• Only 22.5% of infected men were detected by single urethral swab culture, emphasizing the need for multiple sampling approaches 2

Simultaneous Testing Requirements

• Always test simultaneously for Chlamydia trachomatis and Neisseria gonorrhoeae using available methods (culture for gonorrhea, available testing for chlamydia) 3
• Consider HIV testing in all patients with suspected trichomoniasis 3
• In one study, 15% of men with trichomoniasis had concurrent gonorrhea 5

Clinical Context for Testing

Test These Male Patients:

• Men with urethral discharge or urethritis symptoms 1, 3
• Asymptomatic men whose female partners are diagnosed with trichomoniasis (73% of male partners are infected) 2
• Men with multiple sexual partners or other STI risk factors 1, 3
• Men with lower urinary tract symptoms, especially hematuria 4

Important Clinical Findings:

• Up to 80% of male infections are asymptomatic, so absence of symptoms does not exclude infection 1
• Trichomoniasis can cause urethritis, epididymitis, and prostatitis in males 1
• Urethral strictures have been identified in some infected men 4

Critical Pitfalls to Avoid

• Never rely on wet mount alone—its 60% sensitivity means 40% of infections will be missed, and organisms lose motility rapidly after collection 1, 3
• Do not delay wet mount examination beyond 2 hours as organisms become undetectable 1, 3, 6
• Do not refrigerate culture specimens—maintain at room temperature for optimal organism viability 1
• Do not assume negative results exclude infection given the poor sensitivity of non-NAAT methods; consider empiric treatment of partners of infected women even with negative testing 2
• Recognize that InPouch TV culture is not widely available—confirm your laboratory offers this testing before ordering 1

Treatment Considerations

• The majority (73%) of male sexual partners of infected women are infected, emphasizing the critical importance of partner evaluation and treatment 2
• In clinical practice, 80% of men diagnosed with trichomoniasis by urine cytology received specific metronidazole therapy based on results 4
• Consider empiric treatment of male partners of infected women given the high transmission rate and poor sensitivity of available non-NAAT tests 2