From the Guidelines
Urine testing for Trichomonas vaginalis is a recommended and convenient screening method, comparable to cervical testing, due to its ease of collection, non-invasive sampling, and patient comfort, as supported by the most recent evidence from 2018 1.
Key Points
- Urine nucleic acid amplification tests (NAATs) and cervical swabs have similar sensitivity and specificity for detecting Trichomonas vaginalis, a common sexually transmitted infection.
- The high sensitivity of molecular testing methods, such as NAATs, has improved detection rates compared to older microscopy techniques, allowing for more accurate diagnosis from either specimen type 1.
- Urine testing is particularly useful for screening asymptomatic individuals or when pelvic examination is not feasible, while cervical testing may be preferred when performing a pelvic exam for other reasons or when collecting samples for multiple STI tests simultaneously.
- For treatment, a single 2-gram oral dose of metronidazole or tinidazole is recommended for uncomplicated trichomoniasis, with follow-up testing recommended only if symptoms persist, as per the guidelines 1.
Considerations
- Partners should be treated concurrently to prevent reinfection, and patients should abstain from sexual activity until both they and their partners complete treatment and are symptom-free.
- The choice between urine and cervical testing should be based on individual patient needs and preferences, as well as the availability of testing methods and laboratory capabilities.
- It is essential to note that the sensitivity of wet mount for trichomonads requires live organisms to visualize movement and has poor sensitivity, approximately 60%, as reported in the study 1.
- In contrast, NAATs have demonstrated superior sensitivity for trichomonas diagnosis in both men and women, although they are not yet licensed for male specimens, as mentioned in the study 1.
From the Research
Urine Trichomonas Testing vs Cervical Testing
- Urine trichomonas testing is a method used to diagnose Trichomonas vaginalis infection, which can be performed on a variety of genital specimens, including urine 2.
- Cervical testing, on the other hand, involves collecting a sample from the cervix to diagnose the infection.
- Studies have shown that Trichomonas vaginalis infection is associated with increased risk of cervical carcinogenesis, including high-grade squamous intraepithelial lesion diagnosis and cervical cancer 3.
- The diagnosis of Trichomonas vaginalis infection is usually made from wet mount microscopy and direct visualization, which are insensitive, while DNA amplification techniques perform with good sensitivity, but are not yet approved for diagnostic purposes 4.
Comparison of Testing Methods
- Newly available diagnostic methods, including point-of-care assays and multiple nucleic acid amplification tests, can be performed on a variety of genital specimens in women and men, including urine, allowing more accurate and convenient testing and screening of those at risk for infection 2.
- There is no direct comparison between urine trichomonas testing and cervical testing in the provided studies, but it is mentioned that urine testing is a convenient and accurate method for diagnosing Trichomonas vaginalis infection 2.
Treatment and Management
- The treatment of Trichomonas vaginalis infection usually involves a single dose of metronidazole, but a 7-day dose of metronidazole has been shown to be more effective in clearing the infection in women 5.
- Concomitant treatment of sexual partners is recommended to prevent reinfection 4.
- Metronidazole resistance is an emerging problem, and the minimal lethal concentration (MLC) associated with treatment failure has been determined to be ≥50 μg/mL for metronidazole and ≥6.3 μg/mL for tinidazole 6.