Screening for Other STIs in Women with Confirmed Trichomonas
Yes, all women with laboratory-confirmed Trichomonas vaginalis infection should be screened for other sexually transmitted infections, particularly gonorrhea, chlamydia, syphilis, and HIV. 1
Rationale for Concurrent STI Screening
Trichomonas vaginalis frequently coexists with other sexually transmitted infections, making screening essential rather than optional. The evidence demonstrates:
- Approximately 30% of women with trichomoniasis have at least one concurrent STI. 2
- Among women with trichomonas, 10% have concurrent gonorrhea and 15% have concurrent chlamydia. 2
- Trichomonas infection is associated with increased HIV acquisition risk, making HIV screening particularly important. 3
Specific Screening Recommendations
Mandatory Testing Panel
Screen all women with confirmed trichomonas for the following:
- Chlamydia trachomatis using NAAT (vaginal swab is optimal specimen type) 1, 4
- Neisseria gonorrhoeae using NAAT (vaginal swab is optimal specimen type) 1, 4
- Syphilis serology 1
- HIV antibody testing 1
Testing Frequency and Follow-Up
Retesting in 3 months is indicated for women found positive for trichomoniasis because of high reinfection rates. 1 This applies even after successful treatment, as the risk of reinfection from untreated partners or new exposures remains substantial.
Clinical Context
The association between trichomonas and other STIs reflects shared risk factors and transmission patterns rather than biological causation. 2 Women with trichomonas demonstrate behavioral and demographic risk factors that increase their likelihood of exposure to multiple sexually transmitted pathogens simultaneously.
Trichomoniasis has been associated with pelvic inflammatory disease and adverse birth outcomes, making comprehensive STI screening even more critical in reproductive-age women. 5, 3
Common Pitfalls to Avoid
Do not assume that treating trichomonas alone is sufficient. The high prevalence of concurrent infections (30%) means that failing to screen will miss a substantial proportion of coinfections that require different antimicrobial therapy. 2
Do not delay screening until symptoms of other STIs develop. Asymptomatic infection is common for gonorrhea, chlamydia, and HIV, and waiting for symptoms will result in missed diagnoses and ongoing transmission. 3
Ensure partner notification and concurrent partner treatment. 3 The high reinfection rate at 3 months reflects inadequate partner management in many cases.