Impact of Trichomonas vaginalisTranscription-Mediated Amplification-Based Analyte-Specific-Reagent Testing in a Metropolitan Setting of High Sexually Transmitted Disease Prevalence

ABSTRACTTrichomoniasis is a significant sexually transmitted disease (STD) in the spectrum of public health and primary care because of its association with agents such as human immunodeficiency virus and Neisseria gonorrhoeae. However, its true significance may be underestimated due to diagnostic modalities that exhibit poor sensitivity. A total of 1,086 genital specimens from two urban emergency departments, a suburban urgent-care facility, and a metropolitan outpatient physician group were subjected to transcription-mediated amplification-based Trichomonas vaginalisanalyte-specific-reagent (ASR) testing (Gen-Probe, Inc.). The rate of positive molecular ASR results (14.5%) doubled that of direct saline preparation (7.0%; P< 0.0002). Analogous increases were observed at one emergency department and within the outpatient physician group (P< 0.0002). No significant increase in the rate of positive molecular ASR results was observed from the facilities that encountered a lower frequency of black/African American patients. While positive T. vaginalisfindings via direct saline preparation did not have a significant association with concomitant Chlamydia trachomatisor N. gonorrhoeaeinfection overall, a positive T. vaginalisASR result was a better predictor of concomitant C. trachomatisor N. gonorrhoeaeinfection (odds ratios of 2.34 and 4.46, respectively; P< 0.0001). The increased rate of positive T. vaginalisASR results was observed in both point-of-care (P= 0.02 versus direct saline preparation) and laboratory (P= 0.003) testing. Highly sensitive T. vaginalismolecular ASR not only transcends issues of specimen integrity and microscopic acumen but also has an increased ability to predict the likelihood of additional STDs in defined populations.