Screening for Trichomonas vaginalis in High-risk Adolescent Females with a New Transcription-mediated Nucleic Acid Amplification Test (NAAT): Associations with Ethnicity, Symptoms, and Prior and Current STIs

Purpose: The importance of diagnosing trichomoniasis is highlighted by its strong association with HIV acquisition and viral shedding. The low sensitivity of wet preparation and often asymptomatic nature of trichomoniasis results in failure to recognize and treat this sexually transmitted infection. The purpose of this study was to evaluate the feasibility of screening high-risk adolescent females using a new highly sensitive and specific NAAT assay. Methods: We enrolled a consecutive, clinical sample of 144 sexually active females, aged 13 through 21. Subjects completed a questionnaire on sexual history and current vaginal symptoms, and provided two self- or physician-collected vaginal swabs and urine. A wet preparation test was performed with one swab and the APTIMA Trichomonas vaginalis (ATV) assay (Gen-Probe, Inc.) was performed with the other and with urine. Results: Mean age was 18 ± 1.6 years; 55% Hispanic and 35% black. A three-fold higher prevalence of trichomoniasis (6.3%) was detected by ATV than by wet preparation (2.1%) with 100% concordance between vaginal swab and urine. Prevalence of chlamydia by APTIMA was 11%; no gonorrhea was detected. Subjects with trichomoniasis were more likely than those without to be black (P < 0.01), and to report past gonorrhea (P < 0.01) and past PID (P < 0.001). No vaginal symptom distinguished those with trichomoniasis. Conclusion: Three times as many cases of trichomoniasis were identified with ATV compared to wet preparation and identical results were obtained with vaginal swabs and urine. No symptoms were associated with trichomoniasis. These findings highlight the imperative and feasibility of screening and treating at-risk populations.