Skip to main content
NCBI home page
Infectious Diseases in Obstetrics and Gynecology logoLink to Infectious Diseases in Obstetrics and Gynecology
. 2000;8(5-6):248–257. doi: 10.1155/S1064744900000375

Systematic review of diagnostic tests for vaginal trichomoniasis.

S R Patel 1, W Wiese 1, S C Patel 1, C Ohl 1, J C Byrd 1, C A Estrada 1
PMCID: PMC1784697  PMID: 11220487

Abstract

OBJECTIVE: To review critically and to summarize the evidence of diagnostic tests and culture media for the diagnosis of Trichomonas vaginitis. METHODS: We performed a systematic review of literature indexed in MEDLINE of studies that used Trichomonas culture as the reference standard (9,882 patients, 35 studies). Level I studies (5,047 patients, 13 studies) fulfilled at least two of three criteria: 1) consecutive patients were evaluated prospectively, 2) decision to culture was not influenced by test results, and 3) there was independent and blind comparison to culture. RESULTS: The sensitivity of the polymerase chain reaction technique (PCR) was 95% (95% CI 91% to 99%), and the specificity was 98% (95% CI 96% to 100%). One study was classified as Level I evidence (52 patients). The sensitivity of the enzyme-linked immunosorbent assay was 82% (95% CI 74% to 90%), and the specificity was 73% (95% CI 35% to 100%). The sensitivity of the direct fluorescence antibody was 85% (95% CI 79% to 90%), and the specificity was 99% (95% CI 98% to 100%). Sensitivities of culture media were 95% for Diamond's, 96% for Hollander, and 95% for CPLM. CONCLUSIONS: The sensitivity and specificity of tests to diagnose trichomoniasis vary widely.

Full Text

The Full Text of this article is available as a PDF (1.4 MB).

Selected References

These references are in PubMed. This may not be the complete list of references from this article.

  1. Beal C., Goldsmith R., Kotby M., Sherif M., el-Tagi A., Farid A., Zakaria S., Eapen J. The plastic envelope method, a simplified technique for culture diagnosis of trichomoniasis. J Clin Microbiol. 1992 Sep;30(9):2265–2268. doi: 10.1128/jcm.30.9.2265-2268.1992. [DOI] [PMC free article] [PubMed] [Google Scholar]
  2. Bickley L. S., Krisher K. K., Punsalang A., Jr, Trupei M. A., Reichman R. C., Menegus M. A. Comparison of direct fluorescent antibody, acridine orange, wet mount, and culture for detection of Trichomonas vaginalis in women attending a public sexually transmitted diseases clinic. Sex Transm Dis. 1989 Jul-Sep;16(3):127–131. doi: 10.1097/00007435-198907000-00002. [DOI] [PubMed] [Google Scholar]
  3. Boeke A. J., Dekker J. H., Peerbooms P. G. A comparison of yield from cervix versus vagina for culturing Candida albicans and Trichomonas vaginalis. Genitourin Med. 1993 Feb;69(1):41–43. doi: 10.1136/sti.69.1.41. [DOI] [PMC free article] [PubMed] [Google Scholar]
  4. Briselden A. M., Hillier S. L. Evaluation of affirm VP Microbial Identification Test for Gardnerella vaginalis and Trichomonas vaginalis. J Clin Microbiol. 1994 Jan;32(1):148–152. doi: 10.1128/jcm.32.1.148-152.1994. [DOI] [PMC free article] [PubMed] [Google Scholar]
  5. Bózner P., Gombosová A., Valent M., Demes P., Alderete J. F. Proteinases of Trichomonas vaginalis: antibody response in patients with urogenital trichomoniasis. Parasitology. 1992 Dec;105(Pt 3):387–391. doi: 10.1017/s0031182000074552. [DOI] [PubMed] [Google Scholar]
  6. Carney J. A., Unadkat P., Yule A., Rajakumar R., Lacey C. J., Ackers J. P. New rapid latex agglutination test for diagnosing Trichomonas vaginalis infection. J Clin Pathol. 1988 Jul;41(7):806–808. doi: 10.1136/jcp.41.7.806. [DOI] [PMC free article] [PubMed] [Google Scholar]
  7. Carr P. L., Felsenstein D., Friedman R. H. Evaluation and management of vaginitis. J Gen Intern Med. 1998 May;13(5):335–346. doi: 10.1046/j.1525-1497.1998.00101.x. [DOI] [PMC free article] [PubMed] [Google Scholar]
  8. DeMeo L. R., Draper D. L., McGregor J. A., Moore D. F., Peter C. R., Kapernick P. S., McCormack W. M. Evaluation of a deoxyribonucleic acid probe for the detection of Trichomonas vaginalis in vaginal secretions. Am J Obstet Gynecol. 1996 Apr;174(4):1339–1342. doi: 10.1016/s0002-9378(96)70682-8. [DOI] [PubMed] [Google Scholar]
  9. Draper D., Parker R., Patterson E., Jones W., Beutz M., French J., Borchardt K., McGregor J. Detection of Trichomonas vaginalis in pregnant women with the InPouch TV culture system. J Clin Microbiol. 1993 Apr;31(4):1016–1018. doi: 10.1128/jcm.31.4.1016-1018.1993. [DOI] [PMC free article] [PubMed] [Google Scholar]
  10. Garber G. E., Sibau L., Ma R., Proctor E. M., Shaw C. E., Bowie W. R. Cell culture compared with broth for detection of Trichomonas vaginalis. J Clin Microbiol. 1987 Jul;25(7):1275–1279. doi: 10.1128/jcm.25.7.1275-1279.1987. [DOI] [PMC free article] [PubMed] [Google Scholar]
  11. Gaydos C. A., Howell M. R., Pare B., Clark K. L., Ellis D. A., Hendrix R. M., Gaydos J. C., McKee K. T., Jr, Quinn T. C. Chlamydia trachomatis infections in female military recruits. N Engl J Med. 1998 Sep 10;339(11):739–744. doi: 10.1056/NEJM199809103391105. [DOI] [PubMed] [Google Scholar]
  12. Gelbart S. M., Thomason J. L., Osypowski P. J., James J. A., Hamilton P. R. Comparison of Diamond's medium modified and Kupferberg medium for detection of Trichomonas vaginalis. J Clin Microbiol. 1989 May;27(5):1095–1096. doi: 10.1128/jcm.27.5.1095-1096.1989. [DOI] [PMC free article] [PubMed] [Google Scholar]
  13. Gerbase A. C., Rowley J. T., Mertens T. E. Global epidemiology of sexually transmitted diseases. Lancet. 1998;351 (Suppl 3):2–4. doi: 10.1016/s0140-6736(98)90001-0. [DOI] [PubMed] [Google Scholar]
  14. Gombosová A., Valent M. Dot-immunobinding assay with monoclonal antibody for detection of Trichomonas vaginalis in clinical specimens. Genitourin Med. 1990 Dec;66(6):447–450. doi: 10.1136/sti.66.6.447. [DOI] [PMC free article] [PubMed] [Google Scholar]
  15. Gram I. T., Macaluso M., Churchill J., Stalsberg H. Trichomonas vaginalis (TV) and human papillomavirus (HPV) infection and the incidence of cervical intraepithelial neoplasia (CIN) grade III. Cancer Causes Control. 1992 May;3(3):231–236. doi: 10.1007/BF00124256. [DOI] [PubMed] [Google Scholar]
  16. Hasselblad V., Hedges L. V. Meta-analysis of screening and diagnostic tests. Psychol Bull. 1995 Jan;117(1):167–178. doi: 10.1037/0033-2909.117.1.167. [DOI] [PubMed] [Google Scholar]
  17. Haynes R. B., Wilczynski N., McKibbon K. A., Walker C. J., Sinclair J. C. Developing optimal search strategies for detecting clinically sound studies in MEDLINE. J Am Med Inform Assoc. 1994 Nov-Dec;1(6):447–458. doi: 10.1136/jamia.1994.95153434. [DOI] [PMC free article] [PubMed] [Google Scholar]
  18. Heine R. P., Wiesenfeld H. C., Sweet R. L., Witkin S. S. Polymerase chain reaction analysis of distal vaginal specimens: a less invasive strategy for detection of Trichomonas vaginalis. Clin Infect Dis. 1997 May;24(5):985–987. doi: 10.1093/clinids/24.5.985. [DOI] [PubMed] [Google Scholar]
  19. Imandel K., Aflatoni M., Behjatnia Y. Clinical manifestations of female trichomoniasis and comparison of direct microscopy and culture media in its diagnosis. Bull Soc Pathol Exot Filiales. 1985;78(3):360–367. [PubMed] [Google Scholar]
  20. Irwig L., Tosteson A. N., Gatsonis C., Lau J., Colditz G., Chalmers T. C., Mosteller F. Guidelines for meta-analyses evaluating diagnostic tests. Ann Intern Med. 1994 Apr 15;120(8):667–676. doi: 10.7326/0003-4819-120-8-199404150-00008. [DOI] [PubMed] [Google Scholar]
  21. Jaeschke R., Guyatt G., Sackett D. L. Users' guides to the medical literature. III. How to use an article about a diagnostic test. A. Are the results of the study valid? Evidence-Based Medicine Working Group. JAMA. 1994 Feb 2;271(5):389–391. doi: 10.1001/jama.271.5.389. [DOI] [PubMed] [Google Scholar]
  22. Kahn J. O., Walker B. D. Acute human immunodeficiency virus type 1 infection. N Engl J Med. 1998 Jul 2;339(1):33–39. doi: 10.1056/NEJM199807023390107. [DOI] [PubMed] [Google Scholar]
  23. Kardaun J. W., Kardaun O. J. Comparative diagnostic performance of three radiological procedures for the detection of lumbar disk herniation. Methods Inf Med. 1990 Jan;29(1):12–22. [PubMed] [Google Scholar]
  24. Krieger J. N., Tam M. R., Stevens C. E., Nielsen I. O., Hale J., Kiviat N. B., Holmes K. K. Diagnosis of trichomoniasis. Comparison of conventional wet-mount examination with cytologic studies, cultures, and monoclonal antibody staining of direct specimens. JAMA. 1988 Feb 26;259(8):1223–1227. doi: 10.1001/jama.259.8.1223. [DOI] [PubMed] [Google Scholar]
  25. La Vecchia C. The epidemiology of cervical neoplasia. Biomed Pharmacother. 1985;39(8):426–433. [PubMed] [Google Scholar]
  26. Laga M., Manoka A., Kivuvu M., Malele B., Tuliza M., Nzila N., Goeman J., Behets F., Batter V., Alary M. Non-ulcerative sexually transmitted diseases as risk factors for HIV-1 transmission in women: results from a cohort study. AIDS. 1993 Jan;7(1):95–102. doi: 10.1097/00002030-199301000-00015. [DOI] [PubMed] [Google Scholar]
  27. Laird N. M., Mosteller F. Some statistical methods for combining experimental results. Int J Technol Assess Health Care. 1990;6(1):5–30. doi: 10.1017/s0266462300008916. [DOI] [PubMed] [Google Scholar]
  28. Levi M. H., Torres J., Piña C., Klein R. S. Comparison of the InPouch TV culture system and Diamond's modified medium for detection of Trichomonas vaginalis. J Clin Microbiol. 1997 Dec;35(12):3308–3310. doi: 10.1128/jcm.35.12.3308-3310.1997. [DOI] [PMC free article] [PubMed] [Google Scholar]
  29. Lin P. R., Shaio M. F., Liu J. Y. One-tube, nested-PCR assay for the detection of Trichomonas vaginalis in vaginal discharges. Ann Trop Med Parasitol. 1997 Jan;91(1):61–65. doi: 10.1080/00034983.1997.11813112. [DOI] [PubMed] [Google Scholar]
  30. Lisi P. J., Dondero R. S., Kwiatkoski D., Spence M. R., Rein M. F., Alderete J. F. Monoclonal-antibody-based enzyme-linked immunosorbent assay for Trichomonas vaginalis. J Clin Microbiol. 1988 Sep;26(9):1684–1686. doi: 10.1128/jcm.26.9.1684-1686.1988. [DOI] [PMC free article] [PubMed] [Google Scholar]
  31. Madico G., Quinn T. C., Rompalo A., McKee K. T., Jr, Gaydos C. A. Diagnosis of Trichomonas vaginalis infection by PCR using vaginal swab samples. J Clin Microbiol. 1998 Nov;36(11):3205–3210. doi: 10.1128/jcm.36.11.3205-3210.1998. [DOI] [PMC free article] [PubMed] [Google Scholar]
  32. Mason P. R. Serodiagnosis of Trichomonas vaginalis infection by the indirect fluorescent antibody test. J Clin Pathol. 1979 Dec;32(12):1211–1215. doi: 10.1136/jcp.32.12.1211. [DOI] [PMC free article] [PubMed] [Google Scholar]
  33. McGregor J. A., French J. I., Parker R., Draper D., Patterson E., Jones W., Thorsgard K., McFee J. Prevention of premature birth by screening and treatment for common genital tract infections: results of a prospective controlled evaluation. Am J Obstet Gynecol. 1995 Jul;173(1):157–167. doi: 10.1016/0002-9378(95)90184-1. [DOI] [PubMed] [Google Scholar]
  34. McKibbon K. A., Walker-Dilks C. J. Beyond ACP Journal Club: how to harness MEDLINE for diagnostic problems. ACP J Club. 1994 Sep-Oct;121 (Suppl 2):A10–A12. [PubMed] [Google Scholar]
  35. Midgette A. S., Stukel T. A., Littenberg B. A meta-analytic method for summarizing diagnostic test performances: receiver-operating-characteristic-summary point estimates. Med Decis Making. 1993 Jul-Sep;13(3):253–257. doi: 10.1177/0272989X9301300313. [DOI] [PubMed] [Google Scholar]
  36. Moses L. E., Shapiro D., Littenberg B. Combining independent studies of a diagnostic test into a summary ROC curve: data-analytic approaches and some additional considerations. Stat Med. 1993 Jul 30;12(14):1293–1316. doi: 10.1002/sim.4780121403. [DOI] [PubMed] [Google Scholar]
  37. Mosteller F., Colditz G. A. Understanding research synthesis (meta-analysis). Annu Rev Public Health. 1996;17:1–23. doi: 10.1146/annurev.pu.17.050196.000245. [DOI] [PubMed] [Google Scholar]
  38. Ohlemeyer C. L., Hornberger L. L., Lynch D. A., Swierkosz E. M. Diagnosis of Trichomonas vaginalis in adolescent females: InPouch TV culture versus wet-mount microscopy. J Adolesc Health. 1998 Mar;22(3):205–208. doi: 10.1016/s1054-139x(97)00214-0. [DOI] [PubMed] [Google Scholar]
  39. Petrin D., Delgaty K., Bhatt R., Garber G. Clinical and microbiological aspects of Trichomonas vaginalis. Clin Microbiol Rev. 1998 Apr;11(2):300–317. doi: 10.1128/cmr.11.2.300. [DOI] [PMC free article] [PubMed] [Google Scholar]
  40. Philip A., Carter-Scott P., Rogers C. An agar culture technique to quantitate Trichomonas vaginalis from women. J Infect Dis. 1987 Feb;155(2):304–308. doi: 10.1093/infdis/155.2.304. [DOI] [PubMed] [Google Scholar]
  41. Reid M. C., Lachs M. S., Feinstein A. R. Use of methodological standards in diagnostic test research. Getting better but still not good. JAMA. 1995 Aug 23;274(8):645–651. [PubMed] [Google Scholar]
  42. Romia S. A., Othman T. A. Detection of antitrichomonal antibodies in sera and cervical secretions in trichomoniasis. J Egypt Soc Parasitol. 1991 Aug;21(2):373–381. [PubMed] [Google Scholar]
  43. Schmid G. P., Matheny L. C., Zaidi A. A., Kraus S. J. Evaluation of six media for the growth of Trichomonas vaginalis from vaginal secretions. J Clin Microbiol. 1989 Jun;27(6):1230–1233. doi: 10.1128/jcm.27.6.1230-1233.1989. [DOI] [PMC free article] [PubMed] [Google Scholar]
  44. Schwebke J. R., Morgan S. C., Pinson G. B. Validity of self-obtained vaginal specimens for diagnosis of trichomoniasis. J Clin Microbiol. 1997 Jun;35(6):1618–1619. doi: 10.1128/jcm.35.6.1618-1619.1997. [DOI] [PMC free article] [PubMed] [Google Scholar]
  45. Shaio M. F., Lin P. R., Liu J. Y. Colorimetric one-tube nested PCR for detection of Trichomonas vaginalis in vaginal discharge. J Clin Microbiol. 1997 Jan;35(1):132–138. doi: 10.1128/jcm.35.1.132-138.1997. [DOI] [PMC free article] [PubMed] [Google Scholar]
  46. Sharma P., Malla N., Gupta I., Ganguly N. K., Mahajan R. C. A comparison of wet mount, culture and enzyme linked immunosorbent assay for the diagnosis of trichomoniasis in women. Trop Geogr Med. 1991 Jul;43(3):257–260. [PubMed] [Google Scholar]
  47. Smith R. F. Detection of Trichomonas vaginalis in vaginal specimens by direct immunofluorescence assay. J Clin Microbiol. 1986 Dec;24(6):1107–1108. doi: 10.1128/jcm.24.6.1107-1108.1986. [DOI] [PMC free article] [PubMed] [Google Scholar]
  48. Sobel J. D. Vaginitis. N Engl J Med. 1997 Dec 25;337(26):1896–1903. doi: 10.1056/NEJM199712253372607. [DOI] [PubMed] [Google Scholar]
  49. Spence M. R., Hollander D. H., Smith J., McCaig L., Sewell D., Brockman M. The clinical and laboratory diagnosis of Trichomonas vaginalis infection. Sex Transm Dis. 1980 Oct-Dec;7(4):168–171. doi: 10.1097/00007435-198010000-00004. [DOI] [PubMed] [Google Scholar]
  50. Su K. E. Antibody to Trichomonas vaginalis in human cervicovaginal secretions. Infect Immun. 1982 Sep;37(3):852–857. doi: 10.1128/iai.37.3.852-857.1982. [DOI] [PMC free article] [PubMed] [Google Scholar]
  51. Tabrizi S. N., Paterson B., Fairley C. K., Bowden F. J., Garland S. M. A self-administered technique for the detection of sexually transmitted diseases in remote communities. J Infect Dis. 1997 Jul;176(1):289–292. doi: 10.1086/517269. [DOI] [PubMed] [Google Scholar]
  52. Thomason J. L., Gelbart S. M., Sobun J. F., Schulien M. B., Hamilton P. R. Comparison of four methods to detect Trichomonas vaginalis. J Clin Microbiol. 1988 Sep;26(9):1869–1870. doi: 10.1128/jcm.26.9.1869-1870.1988. [DOI] [PMC free article] [PubMed] [Google Scholar]
  53. Watt R. M., Philip A., Wos S. M., Sam G. J. Rapid assay for immunological detection of Trichomonas vaginalis. J Clin Microbiol. 1986 Oct;24(4):551–555. doi: 10.1128/jcm.24.4.551-555.1986. [DOI] [PMC free article] [PubMed] [Google Scholar]
  54. Weinberger M. W., Harger J. H. Accuracy of the Papanicolaou smear in the diagnosis of asymptomatic infection with Trichomonas vaginalis. Obstet Gynecol. 1993 Sep;82(3):425–429. [PubMed] [Google Scholar]
  55. Wiese W., Patel S. R., Patel S. C., Ohl C. A., Estrada C. A. A meta-analysis of the Papanicolaou smear and wet mount for the diagnosis of vaginal trichomoniasis. Am J Med. 2000 Mar;108(4):301–308. doi: 10.1016/s0002-9343(99)00466-0. [DOI] [PubMed] [Google Scholar]
  56. Yule A., Gellan M. C., Oriel J. D., Ackers J. P. Detection of Trichomonas vaginalis antigen in women by enzyme immunoassay. J Clin Pathol. 1987 May;40(5):566–568. doi: 10.1136/jcp.40.5.566. [DOI] [PMC free article] [PubMed] [Google Scholar]
  57. de Carli G. A., Bertschinger B., Saraiva P. J., Miron C. F. Laboratory diagnosis of Trichomonas vaginalis among women attending a venereal diseases control division. First report. Rev Latinoam Microbiol. 1987 Jul-Sep;29(3):301–303. [PubMed] [Google Scholar]

Articles from Infectious Diseases in Obstetrics and Gynecology are provided here courtesy of Wiley

RESOURCES