title: Trichomonas vaginalis: underdiagnosis in urban Australia could facilitate re-emergence.
abstract: OBJECTIVE
  Trichomonas vaginalis (TV) has a low profile in urban sexually transmitted infection (STI) clinics in many developed countries. The objective of this study was to determine the true prevalence of TV in an Australian urban sexual health setting using sensitive molecular diagnostic techniques.
  
  
  METHODS
  A cross-sectional study investigating the aetiology of cervicitis in women attending two urban sexual health clinics in Sydney, Australia, enrolled 356 consecutive eligible women from 2006 to 2008. The diagnostic yield from the standard clinical practice of discretionary high vaginal wet preparation microscopy in women with suspicious vaginal discharge was compared with universal use of nested PCR for TV of cervical samples.
  
  
  RESULTS
  TV was detected by PCR in 17/356 women (4.8%, 95% CI 2.8 to 7.5%), whereas only four cases (1.1%, 95% CI 0.3 to 2.8%) were detected by discretionary wet preparation microscopy. Eleven of the 17 women (p=0.003) were of culturally and linguistically diverse background. Additionally, cervicitis was found to be significantly associated with TV, RR 1.66 (1.14 to 2.42), p=0.034.
  
  
  CONCLUSIONS
  Traditional TV-detection methods underestimate TV prevalence in urban Australia. The TV prevalence of 4.8% by PCR testing in this study exceeds previously reported urban Australian TV rates of <1%. An increase in trichomoniasis-associated adverse reproductive outcomes and enhanced HIV transmission poses a salient public health threat. Accordingly, TV warrants a higher profile in urban STI clinic settings in developed countries, and we suggest that priority be given to development of standardised molecular TV detection techniques and that these become part of routine STI testing.
authors.affiliation: Short Street Clinic, St George Hospital, Kogarah, New South Wales, Australia. luskjo@bigpond.com
authors.forename: M Josephine
authors.initials: MJ
authors.lastname: Lusk
authors.forename: Zin
authors.initials: Z
authors.lastname: Naing
authors.forename: Ben
authors.initials: B
authors.lastname: Rayner
authors.forename: Nikolas
authors.initials: N
authors.lastname: Rismanto
authors.forename: Christopher J
authors.initials: CJ
authors.lastname: McIver
authors.forename: Robert G
authors.initials: RG
authors.lastname: Cumming
authors.forename: Kevin
authors.initials: K
authors.lastname: McGeechan
authors.forename: William D
authors.initials: WD
authors.lastname: Rawlinson
authors.forename: Pam
authors.initials: P
authors.lastname: Konecny
mesh_terms: D000328:Adult; D021821:Communicable Diseases, Emerging / Q000175:diagnosis* / Q000453:epidemiology; D017280:Condoms / Q000706:statistics & numerical data; D003430:Cross-Sectional Studies; D003951:Diagnostic Errors; D005260:Female; D006801:Humans; D009517:New South Wales / Q000453:epidemiology; D016133:Polymerase Chain Reaction; D015995:Prevalence; D011446:Prospective Studies; D012747:Sexual Partners; D014247:Trichomonas Vaginitis / Q000175:diagnosis* / Q000453:epidemiology; D014246:Trichomonas vaginalis; D014504:Urban Health