title: Trichomoniasis: How do we diagnose in a resource poor setting?
abstract: BACKGROUND
  Diagnosis of Trichomonas vaginalis vaginalis infection based solely on clinical symptoms and signs is unreliable because the spectrum of infection is broad and other sexually transmitted pathogens cause similar signs and symptoms.
  
  
  OBJECTIVE
  Our study was undertaken to study the frequency of T. vaginalis infection in women presenting with vaginal discharge, to characterize the clinical features, and to study the sensitivity and specificity of microbiological investigations in the diagnosis of the same.
  
  
  METHODS
  This was a hospital-based descriptive study done on 400 female patients with vaginal discharge attending the Gynecology out-patient department (OPD) of JIPMER, Puducherry, from May 2010 to July 2011. Women of age between 20 years and 50 years presenting with vaginal discharge irrespective of marital status, were included, and detailed history was elicited and thorough examination was performed.
  
  
  RESULTS
  In 400 women presenting with vaginal discharge from Gynecology out-patient department (OPD) included in the study, T. vaginalis infection was found in 27 (6.75%) women. The risk factors for trichomoniasis included history of pre- or extramarital sexual contact in the woman or her partner, symptomatic partner, and alcohol consumption. A positive association with pelvic inflammatory disease was also observed. The most frequent symptoms included lower abdominal pain, dysuria, and dyspareunia. Combining of Whiff test, pH > 4.5, and pus cells in Gram-stained smear, the specificity in diagnosing the infection (97.3%) approached that of the reference standard, i.e., culture. On combining wet mount with Papanicolaou smear, the sensitivity increased to 92.6%, which was higher than that individually done.
  
  
  CONCLUSIONS
  To conclude, diagnosis of T. vaginalis infection based solely on clinical symptoms and signs is unreliable, and combination of simple laboratory tests increases the diagnostic performance close to the reference standard (culture), especially in resource poor settings.
authors.affiliation: Department of Dermatology, Sexually Transmitted Diseases and Leprosy, Jawaharlal Institute of Postgraduate Medical Education and Research, Puducherry, India.
authors.forename: R
authors.initials: R
authors.lastname: Sivaranjini
authors.forename: T J
authors.initials: TJ
authors.lastname: Jaisankar
authors.forename: Devinder Mohan
authors.initials: DM
authors.lastname: Thappa
authors.forename: Rashmi
authors.initials: R
authors.lastname: Kumari
authors.forename: Laxmisha
authors.initials: L
authors.lastname: Chandrasekhar
authors.forename: M
authors.initials: M
authors.lastname: Malathi
authors.forename: Subhash Chandra
authors.initials: SC
authors.lastname: Parija
authors.forename: Syed
authors.initials: S
authors.lastname: Habeebullah
keywords: Culture; Papanicolaou smear; Trichomonas vaginalis; vaginal discharge; wet mount
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