Trichomoniasis in men — common, often undetected
As you review the chart for your next patient, a heterosexual women seeking treatment for a yellow-green vaginal discharge and vulvar irritation, you see her test results are positive for trichomoniasis. When you discuss the test results with the patient, she tells you her partner has had no symptoms of infection.
If this scenario is replayed in your practice, it is no surprise. Results of a new study indicate about three-quarters of the male sexual partners of women with trichomoniasis are infected, but have no symptoms.1
Trichomoniasis, caused by infection from the protozoan T. vaginalis, is a common sexually transmitted disease (STD). A recent study conducted by the Centers for Disease Control and Prevention (CDC) indicates an overall 3% prevalence among U.S. women.2 Transmitted by sexual intercourse, the infection is associated with the presence of other STDs, adverse reproductive outcomes, and HIV infection.2
Most male partners of women with trichomoniasis are coinfected but are asymptomatic, says Arlene Sena, MD, MPH, clinical associate professor in the division of infectious diseases at the University of North Carolina at Chapel Hill and medical director of the Durham (NC) County Health Department. The absence of symptoms may make it more difficult to encourage these sexual partners to come to a clinic for evaluation and treatment, observes Sena, lead author of the latest research paper.
"Other complicating issues are that most clinicians still consider trichomoniasis a minor STD, and there are limited methods for laboratory testing of Trichomonas vaginalis in men," she states.
Test men for infection
To conduct the prospective, multicenter study, researchers enrolled 540 women with trichomoniasis, diagnosed using wet mount microscopy and/or culture, and 261 of their male partners. T. vaginalis infection was detected in about 72% of the men, of which 77.3% were asymptomatic.1
Researchers also found that a vaginal pH of >4.5 in a woman was independently associated with infection in the male partner. Younger male age also was found to be an independent risk factor for concordant trichomoniasis.1
In men, culture testing of urethral swab, urine, and semen is required for optimal sensitivity when testing for trichomoniasis, according to the CDC.3 While there is no polymerase chain reaction (PCR) test approved for T. vaginalis in men in the United States, such testing might be available from commercial laboratories that have developed their own PCR tests, states the CDC.3
While rapid testing currently is not available to test men for trichomoniasis, two point-of-care tests give quick results for tests in women:
- OSOM Trichomonas Rapid Test (Genzyme Diagnostics; Cambridge, MA), an immunochromatographic capillary flow dipstick technology;
- Affirm VP III (Becton, Dickinson & Co.; Franklin Lakes, NJ), a nucleic acid probe test that evaluates for T. vaginalis, G. vaginalis, and C. albicans.
Both tests are performed on vaginal secretions and have a sensitivity of more than 83% and a specificity of more than 97%. Results of the OSOM test are available in about 10 minutes, while results of the Affirm VP III test are available within 45 minutes.3
The OSOM test received a Clinical Laboratory Improvement Act (CLIA) waiver from the Food and Drug Administration in 2005, which has expanded the number of clinics and providers' offices that can use the test, reports Erin Emlock, Genzyme company spokeswoman. The test is easy to run, since it is a one-reagent, dipstick format, and its results are easy to read, she notes. The test has just received a specific Current Procedural Terminology (CPT) code, 87808QW, which should aid in reimbursement, says Emlock.
In a population of women at high risk for STDs and in a research setting with expert microscopists, the OSOM test was more sensitive than wet mount for detecting T. vaginalis. The OSOM test was easier to perform and faster than culture, researchers report.4
Treatment regimens for trichomoniasis include:
- Metronidazole 2 g orally in a single dose; or
- Tinidazole (Tindamax, Mission Pharmacal, San Antonio) 2 g orally in a single dose.3
Be sure that patients understand how to take or use prescribed medications, and that they will return if the problem is not cured or recurs, advise the authors of Contraceptive Technology. Make sure sex partners are treated, and advise on the use of condoms to prevent future infections. Counsel patients to avoid drinking alcohol until 24 hours after completing metronidazole therapy, they add.5
What can clinicians do now? "I think the current best option is through patient education with the infected patient regarding the sexual transmission of trichomoniasis, the complications of untreated infection, and the high likelihood of infection in her male partner(s) even in the absence of symptoms warranting his notification, evaluation, and treatment," states Sena.
References
- Sena AC, Miller WC, Hobbs MM, et al. Trichomonas vaginalis infection in male sexual partners: Implications for diagnosis, treatment, and prevention. Clin Infect Dis 2007; 44:13-22.
- Sutton MY, Sternberg MR, Koumans EH, et al. Prevalence of Trichomonas vaginalis in the United States, 2001-2002. Presented at the 2006 National STD Prevention Conference. Jacksonville, FL; May 2006.
- Centers for Disease Control and Prevention. Sexually transmitted diseases treatment guidelines, 2006. MMWR 2006; 55(RR-11):40.
- Huppert JS, Batteiger BE, Braslins P, et al. Use of an immunochromatographic assay for rapid detection of Trichomonas vaginalis in vaginal specimens. J Clin Microbiol 2005; 43:684-687.
- Hatcher RA, Trussell J, Stewart F, et al. Contraceptive Technology: 19th revised edition. New York City: Ardent Media; in press.
Resource
For more information about Genzyme's OSOM Trichomonas Rapid Test, contact: Tom Krueger, Genzyme Diagnostics. Telephone: (858) 777-2633. Web: www.genzymediagnostics.com.
As you review the chart for your next patient, a heterosexual women seeking treatment for a yellow-green vaginal discharge and vulvar irritation, you see her test results are positive for trichomoniasis. When you discuss the test results with the patient, she tells you her partner has had no symptoms of infection.You have reached your article limit for the month. Subscribe now to access this article plus other member-only content.
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