Infection by the protozoan Trichomonas vaginalis is the most common nonviral sexually transmitted infection (STI), with an estimated 6.8 million cases in the United States annually.1
“In the United States, between 8% and 27% of females and 4% to 10% of males are infected,” says Jeffrey Jenks, MD, MPH, lead author of a study on this topic and an adjunct associate professor of medicine in the division of infectious diseases at Duke University in Durham, NC. “It’s super prevalent, but it’s not a reportable disease in North Carolina. We’re testing less than we should, which is part of the problem.”
As a result, trichomoniasis goes undiagnosed because most infected people (up to three out of four) do not experience symptoms, Jenks says. Left undiagnosed and untreated, trichomoniasis can increase the risk of pelvic inflammatory disease, infertility, and acquiring HIV and other STIs.
There also is evidence that untreated trichomoniasis in pregnancy is associated with premature rupture of membranes and low birth weight infants.1 “It can cause some of the same harmful effects as chlamydia and gonorrhea,” Jenks adds.
The Centers for Disease Control and Prevention (CDC) guidelines recommend diagnostic testing for T. vaginalis for women seeking care for vaginal discharge. The CDC also recommends clinicians consider annual screening for patients receiving care in high-prevalence settings, such as STI clinics and correctional facilities.2 “There are no recommendations to screen during pregnancy,” Jenks notes.
Jenks and colleagues studied trichomoniasis and retesting in Durham County, NC. Providers obtained samples for testing during a pelvic exam. Diagnosis of trichomoniasis was made based on the presence of motile trichomonads on wet mount or a positive transcription-mediated amplification test for T. vaginalis.1
Since the study was completed, the Food and Drug Administration approved the use of Hologic’s Aptima Trichomonas vaginalis assay for use with patient-collected vaginal swabs in a clinical setting as well as for female and male urine samples.3
Collecting urine for screening might be more convenient for some patients, and it may be easier for clinicians to recommend testing to pregnant women and others who are asymptomatic. The cost would be an issue, but collecting a sample of urine for screening is something patients typically expect at primary care visits and sexual and reproductive care visits.
“We’re starting to do more screening here at Durham County Public Health, where I’m medical director, but there’s not a lot of data out there,” Jenks says. “My impression is when it comes to public health, it all has to do with the funding that’s out there to do testing for these pathogens. There’s not [enough] evidence to support routine screening to prevent these negative sequelae.”
Recently, the Durham County Department of Public Health began to screen asymptomatic women for trichomoniasis. “We’ll collect the data and see how many infections we’re picking up in asymptomatic women and the cost of testing them,” Jenks says. “We need more data and more public health funding.”
Plans are to expand asymptomatic testing to maternal health and family planning clinics. “We’d like to do screening for everyone who comes here for other screening,” Jenks says.
Since the STI is not completely harmless but is not well known among patients, it is useful to provide brochures and posters in exam rooms that discuss trichomoniasis and other common STIs. Providers can refer patients to the CDC’s website and mention trichomoniasis when discussing other STIs.
“We’re seeing an increase in STIs — gonorrhea, syphilis, chlamydia, and congenital syphilis, which has increased by 1,000% from 2012 to 2022,” Jenks explains.
Retesting after treatment is recommended for people who are diagnosed with trichomoniasis, but it is not always performed. Jenks and colleagues found that of 193 females treated for trichomoniasis between March 1, 2021, and May 31, 2022, 32% had retesting performed within the recommended three months, and half were retested within a year after treatment. Of the female patients who returned for retesting, 10% were positive on repeat testing.1
“A lot of patients won’t show up because they’re feeling well,” Jenks says. “We’ve been more intentional about retesting in the clinic when they come in for other reasons.”
Retesting catches both ongoing and new infections. Clinicians confronted with patients who test positive after retesting can address testing and treating the patients’ sexual partners.
“Clinicians should be intentional about scheduling everyone who tests positive for trichomoniasis with a follow-up appointment within a few months,” Jenks says. “Try to develop strategies to increase the chance that those who test positive will come back and be retested.”
REFERENCES
- Jenks JD, Ryan E, Stancil C, et al. Trichomoniasis and retesting in Durham County, North Carolina, United States, 2021-2022. Int J STD AIDS 2024;15:9564624241227469.
- Centers for Disease Control and Prevention. Trichomoniasis. Page last reviewed Sept. 21, 2022. https://www.cdc.gov/std/treatm...
- Hologic. Expanded sample collection methods offer greater flexibility and access to reliable trichomoniasis testing. 2024. https://www.hologic.com/about/...
Infection by the protozoan Trichomonas vaginalis is the most common nonviral sexually transmitted infection, with an estimated 6.8 million cases in the United States annually. It can go undiagnosed because most infected people (up to three out of four) do not experience symptoms. Left undiagnosed and untreated, trichomoniasis can increase the risk of pelvic inflammatory disease, infertility, and acquiring HIV and other STIs.
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