Pediatric Trichomoniasis Workup

  • Author: Robert W Tolan Jr, MD; Chief Editor: Russell W Steele, MD   more...
 
Updated: Jan 10, 2012
 

Laboratory Studies

Obtain laboratory tests in patients who present with symptoms suggestive of vaginitis. Tests for trichomoniasis are quick and can be performed in the medical office.[5] Self-testing has also been proposed.[6] The basic evaluation includes tests to exclude other possible causes of the patient's complaints.

Vaginal pH

Determine vaginal pH by touching a swab containing vaginal secretions to pH paper with a range of 3.5-5.5.

A normal pH practically excludes the diagnosis of trichomoniasis. A pH of greater than 4.5 is found with trichomoniasis and bacterial vaginosis.[7]

Whiff test

This tests for the presence of amines by adding potassium hydroxide to a sample of vaginal discharge and checking for a fishy odor. Whiff test is useful for excluding bacterial vaginitis.

Vaginal pH and whiff test now are combined on 1 card, the FemExam pH and Amines TestCard. It replaces the pH paper color change and odor test with plus or minus signs.

Wet mount

Saline microscopy of vaginal secretions smeared on glass slides allows the identification of the flagellated, jerky, motile, teardrop-shaped protozoan. Wet mount also allows the identification of clue cells. The ratio of white cells to epithelial cells can also be noted.

Wet mount has been demonstrated to have a sensitivity of 40-60%. Specificity approaches 100% if the wet mount smear is examined immediately.

Pap smear

Sensitivity for detecting trichomonads is similar to that of wet mount, which is 40-60%.

Specificity approaches 95-99% in trained technicians.

Cultures

Perform T vaginalis cultures in individuals in whom suspicion of trichomoniasis is high but in whom the saline wet mount does not reveal the protozoan. Cultures have also been demonstrated to be useful in individuals with suspected resistant trichomoniasis. Physicians can determine whether trichomonads are the cause of the vaginitis and can obtain the susceptibility of the strain.

In the study conducted by Wolner-Hanssen et al, 35.6% of episodes of trichomoniasis were detected by culture and not by wet mount or Pap smear.[3]

However, most physicians do not routinely perform vaginal secretion cultures. Currently, the InPouch TV culture system is a readily available method.

Direct immunofluorescence assay

Direct fluorescent antibody staining is found to be more sensitive than wet mount; however, this study is less sensitive than culture.

This study allows rapid diagnosis but requires a trained microscopist and a fluorescent microscope.

Rapid antigen testing is more sensitive and specific than wet mount and equivalent to culture.[8]

Transcription-mediated amplification testing is the optimal testing modality in resource-rich circumstances.

Polymerase chain reaction (PCR)

PCR is presently being studied and may be available soon for widespread use for the detection of T vaginalis via urine examination.[9, 10] Similarly, a transcription-mediated amplification assay is being validated.[11]

Evaluation for other STDs

Always perform testing for syphilis, Neisseria gonorrhoeae, Chlamydia trachomatis, HIV, hepatitis B, and hepatitis C.

A high rate of co-infection with N gonorrhoeae is observed.

Proceed to Treatment & Management
 
 
Contributor Information and Disclosures
Author

Robert W Tolan Jr, MD  Chief, Division of Allergy, Immunology and Infectious Diseases, The Children's Hospital at Saint Peter's University Hospital; Clinical Associate Professor of Pediatrics, Drexel University College of Medicine

Robert W Tolan Jr, MD is a member of the following medical societies: American Academy of Pediatrics, American Medical Association, American Society for Microbiology, American Society of Tropical Medicine and Hygiene, Infectious Diseases Society of America, Pediatric Infectious Diseases Society, Phi Beta Kappa, and Physicians for Social Responsibility

Disclosure: Novartis Honoraria Speaking and teaching

Specialty Editor Board

Ashir Kumar, MD, MBBS, FAAP  Professor Emeritus, Department of Pediatrics and Human Development, Michigan State University College of Human Medicine

Ashir Kumar, MD, MBBS, FAAP is a member of the following medical societies: American Association of Physicians of Indian Origin and Infectious Diseases Society of America

Disclosure: Nothing to disclose.

Mary L Windle, PharmD  Adjunct Associate Professor, University of Nebraska Medical Center College of Pharmacy; Editor-in-Chief, Medscape Drug Reference

Disclosure: Nothing to disclose.

Martin Weisse, MD  Program Director, Associate Professor, Department of Pediatrics, West Virginia University

Martin Weisse, MD is a member of the following medical societies: Ambulatory Pediatric Association, American Academy of Pediatrics, and Pediatric Infectious Diseases Society

Disclosure: Nothing to disclose.

Daniel Rauch, MD, FAAP  Director, Pediatric Hospitalist Program, Associate Professor, Department of Pediatrics, New York University School of Medicine

Daniel Rauch, MD, FAAP is a member of the following medical societies: Ambulatory Pediatric Association, American Academy of Pediatrics, and Society of Hospital Medicine

Disclosure: Baxter Honoraria Consulting

Chief Editor

Russell W Steele, MD  Head, Division of Pediatric Infectious Diseases, Ochsner Children's Health Center; Clinical Professor, Department of Pediatrics, Tulane University School of Medicine

Russell W Steele, MD is a member of the following medical societies: American Academy of Pediatrics, American Association of Immunologists, American Pediatric Society, American Society for Microbiology, Infectious Diseases Society of America, Louisiana State Medical Society, Pediatric Infectious Diseases Society, Society for Pediatric Research, and Southern Medical Association

Disclosure: Nothing to disclose.

Additional Contributors

The authors and editors of Medscape Reference gratefully acknowledge the contributions of previous authors Renee Wilson, MD and Binita R Shah, MD, FAAP to the development and writing of this article.

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