Diagnostic Tests



Females


There are several steps involved in the diagnosis of trichonomiasis. After taking a history of a patient, a clinician can elminate non-sexually transmitted diseases with similar presentation. Physical examination and laboratory tests are required however, in order to distinguish Trichomoniasis from bacterial vaginosis.


Physical Examination: The vulva of the patient is examined for erythema, excoriation, and lesions. If grouped vesicles or ulcerations are present, the patient probably has herpes simplex infection. After a speculum is inserted, the physician assesses the erythema of the vaginal walls. Bacterial vaginosis causes at most, minimal inflammation, while trichomoniasis results in red blotches on the vaginal wall or cervix. It may also reveal a distinctive, inflamed "strawberry cervix." At this time, the vaginal discharge is examined. A finely granular appearance is normal whereas a homogeneous, creamy discharge or a discharge containing bubbles is considered abnormal. A sample of discharge for a wet mount is then collected by sweeping a cotton swab through the vaginal fornices. Material within the cervix can then be removed using swabs inserted into the cervix. Profuse or greenish-yellow discharge is indicative of Trichomoniasis.
Determination of pH: The pH of vaginal secretions can also provide useful information. Normal pH is 4.5 or less while pH above 4.5 may be a sign of infection. Studies have found that 66% to 91% of patients with trichomoniasis had pH levels above 4.5. This test is not conclusive however, because 905 of women infected with bacterial vaginosis also exhibit elevated pH levels.


Whiff Test:
Usiing material collected from the lower lip of the speculum, more conclusions can be made. A sample with a pungent, amine-like, “fishy” odor is considered a positive result. Over 50% of patients with trichomoniasis have a positive Whiff test.
Wet Mount: This method of diagnosis is the most preferred by physicians. Vaginal discharge from the physical test is used to make a wet mount and is then examined under a light microscope. Infected patients usually have squamous vaginal epithelial cells with sharply-defined boarders, easily discernable nuclei, and a relatively clean appearance. Diagnosis, however, is best confirmed by actually observing the parasite. Rapidly moving Trichomonads can often be observed in a wet mount. The wet mount has been shown to have a sensitivity ranging from 50% to 90%.

Wet Mount: This method of diagnosis is the most preferred by physicians. Vaginal discharge from the physical test is used to make a wet mount and is then examined under a light microscope. Infected patients usually have squamous vaginal epithelial cells with sharply-defined boarders, easily discernable nuclei, and a relatively clean appearance. Diagnosis, however, is best confirmed by actually observing the parasite. Rapidly moving Trichomonads can often be observed in a wet mount. The wet mount has been shown to have a sensitivity ranging from 50% to 90%.

Picture Courtesy of National Institute for Health

 

Stained Smears: The wet mount is by far the best way to diagnose trichomoniasis. Gram staining, on the other hand, is not very useful in identifying trichomonads, but can be used to rule out candidiasis (another disease with similar presentation).Papanicolaou smears (Pap smears) have been reported to show trichomonads. Their sensitivity, however, range from 30% to 90% .

 

Picture Courtesy of The National Institute for Health

 

Males:


In men, the disease can be hard to diagnose without special culture techniques, but men are treated presumptively if infection is diagnosed in female sexual partners. Men may also be treated presumptively if they have ongoing symptoms of urethral burning and/or itching despite treatment for gonorrhea and chlamydia. There are three means by which men can be diagnosed- examining prostatic secretions, centrifuging the urine, or collecting urethral discharge .