Trichomoniasis is a sexually transmitted infection that is highly prevalent worldwide and has been linked to preterm birth and human immunodeficiency virus acquisition. In females, trichomoniasis causes vaginitis, while in males, it is frequently asymptomatic but can be a cause of urethritis. Control efforts have been hampered by the lack of a sensitive diagnostic technique for this infection in males. Men attending a sexually transmitted disease (STD) clinic for a new complaint were screened for Trichomonas vaginalis by culture and by PCR analysis of urine and urethral-swab specimens. The prevalence of Trichomonas determined by culture was 5% (15 of 300 specimens), compared to 17% (52 of 300) determined by PCR. Urine specimens yielded a greater number of positive results by PCR than did urethral-swab specimens. The sensitivity of PCR analysis of urine specimens in comparison to that of culture was 100%. The use of PCR techniques in urine specimenbased detection of T. vaginalis was highly sensitive and revealed a prevalence of infection more than three times that revealed by culture for men at high risk for STDs.Bacterial sexually transmitted diseases (STDs), such as syphilis, gonorrhea, and chlamydia, are declining in the United States; however, infections caused by Trichomonas vaginalis have not evidenced similar declines. Despite the fact that vaginal trichomoniasis has been linked to preterm birth and the acquisition of human immunodeficiency virus (HIV) (3, 11), increased screening efforts have not been made. For women, the most commonly used diagnostic test for Trichomonas is a direct microscopic examination of the vaginal fluid. Although it is highly specific, the sensitivity of this technique in comparison to that of culture ranges from 50 to 80% (9). Culture of vaginal specimens for the organism is the current "gold standard"; however, the use of PCR techniques for detection in females has been studied, with varied results, and current techniques do not appear to have greater sensitivity than culture does (4,12,13,15). Diagnostic techniques for Trichomonas in males are not routinely used, as the current gold standard (culture of urine and urethral swabs) (10) is cumbersome and likely suboptimal. Few studies have addressed the utility of PCR testing for Trichomonas in males. We compared PCR results for urethral and urine specimens to those of culture techniques for the diagnosis of Trichomonas in men attending an STD clinic.
MATERIALS AND METHODSHeterosexual males attending the Jefferson County Health Department STD Clinic in Birmingham, Ala., for STD screening or the treatment of its symptoms, were invited to participate in this diagnostic study. The study was approved by the Institutional Review Boards of the Jefferson County Health Department and the University of Alabama at Birmingham. Men were excluded from participation if they had urinated in the previous hour or had taken antibiotics during the preceding 14 days. Reported symptoms of urethral discharge and dysuria were recorded, as well as the nu...