O06.1 Evaluation of 5 Different Tests For Trichomonas Vaginalis (TV) Infection and Cost Effective Planning For Clinical Implementation

Abstract

Pipelle, and the tissue was split for microbiological and histological assessment. Cultivated microorganisms were identified using phenotypic and genotypic characteristics. Fisher's exact tests were used to assess the association between microorganisms and endometritis (plasma cells ± neutrophils). Results Of 136 women with clinical PID, 55 (40%) had histologic evidence of endometritis, and endometrial GC and/or CT was associated with endometritis (29% vs. 6%, P < 0.001). In addition to STIs, a broad range of bacteria representing 63 different species were recovered from 53 (39%) of the endometrial biopsy samples, including 8 novel species. The recovery of any non-GC/non-CT organisms from the endometrium was associated with histologic endometritis (53% vs. 30%, P = 0.008). Both G. vaginalis (35% vs. 16%, P = 0.01) and A. vaginae (22% vs. 3%, P < 0.001) were associated with histologic endometritis. Other anaerobic bacteria associated with bacterial vaginosis including Prevotella timonensis, P. amnii and Peptoniphilus harei were also more frequent in the endometrium of women having endometritis (11% vs. 3%, P = 0.06) but this did not reach statistical significance. After excluding women having GC and/or CT, A. vaginae was still independently associated with endometritis (17% vs. 3%, P = 0.03). Conclusions Health Protection Agency, London, UKBackground TV is the most common non-viral STI in the world. Despite this, TV infection in UK Genitourinary clinics is mainly (and often exclusively) diagnosed by wet mount microscopy alone. Microscopy is known to have a low and variable sensitivity and therefore greatly underestimates the true prevalence of TV infection. Objectives A clinical trial was conducted to evaluate the performance of five methods for detecting TV: an in-house PCR; the Aptima TV kit; the OSOM Trichomonas Rapid Test (POCT); culture and microscopy to diagnose infection in symptomatic women. The results of the study were used to power a financial model for clinical implementation of a molecular test. Methods Symptomatic women were recruited for testing. Results and resource costs from the study were extrapolated to calculate the cost of implementing POCT and in house PCR compared to wet mount microscopy in the clinic. Results A composite reference standard of 2 more or more positives was used. 246 women were recruited of which 24 had a positive test by 2 or more of the 5 methods. Aptima TV kit, POCT, Real-time PCR and culture (sensitivities 92, 92, 88 and 88%) all out performed wet-mount microscopy (sensitivity 38%). The prevalence based on two tests as reference standard was 9.75%. Conclusions Cost modelling showed although initial outlay costs for PCR and POCT were high, savings were made in labour costs. PCR and POCT would improve the rate of TV diagnosis in this group and therefore reduce repeat visits due to false positive results. PCR requires additional clinical time for recalling the patient for a further visit to give a positive result, treatment and contact tracing. Implementation of newer test...

Prevalence and risk factors of three curable sexually transmitted infections among women in Nairobi, Kenya

“…It was not clear why the prevalence of TV in this study was low as most studies have shown that a higher prevalence of TV is found in women above the age of 30 years, which was the age for a majority of participants in this study. The low GC and TV prevalence could be explained by the fact that molecular methods were used for the detection of CT while GC was detected by culture while TV was detected by wet mount whose sensitivity varies from 38 to 82 % [ 17 , 18 ].…”

Detecting asymptomatic Trichomonas vaginalis in females using the BD ProbeTec™ Trichomonas vaginalis Qx nucleic acid amplification test

“…15 Meanwhile, a preliminary assessment of the cost implications of TV NAATs suggests that while initial outlay costs may be high if the relevant processing system is not already in place, there may be savings in overall labour costs. 16 Without national prevalence data on the burden of asymptomatic infection, determining a prevalence threshold at which to offer universal screening is difficult. However, it is probably not justified to continue in our very low prevalence setting.…”