Trichomoniasis Testing

The most common mistake that many people make is how they start to do a Google search the moment that they experience a particular symptom – only to cause them more fear and anxiety even if their condition is a benign and straightforward phenomenon that could be addressed with a simple over the counter medication. This does not go to say that trying to inform yourself regarding the potential condition that you might have is counterintuitive, but without looking at the whole picture and even considering that need for a professional consultation, you are intentionally putting yourself in a risky position that could either further exacerbate your condition due to an uninformed treatment strategy, or create a whole new problem entirely due to the management plan that you have implemented without the guidance of a licensed physician.

This issue is more common for diseases that are often mistaken with other conditions with whom it shares manifestations. This is not particularly evident in terminal and severe infections as they usually have a distinctive feature that immediately brings to mind the specific disease that causes it, but it is widely prevalent in conditions that are more common and are widely misunderstood by many.

The Plight of Sexual Condition Diagnosis

To make it even more specific, this context is relatively more relevant in sexual health due to several factors that somehow make this area more prone to the misuse of medication, misdiagnosis, and ultimately, exacerbation of the preexisting disease. Sexual health is not necessarily a more complex and challenging field on its own as it is essentially similar to the conditions that plague other parts of the body. Apart from the fact that the genitalia is a relatively more sensitive organ that should be handled with care lest it produces long-term issues such as infertility, sexual health problems are somewhat similar to how medicine is approached in any other field.

However, what makes sexual health more daunting is that the field is prone to misinformation and missing links, mainly due to people trying to withhold information due to their fear that their peers might judge them. Of course, this is not necessarily a shocking fact, as it is widely known that the field of sexual health has been continuously stereotyped and shrouded in controversies. It has become somewhat difficult for some to open up regarding the issues they are experiencing.

While one could sympathize with this plight, it is irrefutable that sexual health conditions need to be approached with the proper diagnostic and treatment strategy. This is not possible without the complete information necessary to make the prescription. Add that to the large portion of the population that seems to disregard physician visits entirely, and you will now begin to understand why the field is severely crippled nowadays.

To supplement this issue, it is more efficient to simply inform the public and provide them with the necessary information, not to treat their disease, but to obtain more relevant and accurate data to highlight the correct diagnosis for their condition further. Of course, this would still entail a proper consultation with your physician, but providing you with a stepping stone to somehow get an insight as to how you will be tested and whether or not you can avail of it on your own will go a long way in ensuring that no cases are left undiagnosed – only to cause further health problems down the line.

Defining Trichomoniasis

Trichomoniasis is perhaps one of the best conditions to use in characterizing the plight of the sexual health field as it is one of the infections that most often than not mimics the presentation of other diseases – making it extremely easy for laypeople to mistake it for something else when they only rely on the symptomatic manifestation of the disease if there is any. Trichomoniasis, commonly known as “trich,” is a sexually transmitted condition caused by a protozoan parasite known as Trichomonas vaginalis, and it is more prevalent among women than men. The exact cause of this disparity is not entirely known, and its widely asymptomatic nature in around 70% of the affected population likewise remains unexplained within the scientific community.

Trichomoniasis is considered one of the most common curable STDs in the United States, and this is mainly due to the widely asymptomatic nature of the disease, coupled with the viability of its transmission even in patients that are not showing any symptoms of the infection.

Common Manifestations

As previously mentioned, Trichomoniasis is mainly asymptomatic in around 70% of the affected population – making it extremely hard to diagnose unless the physician is intentionally looking for a potential infection. However, in cases where Trichomoniasis does prove a few symptomatic manifestations, this commonly comprises pyuria, dysuria, discharge, irritation, and general discomfort during and after intercourse in both infected male and female patients. The symptoms would often appear in around 5 to 28 days following exposure, but it is still possible for some patients to develop symptoms past this determined incubation period.

Preventive Measures

The most common preventive measure, similar to how you could protect yourself from any other STD, is to abstain from sexual intercourse, especially with people you are not familiar with. While challenging for some people to perform, abstinence is essentially a guaranteed protection due to how it removes you from the equation – eliminating the source of infection and ultimately protecting you from a potential transmission case. Of course, the use of contraceptives would also go a long way in ensuring that the transmission of the pathogen, while still possible, is minimized for as long as you are wearing latex condoms or ensuring that both you and your partner are protected from any potential infections. This would also mean that monogamy would be a great supplement in ensuring that you are always informed about your partner’s sexual health status and that you are not unnecessarily exposing yourself to a potential carrier of the infection.

Recommended Treatment Approach

According to the Centers for Disease Control and Prevention, 2g of single oral dose Metronidazole and Tinidazole is recommended to treat Trichomoniasis in both men and women who were successfully diagnosed with the condition. However, it must be noted that the recent sexual partners of infected patients must also be screened and treated for the disease to ensure that their condition will not progress in silence and that they would no longer be able to transmit the infection to you or your partner.

The Significance of Trichomoniasis Testing

Trichomoniasis testing is admittedly one of the most finicky STD tests available in the field. It requires specific laboratory tests that can be used to pinpoint the presence of the causative microorganism in the patient’s system. In most cases, using the patient’s symptomatic manifestations alone would only cause confusion and should not be used as grounds for a conclusive diagnosis in any situation.

Importance of Testing

While Trichomoniasis is not necessarily a life-threatening condition during its early stages due to how it is widely asymptomatic and that its complications mainly occur when the condition is left to persist for a while, testing for Trichomoniasis not only ensures that you will not proceed to the stage where you would have to concern yourself with the complications that come along with the infection, but also guarantees that you will not transmit the condition to your sexual partners. Sure, Trichomoniasis can be easily treated, but always do note that the disease is highly contagious, and passing it on to your partner could always lead to further infections that could exacerbate the already heightened prevalence of the condition within the community. Essentially, testing for Trichomoniasis, whether through a targeted testing procedure or a routine check-up, aims to limit Trichomoniasis cases, especially considering that the condition is widely underreported to begin with.

Timeline of Testing

There is no one timeline for testing for Trichomoniasis as there are several tests that work in different time points depending on how sensitive they are, the demographics of the tested group, and the available resources in the facilities near you. Essentially, there is no one way to have yourself tested for Trichomoniasis, and there is also no one surefire duration in which you would get the most accurate results from the test you have requested.

However, it is recommended that for cases like this where the condition is widely asymptomatic, and it is hard to determine whether you have an underlying condition, to begin with, that you simply get yourself tested routinely, especially when you are sexually active, have several risk factors, or are engaging with multiple sexual partners.

The Process and What to Expect

In most situations, wet mount microscopy is utilized to diagnose the condition as it is highly accessible and affordable. The results could be provided as soon as the assigned laboratory technician starts to view the microorganism present in the sample provided. As such, you can expect that the sample that would most often be collected is a swab of your genitalia/discharge. There is no obvious pain that should be expected from such a testing procedure as it would only use a cotton swab, but other more invasive testing procedures may employ specialized laboratory facilities that may collect other specimens such as urine samples for the execution of the necessary tests.

Who Should be Tested?

To ensure that all affected individuals will be successfully diagnosed with the condition even when they are asymptomatic, it is highly recommended that the test be performed for all people who are sexually active, particularly those who are at high risk for this condition, such as female patients, those who have multiple sexual partners, patients with a preexisting sexually transmitted infection, women of old age, and other individuals that may be at a heightened risk for the condition either due to their condition or their occupation.

What Tests are Available?

In total, four available FDA-cleared diagnostic procedure variations are often used to diagnose Trichomoniasis cases. The following table highlights the available procedures and their respective parameters, such as the sample required, the waiting time, the tool used, and its common indication.

Tests Specific for Trichomoniasis Diagnosis

Sample Culture

Complete Mechanism

Employing culture methods to propagate the present microorganism in a submitted patient sample is indeed a daunting and time-consuming process that many people would most often try to avoid, mainly due to the need to have an immediate result for a potentially infected patient.

Sample culturing is a relatively simple process that would often begin with the collection of a sample by using cotton swabs, gently swiping it either in the slightly inner portion of the vagina or near the opening of the urethra in males, then trying to grow it in the appropriate culture medium where it will then be propagated for a few days. This procedure was used before molecular techniques were developed to diagnose conditions like Trichomoniasis, but this microscopic procedure that aims to determine whether T. vaginalis is present in the genitalia can sometimes be used when there is a lack of resources in a particular context.

Estimated Waiting Time

The waiting time for culturing techniques could range from days to weeks, depending on the method and scope that the procedure calls for in each context. Do expect that your result might take a while since these microorganisms need to be manually grown, propagated, and examined by lab technicians before your physician can receive the result showing whether you are infected or not.

Sample to be Collected

Culturing methods commonly employ genital swabs as these are the ones that are then inoculated into the appropriate culture medium that will be used for the sample. Urine samples, however, are more preferred in the case of male patients.

Average Price

Standard prices are no longer typical due to the lack of a specific culturing technique in today’s practices, but a standard urine culture test would often be priced at around $80.

Covered by Insurance?

Although insurance companies commonly cover a standard urine culture, culture techniques specific for Trichomoniasis may be subject to the insurance company’s discretion when developing the policy.

Reliability and Accuracy

According to the CDC, culture testing has a sensitivity rate of around 44-75%, and it has a specificity rate of <100%.

Direct Microscopy or Wet Mount

Complete Mechanism

A wet mount or a vaginal smear is a test commonly used among women with vaginitis or inflammation within the lining of the vagina. This test is frequently performed with the help of direct microscopy, wherein the sample is directly observed for any presence of pathogenic microorganisms that might be causing the inflammation being observed.

To prepare, patients are usually instructed not to douche, use tampons, or apply any chemicals or medicines within the vaginal area 24 hours before the scheduled testing time. It is also not done when the patient has an active menstrual period, as this might contaminate the sample collected for the test.

When performing the test, your physician will instruct you to lie on the examination table with your feet raised with the help of stirrups. Your doctor will then use a tool known as a speculum to spread the vagina and collect fluid samples using either a swab or a spatula.

The sample will then be smeared into a glass slide and mixed with a saline solution for the wet mount process. Your physician will then examine the sample under a microscope, looking for the presence of any cells, pathogens, or substances that might indicate an underlying infection.

Estimated Waiting Time

Since the procedure is performed in real-time, the results are relatively instantaneous following the sample collection required to perform the test.

Sample to be Collected

The wet mount method is only preferred for female patients, and this would commonly entail the collection of a vaginal swab sample.

Average Price

On average, a vaginal wet mount specific for Trichomoniasis diagnosis may be priced at around $17.

Covered by Insurance?

Some private insurance policies cover vaginal wet mount procedures, but it is still subject to the discretion of the program that you have applied in.

Reliability and Accuracy

It has a relatively low sensitivity rate of around 44-68%, and it immediately drops to 20% if the slide has not been examined 1 hour after the sample has been collected.

Aptima T. vaginalis Assay

Complete Mechanism

An Aptima assay is a highly sensitive nucleic acid amplification test or NAAT that utilizes target capture technology, transcription-mediated amplification or TMA, and hybridization protection assay. Essentially, what the procedure does is that following the collection of samples (which can either be swabs or urine, but both are stored in specimen transport tubes provided in the kit), the target rRNA molecule is then isolated from the sample through the use of a specific capture oligomer that has a particular region that could scout for this target molecule. The formed complex is then removed with the help of temperature lowering and is then bound to magnetic particles during this hybridization phase. Once bound again, the specimen will then be sent to its amplification phase, wherein the nucleic acid hybridization process results are recorded in terms of Relative Light Units or RLU. An RLU value of 0 to <100 would be negative, a value of 100 to <2400 is positive, while a value of 0 or ≥2400 is considered invalid due to the unusually low or high recorded numbers.

Estimated Waiting Time

The estimated turnaround time for the results to be processed and interpreted may sometimes take up to 2 days.

Sample to be Collected

Several Aptima kits are available for you to collect your sample, and the necessary sample will depend on the kit that has been obtained. However, the two most common samples collected over all kits are genital swabs and urine samples.

Average Price

The exact individual price for the Aptima Kit specific for Trichomoniasis testing is not disclosed in the proprietary website of Hologic – the company promoting Aptima, as they are sold wholesale, but to get an insight on how much the kits are, Aptima SARS-CoV-2 Assay Kits are priced at around $12 per test.

Covered by Insurance?

The Aptima Kits are promoted by a private company and therefore not necessarily included in insurance programs. They have, however, certain partnerships for an all-inclusive joint agreement that sets the prices for some of their kits (specified for other conditions) at a much lower cost, albeit the United States is not covered in this 2018 agreement.

Reliability and Accuracy

An Aptima assay has a sensitivity rate of 95.3 to 100% and a specificity rate of 95.2 to 100%.

Osom Trichomonas Rapid Test

Complete Mechanism

The OSOM Trichomonas Rapid Test is an immunochromatographic qualitative procedure used to detect the presence of Trichomonas vaginalis – the causative agent of Trichomoniasis. It does not necessarily detect the presence of T. vaginalis itself, but it does create a visual representation of the existence of T. vaginalis antigens – signifying that you have a current active infection causing the presence of these biomolecules in your system.

The OSOM rapid test uses a color immunochromatographic, capillary flow, dipstick technology that requires the solubilization or dissolution of Trichomonas proteins within the sample provided. This is performed by mixing the obtained sample in a Sample Buffer to disperse the available proteins within the specimen. Following that, a rapid test stick is then placed inside the mixture that will allow the sample itself to migrate or adhere to the membranous surface of the dipstick itself – allowing whatever proteins there were in the sample to react with the rapid test stick that has been placed inside the mixture,

If Trichomonas proteins are present within the sample, complexes composed of primary anti-Trichomonas antibodies conjugated with chromatographic particles will then appear – producing the color blue within the rapid test stick’s surface. This complex will then be bounded by a second anti-Trichomonas antibody coated with a nitrocellulose membrane, causing the blue color to appear with the red control line if the test is positive.

Do not, however, that there are several precautions in place to ensure that you will be able to properly perform the test without contaminating the sample with any other particles that could cause either a false positive or negative result. For instance, it must be noted that the kits must not be frozen and that the sticks must no longer be used if they have already been removed from their canisters for more than 1 hour. In addition to that, you must only use the rayon swab that has been provided in the kit to ensure that your tools are sterile and will not interfere with the test. Finally, one must make sure that the samples that have been collected must be processed preferably immediately to prevent any contamination of the sample. The specimen can be allowed to sit for no more than 24 hours at room temperature, but it may be stored at temperatures of around 4 to -20 degrees Celsius for up to 36 hours.

Estimated Waiting Time

The results are obtained rather rapidly, thus giving it the name of “rapid test” – obtaining results as quickly as 10 minutes after you have placed the dipstick in the mixture.

Sample to be Collected

The sample that will be collected is a genital swab obtained using the provided sterile rayon swab inside the kit.

Average Price

An OSOM Trichomonas Rapid Test Kit is priced at around $280, but the kit itself contains 25 testing sets that will make the average individual price if each test at approximately $11.

Covered by Insurance?

Considering that a private company endorses the test, OSOM rapid testing kits are not covered by most insurance companies in their policies.

Reliability and Accuracy

The OSOM Trichomoniasis Rapid Test Kit has a sensitivity rate of 82 to 95% and a specificity rate of 97 to 100%.

Average Cost and Expenses for Each Testing Procedure

The average prices and whether most insurance policies cover each test were summarized in the table provided below:

Frequently Asked Questions (FAQs)

What is the difference between screening and diagnosis?

Screening aims to look for possible infections in a patient that is not showing any symptoms. Diagnosis seeks to determine the cause of a patient’s manifestations.

What is the gold standard for the diagnosis of Trichomoniasis?

Nucleic acid amplification tests or NAATs remain as the gold standard for the diagnosis of Trichomoniasis, but there is only a handful of FDA-approved tests that can be used for trich, such as the Aptima Assay, Amplivue Assay, and the ProbeTec TV Qx Assay.

Who should be routinely screened for Trichomoniasis infections?

Trichomoniasis screening is recommended for people with an HIV infection, those living in an area where the infection is prevalent, those with multiple sexual partners, and patients with a history of STD infections.

Are there any at-home testing kits available for Trichomoniasis?

Yes, and they are primarily rapid tests used as preliminary testing tools to signal patients to have themselves examined by a professional.

How should a patient collect a urine sample when a test requires such?

They should perform a midstream clean catch urine sample collection wherein you first pee into the toilet then collect the middle part of your urine stream to ensure that any contaminations that may have been present in your genital area were washed off first. It might also be wise to sterilize the genitalia before collecting the sample to decrease the contamination risk further.