Comparison of Three Diagnostic Methods for Trichomonas vaginalis Detection in a Low-Resource Setting

Abstract

Aims: To comparatively evaluate the efficiency of three simple trichomoniasis diagnostic techniques in a low-resource setting at the Baixada Fluminense region, Province of Rio de Janeiro, Brazil. Place and Duration of Study: The sample was obtained from the medical records of women attending the Iguaçu University Clinic's Gynaecology Outpatient Clinic from January to December 2020. The sample consisted of medical records of 135 women aged 17 to 78 years. Methodology: With the aid of a sterile and disposable bi-valve speculum, vaginal secretion was collected with a swab from the vaginal sac. The secretion was used for smears in two slides for wet mount examination and Papanicolaou staining and then seeded in a tube with 6 ml of Diamond's culture medium. Results: The results showed that among the 135 women with clinical signs of vulvovaginitis, 65 (48.15%) were infected by Trichomonas vaginalis. The positivity rates displayed significant differences according to the detection methods used. Wet mount examination and Papanicolaou exams were less efficient, detecting only 7.7% of total infections confirmed by the culture in Diamond's medium. Conclusion: The analysis of the results allowed an update in the detection protocol of Trichomonas vaginalis infections in the Gynaecology Outpatient Clinic of the Iguaçu University. Papanicolaou test was eliminated from the protocol since it requires more resources than the wet mount examination. Wet mount examination was maintained because it detects part of the Trichomonas vaginalis infections at the time of medical attending, following the core principle of the syndromic approach indicated by WHO, but with greater efficacy than the diagnostic determination based on signs and symptoms. Culture by Diamond’s medium proved to be one of the best options for low-resource settings when compared to other detection methods of T. vaginalis analyzed in the current scientific literature, with an acceptable detection rate, only lower than sophisticated and high-cost methods.