Abstract
Sirs,
We read with interest the audit by V Tittle et al., 1 on the clinical practice and demography of Trichomonas vaginalis within their London cohort. We would like to reflect on their recommendation regarding test of cure by sharing the results of a similar audit performed recently within our clinic.
Of 7251 female patients who attended for STI screening between 1 January and 31 December 2011, we identified 51 patients diagnosed with T. vaginalis, giving us a positivity rate of 0.7%. The demographics of our population were 35.3% white, 17.6% African/Caribbean, 19.6% Asian, the remainder mixed. The majority (n = 46, 90.2%) were symptomatic, with vaginal discharge accounting for 85% of all symptoms (n = 39). Most cases were diagnosed within our clinic using wet mount microscopy (n = 48), the remainder referred due to trichomonads seen on cervical cytology. All were treated with first-line antibiotics, and of the 56.9% (n = 29) who attended for test of cure, all were negative. These findings are in keeping with the results of the same audit performed in our clinic in 2002, which reported 36 cases of T. vaginalis with similar ethnic diversity, 75% symptomatic and 83% attending for TOC. There were two women with positive tests of cure, both of whom were asymptomatic at presentation. Another re-audit in 2006 identified 20 cases, 65% of whom were symptomatic, and 75% attended for test of cure – in this instance, all repeat microscopy was negative.
Certainly in our more recent audit, the only identifiable risk factor for ongoing positivity was reinfection (n = 1, re-infected shortly after a negative test of cure) and we experienced no treatment failures. In light of this, and in keeping with current and draft 2013 BASHH guidance, we recommend that symptomatic women, who see a health advisor at diagnosis and are given clear partner notification advice, do not need to return for test of cure unless symptoms persists.