Point-of-care (POC) testing for Trichomonas vaginalis in the emergency department may lead to more accurate treatment of young women, researchers report.
“Treating women for trichomoniasis when they are not infected (inaccurate treatment) exposes them to potential side effects of medication and the emotional distress associated with an STD diagnosis while also generating unnecessary costs,” Dr. Lea E. Widdice of Cincinnati Children’s Hospital Medical Center in Ohio and colleagues note in Pediatrics, online May 20.
“Failure to treat women for trichomoniasis when they are infected (missed treatment) places them at higher risk for symptomatic trichomoniasis, pregnancy complications, and acquisition of HIV,” the team adds.
To investigate the impact of a POC rapid antigen test for T. vaginalis on treatment accuracy, the researchers analyzed medical records before and after implementation of the test in the ED of an urban pediatric academic center. Two other tests, wet mount (a POC test with lower sensitivity and specificity than the antigen test) and culture, were used in the pre-POC study year. Records of women aged 14 to 20 who received a T. vaginalis test in the emergency department during either study period were included in the analysis.
The team found that overall rates of accurate treatment increased from 78.7% pre-POC to 87.7% post-POC (p=0.02). Specifically, rates of not treating uninfected women increased from 61.4% pre-POC to 70.4% post-POC (p=0.06), while rates of treating infected women remained the same pre-POC (17.3%) and post-POC (17.3%).
Rates of inaccurate treatment decreased from 23.1% pre-POC to 13.1% post-POC (p=0.02). Changes in missed treatment rates (14.0% pre-POC; 8.8% post-POC) were not statistically significant (p=0.73).
“Clinicians and their laboratories can improve health care for women by adopting a rapid, sensitive diagnostic test for T. vaginalis into their routine care,” Dr. Widdice told Reuters Health by email. “And if emergency departments used this test routinely, patient care would improve.”
Dr. Mobeen H. Rathore of the University of Florida, Gainesville, commented by email, “This is an important study and adds to the accumulating body of evidence which supports the idea that valid POC testing is important in all health care settings.”
“This is especially important in emergency department care, where an accurate, timely diagnosis while the patient is still present results in better patient management,” said Dr. Rathore, who was not involved in the study. “Of course, this becomes even more important for adolescents and young adults, who may receive most or all of their acute outpatient care in emergency departments.”