A New Strategy for Trichomonas Testing Female Adolescents in the Emergency Department

Study Objective: Sensitive trichomonas diagnostic testing has become available, including nucleic acid amplification tests (NAATs) and a rapid antigen test. The study purpose was to determine if adding sensitive trichomonas testing to routine female sexually transmitted infection (STI) evaluations would increase trichomonas identification and treatment. Design: Two study time periods. Study time 1 (T1) was used for a retrospective review. Study time 2 (T2) was used for a prospective study. Setting: Emergency Department. Participants: Symptomatic female patients aged 13-20 years (N = 447). Interventions: Implementation of routing trichomonas testing in the Emergency Department during T2. Main Outcome Measures: Trichomonas diagnosis and treatment rates were compared during T1 and T2. Results: During T1 31 of 234 of eligible patients (13%) were trichomonas-tested. Laboratory-confirmed trichomonas was identified in 3 of 234 (1.3%). During T2, 212 of 213 of eligible patients (99.5%) were trichomonas-tested; 39 of 212 tested trichomonas-positive (18.4%); 29 of 212 tested rapid trichomonas antigen test-positive (13.6%; P < .001), and 33 of 188 tested trichomonas NAAT-positive (15.5%; P < .001). Trichomonas treatment was given to 3 of 3 laboratory-confirmed trichomonas cases during T1 (100%) compared with 37 of 39 during T2 (95%; P = .688). During T1, 14 of 17 women who received trichomonas treatment (82.4%) did not have a laboratory-confirmed trichomonas diagnosis and during T2 13 of 52 women without a laboratory-confirmed trichomonas diagnosis (25%) were treated for trichomonas (P < .001). Rapid trichomonas antigen tests and trichomonas NAATs were concordant in 178 of 188 patients (94.6%). Conclusion: Incorporating trichomonas rapid antigen tests and NAATs into routine female adolescent STI testing significantly increased the number of laboratory-confirmed adolescent trichomonas diagnosis and treatment and are useful Emergency Department STI screening tools.