760 - Trichomonas Vaginalis in Adult Females in the Emergency Department
Friday, May 15, 2020
9:18 AM – 9:24 AM
Location: Majestic Ballroom: Majestic
Participants should be aware of the following financial/non-financial relationships:
Santiago Cantillo-Campos, n/a: No financial relationships or conflicts of interest
Justin M. Elkins: No financial relationships or conflicts of interest
Joshua D. Niforatos, n/a: No disclosure data submitted.
Cheryl Thompson: No disclosure data submitted.
Johnathan M. Sheele, MD, MPH, MHS: No disclosure data submitted.
Santiago Cantillo Campos: No disclosure data submitted.
Background and Objectives: Trichomonas vaginalis is a common cause of vaginitis in the emergency department (ED). Trichomoniasis can present with nonspecific symptoms, ranging from asymptomatic to severe disease. An untreated infection may lead to adverse reproductive outcomes and an increased risk of infection with other sexually transmitted infections. A better understanding of the presentation of T. vaginalis infection will help ED clinicians more effectively identify and treat these patients.
Methods: A retrospective review was performed on 75,000 ED visits in northeast Ohio for persons ≥18 years of age who were being evaluated for genital-urinary tract infections. Thirty-eight variables related to presentation were pulled from electronic medical records. Individual variables were evaluated for association with T. vaginalis infection using chi-square or t-tests. To account for correlations between variables, individually statistically significant variables were combined in a logistic regression adjusted by potential confounders.
Results: There were 6,826 women tested for T. vaginalis, of which 30.1% (2,057) had a positive result. When compared to uninfected subjects, patients with trichomoniasis tended to be older [mean age 30 (10) vs 28 (9)] and more likely to be of black race (94% vs 88%). Urinalyses of infected patients were more likely to show urine nitrates (6% vs 4%), higher urine white blood cells (WBCs) and WBCs clumps. Compared to T. vaginalis-negative subjects, infected women were at increased risk for being diagnosed with urinary tract infection (16% vs 9%), and infections with chlamydia (12% vs 8%) and gonorrhea (6% vs 3%). Wet prep of patients with T. vaginalis showed higher WBCs [20 (22) vs 10 (4)], and a lower rate of yeasts (5% vs 8%). On regression analyses, T. vaginalis infection in females was associated with increased age, being unmarried, black race, no documented primary care physician, arrival to the ED by emergency medical services, urine leukocyte esterase, vaginal wet prep white blood cells, wet prep clue cells, and wet prep yeast (p<0.05).
Conclusion: Trichomonas in adult female ED patients is likely associated with older age and black race. The most common sexually transmitted co-infection in patients with trichomoniasis was chlamydia. Higher leukocyte esterase in urine and more vaginal leukocytes were positively associated with T. vaginalis.