IGNORED TRICHOMONAL INFESTATION DIAGNOSED BY PAPANICOLAOU SMEAR

Objective-To compare the occurrence of Trichomonas vaginalis as demons trated by culture and by Papanicolaou (PAP) smears in a sexually trans mitted disease (STD) clinic. Setting-The largest out-patient venereolo gical clinic in Denmark. Subject and methods-As the prevalence of tric homonal infestation has decreased considerable in recent years direct microscopy of vaginal wet mounts is no longer performed routinely. Ins tead the screening diagnostic procedure is based on culture. We have r etrospectively collected data on culture-negative women with Trichomon as vaginalis organisms present in cervical smears, taken on a routine basis to exclude atypical cells, and compared with the clinical findin gs.Results-Since 1992 a total of 17 women were found to harbour Tricho monas vaginalis in cervical smear. A vaginal discharge was described i n 10 women, six of whom had concomittant unspecific vaginitis. However , four women had unexplained vaginal discharge that could have been re lated to infestation with Trichomonas vaginalis. In addition one asymp tomatic woman had a male partner with persistent urethritis. Conclusio n-The prevalence of trichomoniasis is underestimated in women attendin g the clinic if the diagnosis is based on culture alone. PAP smears ma y be helpful in demonstrating characteristic trichomonal organisms. In general we do not recommend the PAP smear be used to diagnose STDs. H owever the finding of trichomanal organisms in smears should prompt a repeated culture and direct microscopy of vaginal wet mount.