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Comparison of Conventional Wet-Mount Examination With Cytologic Studies, Cultures, and Monoclonal Antibody Staining of Direct Specimens

John N. Krieger, MD; Milton R. Tam, PhD; Claire E. Stevens, MA, PA; Iris O. Nielsen; Judith Hale, MS, MT(ASCP); Nancy B. Kiviat, MD; King K. Holmes, MD, PhD

JAMA. 1988;259(8):1223-1227.

Abstract
The accuracy of (1) conventional wet-mount examination, (2) Papanicolaoustained gynecologic smears, (3) a direct slide test using fluorescein-conjugated monoclonal antibodies against Trichomonas vaginalis, and (4) two different culture media for the diagnosis of trichomoniasis in a high-risk population of 600 women was compared. Use of Feinberg-Whittington or Diamond's culture medium resulted in a diagnosis of 82 and 78 cases, respectively, and the combination of two cultures identified 88 infected women. In comparison, wet-mount examination detected only 53 (60%) of the cases. Cytologic smears were interpreted as positive for T vaginalis in 49 (56%) of the 88 cases but also resulted in seven false-positive smears, and specimens from 18 women with negative cultures were interpreted as "suspicious" for trichomoniasis. Monoclonal antibody staining detected 76 (86%) of the 88 positive specimens, including 27 (77%) of the 35 cases missed by wet-mount examination. In summary, wet-mount and cytologic studies were insensitive, and cytology study was the least specific method for diagnosis of trichomoniasis. Direct immunofluorescence with monoclonal antibodies holds promise as a sensitive and specific alternative to cultures for rapid detection of T vaginalis in clinical specimens.

(JAMA 1988;259:1223-1227)

Author Affiliations
From the Departments of Urology (Dr Krieger and Ms Nielsen), Medicine (Dr Holmes and Mss Stevens and Hale), and Pathology (Dr Kiviat), University of Washington School of Medicine, Seattle, and the Division of Medical Microbiology, Genetic Systems Corp, Seattle (Dr Tam).

Footnotes
Reprint requests to Department of Urology RL-10, University of Washington School of Medicine, Seattle, WA 98195 (Dr Krieger).

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