Current perspectives on the biology, diagnostics and drug resistance of Trichomonas vaginalis

Trichomonas vaginalis , the most prevalent non-viral sexually transmitted parasite, remains an under-recognised cause of genital tract infections despite its global burden and strong association with reproductive morbidity, adverse pregnancy outcomes, and enhanced HIV transmission. Advances in understanding its biology, including antigenic variation, hydrogenosomal metabolism, and host–parasite interactions, have elucidated its mechanisms of adhesion, cytotoxicity, and immune evasion that underpin its pathogenesis. The diagnosis of T. vaginalis infections still relies heavily on wet mount microscopy, which has low sensitivity and is operator dependent. Integrated culture systems and rapid antigen tests offer modest improvement, but nucleic acid amplification tests represent a major advancement in the diagnostic portfolio of T. vaginalis , providing higher accuracy and the potential for multiplex sexually transmitted infection screening. Rising resistance to nitroimidazoles, driven by alterations in hydrogenosomal redox pathways, coenzymes/cofactors, reduced oxygen scavenging, and altered iron metabolism, poses significant therapeutic challenges. Recognition of the genetic diversity and the role of T. vaginalis virus in virulence modulation add further complexity to our understanding of the disease. This talk will integrate recent insights in parasite biology, diagnostic limitations, evolving resistance mechanisms, and effective management in clinical microbiology settings.