Clinical Utility of Trichomonas vaginalis Reported on Cervical Cytology

OBJECTIVE: Trichomonas vaginalis (T. vaginalis) is the most common nonviral sexually transmitted infection worldwide. Although T. vaginalis may be identified incidentally on cervical cytology, cytology is not considered diagnostic due to historically reported low sensitivity. We evaluated the positive predictive value (PPV) of liquid-based cervical cytology for detecting T. vaginalis and examined subsequent clinical management. METHODS: All liquid-based cervical cytology specimens reported as positive for T. vaginalis (October 1, 2024, to June 30, 2025) were identified from a large academic hospital laboratory in Southeast Michigan. Residual specimens underwent T. vaginalis-specific nucleic acid amplification tests (NAATs) to determine PPV. A retrospective review assessed confirmatory testing and treatment within 2 months of the cytology result. RESULTS: A total of 200 cytology specimens positive for T. vaginalis were included. The mean patient age was 39 years; 81.4% were black or African American. All 200 specimens were confirmed positive by NAAT, yielding a PPV of 100% (95% CI, 98.2%-100%). Follow-up analysis included 132 patients with care documented in the electronic medical record. Of these, 70 had received treatment before cytology results were available and were excluded. Among the remaining 62 patients, only 3 (4.8%) underwent confirmatory testing and 33 (53.2%) received treatment within 2 months. CONCLUSIONS: Among cytology-positive specimens that underwent confirmatory NAAT, liquid-based cervical cytology had an observed PPV of 100% for T. vaginalis. Despite this high concordance, confirmatory testing was rare and nearly half of patients received no treatment, highlighting missed opportunities for timely management. Increased visibility of T. vaginalis findings within cytology reports may improve treatment and follow-up.