Comparison of direct microscopy and culture in the diagnosis of trichomoniasis.

'The discovery of the growing spread of trichomoniasis is due to improved methods of research. Increased morbidity has accompanied inadequate treatment and is especially due to the confused view of the problem, which is a joint task for gynaecologists, venereologists, and urologists. It may be described as a venereal disease because it is transmitted in the great majority of cases by sexual intercourse. It is so widespread and causes so much ill-health among young women that it is becoming an important social problem. It is necessary to treat both men and women to eliminate the parasite from its innermost hiding places.' So wrote Nicoletti (1961) shortly after the testing of metronidazole by the French workers Durel, Roiron, Siboulet, and Borel (1960). That metroni-dazole was to revolutionize the treatment of tricho-moniasis was apparently not realized by these workers, but it was amply demonstrated within a short time by Rodin, King, Nicol, and Barrow (1960) and other venereologists in the United Kingdom and elsewhere. In spite of the widespread use (or misuse) of metronidazole (Flagyl) and the more recently introduced nimorazole (Naxogin), however, tricho-moniasis continues to be not only a highly prevalent but often a distressing condition and Nicoletti's remarks are still relevant. The elimination of trichomoniasis depends not only on the treatment of the obvious case in which the patient presents clinically complaining of an irritating greenish yellow discharge and an unpleasant odour, but also on the detection and successful treatment of the condition in the 'carrier' patient who has mild symptoms or none, or who accepts her vaginal discharge as 'normal' because 'every woman has a discharge anyway'. For the successful detection of the condition, various techniques are available and the present paper reports an attempt to assess the value of some of these techniques in female patients. Identification of the trichomonad Apart from clinical assessment, the methods of identifying Trichomonas vaginalis in women are threefold ; I have used only the first two. (1) Examination of fresh preparations from the vagina or urethra by direct microscopy; (2) Culture in artificial media; (3) Microscopic examination of stained preparations. DIRECT MICROSCOPY In this method a fresh specimen of the vaginal secretion is transferred by means of a sterile wire loop or by glass pipette or plastic spoon from the vaginal vault to a glass microscope slide and examined under a cover slip using either oil immersion high power, dark-field, or phase …