53 Diagnosis of Trichomoniasis in Men by Urine Cytology: Epidemiologic and Clinical Implications

• Published in: American journal of clinical pathology Vol. 149; no. suppl_1; pp. S23 - S24
• Main Authors: Ahmad, Arslan, Laskar, Derek, Zuretti, Alejandro
• Format: Journal Article
• Language: English
• Published: US Oxford University Press 11.01.2018
• Subjects: Age; Cellular biology; Cytology; Diagnosis; Epidemiology; Flagella; Hematuria; Leukocytes (eosinophilic); Medical diagnosis; Patients; Physical characteristics; Protozoa; Trichomonas; Trichomoniasis; Urethritis; Urinary tract; Urine; Vaginitis
• ISSN: 0002-9173; 1943-7722
• DOI: 10.1093/ajcp/aqx116.052

Abstract Background Trichomoniasis is the most prevalent non-viral sexually transmitted infection worldwide. It is caused by the protozoan Trichomonas vaginalis, and the estimated global incidence is over 170 million cases per year, with over 8 million new cases per year in the United States alone. Up to 70% affected are asymptomatic; when symptoms do occur, dysuria, dyspareunia, urethritis, and vaginitis can be observed. Additionally, women are affected at higher rates than men. Despite the relative large overall annual incidence, very few reports have described the characteristics of male patients with T. vaginalis organisms on cytology. Method We sought to determine the incidence and clinical significance of this finding in the urine cytology of male patients at our medium-sized academic medical center located in a major urban area. We retrospectively reviewed our archived urine cytology slides that reported T. vaginalis organisms spanning a 15-year period. Clinical histories from men with Trichomonas-positive urine were also reviewed and correlated. Slides were reviewed, and the morphologic characteristics of the organisms were recorded. Results T. vaginalis were detected in nine of 5,094 urine cytology specimens (0.1%). The patients included six women and three men. The age range for men with Trichomonas-positive urine was from 29 to 52 years (mean age, 44 years; median age, 51 years). On cytologic review, T. vaginalis organisms were pear-shaped, oval, or round; they had cyanophilic staining with often evident eosinophilic cytoplasmic granules; there were pale nuclei; and eccentrically located flagella occasionally observed. Acute inflammation was observed in two of three cases. Clinical history was available in three of three men. Lower urinary tract symptoms were reported in three of three men, most commonly hematuria. Conclusion Urine cytology may represent the initial diagnostic test for Trichomonas in men, and accurate cytologic diagnosis may prevent undesired adverse outcomes for them and their partners.