1. The Dublin Well Woman Centre and The National Virus Reference Laboratory  Approved by ICGP Ethics Committee

2.  Trichomonas vaginalis (TV) - common STI affecting men and women  50% to 60% of TV infections in women asymptomatic  Available effective treatment - one of the most curable STIs  True prevalence underestimated due to insensitive diagnostics ◦76 notifications of TV associated disease in 2013 in Ireland  Nucleic acid amplification tests (NAATs) double the detection rate for TV vs wet mount microscopy

3. Eligibility criteria  Aged 30 or older  Attending for a full screen for sexually transmitted infections  Attending with symptoms suggestive of an STI  Attending for a chlamydia screening test  Clinically warranted on their history – e.g not previously screened for STIs, change in partner recently, partner known to have an STI

4.  Study voluntary  Patient to have usual medical care even if not participating  Test results available to patient within usual timeframe whether or not they participate  Aim of study is to find a better test – with a view to making it widely available if a need is identified  Dublin Well Woman Centre and the National Virus Reference Centre are bearing the cost of their individual contributions to the study

5.  October 2013 – March 2014  Coolock D5, Liffey St D1, and Pembroke Road D4  Inclusion criteria symptomatic /asymptomatic patients >30 yrs  Written informed consent  An additional endocervical swab or FVU sample sent to lab  Gen-Probe APTIMA TV - transcription-mediated amplification (TMA)  TV TMA was performed on residual routine samples taken for gonorrhoea/chlamydia NAAT (APTIMA Combo2) – EC / urine

6.  Age  Symptoms: Y/N if Yes vaginal discharge/ discomfort, or dysuria  New partner in last 3 months: Y/N  Number of partners in the last 3 months: 1 2 3 4 5 More  Number of partners in the last year: 1 2 3 4 5 More

7.  365 patients recruited  206 reported symptoms of either vaginal discharge or dysuria or both - 136 no symptoms  Age for symptomatic and asymptomatic groups was 36.2 and 36.8 respectively  Majority of patients (52%; 189) reported having between 0-1 partners within the last year, 34.5% (126) between 2-3 partners and 4.4% (16) with > 4 partners

8.  Prevalence of any STI 3.8% [95% CI 2.1% to 6.44%]  Prevalence of TV 1.1% [95% CI 0.3% to 2.8%]  75% TV positive patients reported symptoms. One patient reported an epidemiological connection to a patient recently diagnosed with TV  Prevalence of CT 2.7% [95% CI 1.5% to 5.73%]) were positive for CT  7/10 patients with CT infection were asymptomatic on presentation  No NG infections were identified in the cohort

9.  Prevalence of TV infection was 1.1% - higher than that of NG which is routinely tested for in asymptomatic cohorts  The data suggests that symptomatic patients are more likely to be infected with TV than CT, although this difference is not statistically significant  Expansion of routine testing to include TV NAAT analysis for symptomatic patients may be warranted

10. Launch March 2015 Aptima TV rRNA assay – TIGRIS DTS (Hologic) Capacity 1,000 samples per day Sample stability 30 and 60 days at room temperature for swabs and urine respectively Clinical led diagnostic service Specimen collection devices available at nvrl@ucd.ie

11.  NVRL  Sandy McDonnell  Deirdre Burke  Dr. Suzie Coughlan  Dr. Allison Waters TV TMA test kits provided free of charge by Hologic but they had no role in the conduct of the study

12.  DWWC  Dr Shirley McQuade  All the medical and nursing staff at DWWC