Case Series on Trichomonas vaginalis Infections: Impact of Proper Sample Collection and Diagnostic Stewardship
This article has been Reviewed by the following groups
Discuss this preprint
Start a discussion What are Sciety discussions?Listed in
This article is not in any list yet, why not save it to one of your lists.Abstract
This paper elucidates the transformative impact of a strategic shift in diagnostic practices in the detection of Trichomonas vaginalis (T. vaginalis). It explores five cases where the implementation of a specific diagnostic protocol led to effective identification of the infection. In-depth discussions and a comprehensive literature review underline the necessity for precise diagnosis and the paramount importance of diagnostic stewardship in managing sexually transmitted infections.
Article activity feed
-
This is a study that would be of interest to the field and community.
-
-
This is a study that would be of interest to the field and community. However, there are important edits required as highlighted by peer-reviewers - specifically related to referencing. Please address these significant concerns before further consideration can be given to publication.
-
-
Comments to Author
Overall it's well written and the subject matter is important. There are issues with the references which should be reviewed and an incorrect assertion that metronidazole is unsafe in pregnancy which must be corrected. -heading Introduction: 1. Reference 2 (Das et al 2011) does not support 2-10% figure - please review 2. Reference 3 (Patel et al 2006) does not support 7% figure nor any specific reference to Gujarat - please review -heading a) Traditional Diagnostic Approaches: 3. Reference 1 (Schwebke et al 2004) does not support suggestion sensitivity of microscopy is as low as 50% - they state 60-70% sensitivity. Please review. -heading Case presentation: 4. Please specify metronidazole doses used and strength of topical treatments. 5. In case 3 - please remove the following sentence as it …
Comments to Author
Overall it's well written and the subject matter is important. There are issues with the references which should be reviewed and an incorrect assertion that metronidazole is unsafe in pregnancy which must be corrected. -heading Introduction: 1. Reference 2 (Das et al 2011) does not support 2-10% figure - please review 2. Reference 3 (Patel et al 2006) does not support 7% figure nor any specific reference to Gujarat - please review -heading a) Traditional Diagnostic Approaches: 3. Reference 1 (Schwebke et al 2004) does not support suggestion sensitivity of microscopy is as low as 50% - they state 60-70% sensitivity. Please review. -heading Case presentation: 4. Please specify metronidazole doses used and strength of topical treatments. 5. In case 3 - please remove the following sentence as it incorrectly implies oral metronidazole is unsafe in pregnancy: "Considering her pregnancy, the patient was treated with topical metronidazole gel to avoid potential risks associated with oral medication" 6. Cases 4 and 5 have no treatment mentioned. please review. heading Shift in Diagnostic Protocols 7. Reference 7 (Ali and Nozaki 2007) is a review article about therapeutics for parasites. It contains nothing about diagnostic processes. Please review. -heading Treatment Protocols for Trichomonas vaginalis: 8. Please state doses used for metronidazole. 9. Pregnant patients: There is no evidence of teratogenicity from use of oral metronidazole during any stage of pregnancy. However, there is evidence that TV causes serious complications in pregnancy such as pre-term delivery and low birth weight. The efficacy of topical therapeutics for TV are uncertain at best - conflicting results in the literature, some suggesting topical metronidazole is inferior to systemic therapy. This is reflected in the WHO guideline you mention whereby they advise topical metronidazole is not recommended for TV and that oral metronidazole is recommended for treatment of TV in pregnancy (Sherrard, IUSTI/WHO management of vaginal discharge 2018). As such, I cannot condone suggesting to the reader that topical treatment of TV in pregnancy is sufficient. 10. Please provide references for WHO and CDC guidelines. -heading 2. The Role of Sensitization and Training: 11. Reference 8 (Patel AL et al. Clin Infect Dis 2021; 73(Suppl 1):S55-61) - this paper does not exist. Please review. 12. Reference 9 (Luther et al. 2018) does not support the statement made about positive impact on training interventions. Please review.
Please rate the quality of the presentation and structure of the manuscript
Good
To what extent are the conclusions supported by the data?
Partially support
Do you have any concerns of possible image manipulation, plagiarism or any other unethical practices?
No
Is there a potential financial or other conflict of interest between yourself and the author(s)?
No
If this manuscript involves human and/or animal work, have the subjects been treated in an ethical manner and the authors complied with the appropriate guidelines?
Yes
-
Comments to Author
1. Comment I would expect that as part of timely processing of samples, sometimes a mini side lab equiped with basic microscopy equipment and personnel is deployed to achieve this and also reduce GU samples competing with general lab samples. So how did you achieve timely transportation and processing? 196 Timely Processing: Ensuring that samples are transported to the laboratory and 197 processed as swiftly as possible to maintain organism viability. 2. Comment How can sample volume be termed adequate in samples taken with swabs? 202 Volume and Technique: Adequate sample volume and correct swabbing technique to 203 ensure a representative sample.
Please rate the quality of the presentation and structure of the manuscript
Very good
To what extent are the …
Comments to Author
1. Comment I would expect that as part of timely processing of samples, sometimes a mini side lab equiped with basic microscopy equipment and personnel is deployed to achieve this and also reduce GU samples competing with general lab samples. So how did you achieve timely transportation and processing? 196 Timely Processing: Ensuring that samples are transported to the laboratory and 197 processed as swiftly as possible to maintain organism viability. 2. Comment How can sample volume be termed adequate in samples taken with swabs? 202 Volume and Technique: Adequate sample volume and correct swabbing technique to 203 ensure a representative sample.
Please rate the quality of the presentation and structure of the manuscript
Very good
To what extent are the conclusions supported by the data?
Strongly support
Do you have any concerns of possible image manipulation, plagiarism or any other unethical practices?
No
Is there a potential financial or other conflict of interest between yourself and the author(s)?
No
If this manuscript involves human and/or animal work, have the subjects been treated in an ethical manner and the authors complied with the appropriate guidelines?
Yes
-
-
Thank you for your submission to Access Microbiology. The editorial board has now considered your article 'Case Series on Trichomonas vaginalis Infections: Impact of Proper Sample Collection and Diagnostic Stewardship' and awarded the following outcome: Major Revision Required. Major revisions will need to be made before we can consider sending your manuscript for external peer review. Specific comments from the editorial board which should be made prior to resubmission are highlighted in comments below: - This manuscript presents a case series of 5 cases of Trichomonas vaginalis infections and reports a change to local diagnostic and sampling protocols - Whilst it is implied within the manuscript that the key change has been to shift from standard culture to wet mount microscopy, this is not explicitly or clearly described. Please …
Thank you for your submission to Access Microbiology. The editorial board has now considered your article 'Case Series on Trichomonas vaginalis Infections: Impact of Proper Sample Collection and Diagnostic Stewardship' and awarded the following outcome: Major Revision Required. Major revisions will need to be made before we can consider sending your manuscript for external peer review. Specific comments from the editorial board which should be made prior to resubmission are highlighted in comments below: - This manuscript presents a case series of 5 cases of Trichomonas vaginalis infections and reports a change to local diagnostic and sampling protocols - Whilst it is implied within the manuscript that the key change has been to shift from standard culture to wet mount microscopy, this is not explicitly or clearly described. Please include a paragraph which clearly articulates what the previous standard diagnostic protocols were, and how they have now been changed. - Similarly, the manuscript makes repeated reference to improving 'proper sampling', however there is no description as to what the authors mean in relation to sampling standards. How have these changed and what is the new standard? - The abstract states the authors have conducted a comprehensive literature review, however this is not apparent in the main body of the manuscript. A comprehensive literature review of TV infections should be performed or at least referenced int he linked literature. - The authors state disease burden is high however offer no epidemiological data to corroborate estimates of TV incidence or prevalence. - The introduction states 5 cases of female TV infections will be presented, then 4 females and 1 male are discussed in the main body of the manuscript. - It is unclear as to the timescale over which these patients were identified. Please clearly include dates of the cases in order to strengthen your assertion that the diagnoses were a result of changes in diagnostic practices. - The authors report that TV is a 'clinical chameleon', insinuating that this diagnosis cannot be reached on the basis of clinical history and examination findings alone. There is a spectrum of clinical presentations reported ranging from asymptomatic carriage to vaginal/urethral discharge and bleeding - please comment on what protocols are in place to trigger testing for TV - is there a specific set of symptoms, risk profile, patient characteristics? - Despite these non-specific presentations, there is no description of other diagnostic tests or investigations conducted e.g. chlamydia or gonorrhoea NAAT, microscopy for clue cells, syphilis or HIV testing. These should be included with results to ensure no evidence of co-infection. - There is inconsistent reporting of treatment protocols - ranging from a single dose metronidazole to 1 week of therapy. Please provide clearer overview of treatment administered, the rationale, and which treatment guidelines are being followed. - Diagnostic stewardship refers to utilising the correct diagnostic test, for the correct patient, in the correct circumstances. Please expand on how you feel microscopy achieves this goal, given the manuscript currently suggests that this will be undertaken for all patients irrespective of symptoms. - There is limited discussion of what the training package entailed. Please elaborate on who this training was directed to, what did it include, what were the overarching goals, and how has this has impacted practice. Are there quantifiable measures to assess practice before and after implementation of the training? - Finally, the suggested peer reviewers appear to also be affiliated with the All India Institute of Medical Sciences and would be inappropriate to act as reviewers. Please suggest reviewers from alternative institutions, who you have not previously published or worked with. If you are able to address the above concerns, we would be happy to arrange external peer review upon re-submission. Thank you for submitting to Access Microbiology.
-