Reviewer's report
Title:Prevalence of Trichomonus Vaginalis Infection in Egyptian Women: Cross-
Sectional Study
Version:6Date:7 October 2014
Reviewer: Barbara Body
Reviewer's report:
Major compulsory revisions:
1) Although the authors addressed why they chose not to look at other causes of
vaginitis in their cover letter, they didn’t include this information in the manuscript.
A
simple statement such as, “We have previously studied other causes of vaginitis
in our
center and limited this study to a large scale cross-sectional study to assess the
incidence of Trichomonas.” would be sufficient. Statement added at the
beginning of
the discussion (line 156, 157). I think this statement would be better added at line
65.
2) The manuscript needs to clarify exactly what number of specimens were
uniquely
positive by culture, Giemsa, wet prep and Kalon. If Kalon detected all 50
positives –
those positive by culture, Giemsa and Wet prep, that would be remarkable. As
shown by
table 1 (which was added in the previous revision): Culture detected 30 true
positive,
Kalon detected 50 positive (but 20 of them were false positive), Wet mount
detected 10
Positives. The authors have missed my point. It is highly unusual that culture did
not detect most of the specimens positive by Giemsa stain so the question is
‘Were there 30 specimen positive by culture and of those 30, ten were also
detected by Giemsa?’ The statements on lines 183-184 imply Giemsa and wet
prep each detected 10 specimens not detected by culture. I my experience this is
not typical of the performance of the culture or smears.
3) I don’t find credible the high percentage of specimens positive uniquely by
Geimsa
and wet prep (& possibly Kalon), respectively compared to culture. This is not
comparable to data in the literature which would typically show wet prep
orGeimsa to
detect about 50% of those specimens positive by culture. This unusal
performance
needs explanation. Wet mount and Giemsa detected ONLY 10 positive cases –
were those the same 10 in each case and were they also detected by culture?,
Kalon
detected 30 positive cases out of the whole 50 positive cases (as the other 20
positive
cases detected by Kalon were false positive when compared to Culture), and this
is
comparable to Literature (Table 1).
4) The focus of this manuscript and therefore the conclusions and
recommendations
should be statements pertaining to the testing of women for Trichomonas
vaginalis. It is
not appropriate for the conclusion & recommendation section to make
conclusions
about the reliability of the Kalon latex agglutination
test reliability. This manuscript has not presented data that demonstrates by
discrepant
analysis that the results of the Kalon test were correct. The conclusion and
recommendations focused on Latex agglutination, coming from its availability,
easiness,
relatively cheap (in our community), and not time consuming, in order to consider
adding it as a screening test in the gynecology clinics in Egypt (at least university
hospitals) (as done with Pap smear for cancer cervix…) as it will help in rapid
and more
or less accurate screening, and start treatment for cases suspected to have
T.vaginalis
infection.
5) Photos are unlabelled and without narrative duplicate photos are still present
and
need to be removed for the Giemsa stain and wet prep. For the Wet Prep photo, I
would
use only the small photo on the upper left. Label to the photos added. Two
photos of Giemsa are still present – one needs to be deleted.
Minor essential revisions
There are still numerous typographical errors.
Level of interest: An article whose findings are important to those with closely
related research interests
Quality of written English: Acceptable
Statistical review: Yes, and I have assessed the statistics in my report.
Declaration of competing interests:
I have participated in clinical trials for the FDA
clearance of nucleic acid amplification tests from two manufacturers. I did not
receive
compensation but the company for which I work was paid to perform the testing. I
do
not have any other financial or non-financial competing interests