Pap postive, Culture negative - Which more accurate?

[tle08]

I was experiencing some symptoms (watery greenish discharge, itching, inflammation) and went in for a pap. When my lab results came back the doctor told me that I was negative for gonohorrea and chlamydia, but prescribed doxycycline and vandazole for the inflammation in my cervix. Those did not help my symptoms and I didn't feel like my doctor was very helpful. So I went to an OB-GYN to get a second opinion. She looked at my previous lab results and told me that Trichomonas was identified. Not sure why my previous doctor didn't say anything about that, but that's besides the point. The OB-GYN said that in her experience my symptoms were conducive to trich, but took a culture to confirm and would call me with the lab results. In the meantime, she prescribed metranidazole, which has been helping. She called me the next day and told me that the culture lab results came back negative for trich, gono and chlam.

So how is it that my pap smear tested positive for Trichomonas, but my culture tested negative? Which test is more accurate?? Any insight?

I asked my OB-GYN, and she told me that the culture samples are small, so if trich showed up in my pap, then it's likely that is what I have. Also, a number of things could have occurred with the swabs - the samples dried up prior to being analyzed, human error in identifying the organism, etc. However, when I did my own research, it appears paps are not very reliable in diagnosing trich and should be confirmed with a culture...which did not help much in my case.  I have another appointment in about a week. I would like to get a third test to figure out what this is, but with the treatment I'm getting now, it may no longer be present.

[Dallasfan]

The PAP smear you had will definitely show any trichomonas. In fact Trich is one thing that is routinely scanned for when a PAP smear is read. If you had Trich on your PAP smear , then you had trich and you and your partner should be treated. Cultures for trich are not done. They are not routinely done, and are available only as a research tool. I am not sure what  "research" you read, but PAP smears are the  BEST way to diagnose trich in addition to a fresh wet mount microscopic exam. Cultures for Chlamydia and gonorrhea are not available  "the next day'" as you said. You apparently had an elisa or NAAT or similar test done rapidly overnight. Be sure to have your partner examined and treated. Hope you are well soon. Take care.

[tle08]

Thanks for the response, Dallas.

Most of the research I did was online, so it's not the most reliable source of information, I know, but there are several reputable sites I read through. Also, I looked at several forums on this site, particularly the responses from Dr. HHH, which gave me similar information regarding the reliability of paps in diagnosing trich (http://www.medhelp.org/posts/show/248371, http://www.medhelp.org/posts/show/249223). The terminology for the tests I was given came from my physicians, so I'm not sure about the comment regarding the culture being routine or not.

I don't have any doubt that something is wrong, and my partner will be examined and treated, but it is just extremely confusing how one test can come up positive and the other negative. How are you supposed to determined which one is more accurate? Both have potential for error, I'm sure.