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Evidence summaries

Laboratory Testing for Chlamydia Trachomatis and Neisseria Gonorrhoeae

The sensitivity and specificity of nucleic acid amplification is high for the detection of chlamydial and gonococcal infection. However, in women vaginal swabs are more reliable than urine specimens. Level of evidence: "B"

A systematic review 1 including 21 studies with a total of 17,737 samples was abstracted in DARE. There were 572 culture-positive female samples and 901 culture-positive male samples, and 92 other or total culture-positive samples. In detecting gonococcal infections of the endocervix the sensitivity of nucleic acid hybridisation was 92.1% and specificity was 99.1%. For LCR the sensitivity was 96.7% and the specificity 99.1%). In detecting gonococcal infection of the male urethra, the sensitivity of nucleic acid hybridisation was 96.4% and specificity was 98.8%. For LCR the sensitivity was 98.6% and the specificity was 99.97%. For detecting gonococcal infection in a urine specimen, the sensitivity of LCR for women was 96.2% and the specificity was 100.0%. For men, the sensitivity was 98.3% and the specificity was 100.0%.

A study 2 comparing 4 second-generation nucleic acid amplification tests performed with self-collected vaginal swab and first-void urine included 575 women. Vaginal swabs indicated more infections than did urine specimens in all assays. The prevalence rates were 9% (53/575) for Chlamydia trachomatis and 2% (11/575) for Neisseria gonorrhoeae. The clinical sensitivities for C. trachomatis for vaginal specimens varied from 90.0 to 98.1% and for urine specimens from 75.5 to 88.7%. Clinical sensitivities of the assays for N. gonorrhoeae, with limited positive results, ranged from 63.6% to 100%. Specificities for both infections ranged from 98.4 to 100%.

    References

    • Koumans EH, Johnson RE, Knapp JS, St Louis ME. Laboratory testing for Neisseria gonorrhoeae by recently introduced nonculture tests: a performance review with clinical and public health considerations. Clin Infect Dis 1998 Nov;27(5):1171-80. [PubMed] [DARE]
    • Chernesky M, Jang D, Gilchrist J et al. Head-to-head comparison of second-generation nucleic acid amplification tests for detection of Chlamydia trachomatis and Neisseria gonorrhoeae on urine samples from female subjects and self-collected vaginal swabs. J Clin Microbiol 2014;52(7):2305-10. [PubMed]

Primary/Secondary Keywords