Which test is best for chlamydia?

Current Opinion in Infectious Diseases

Volumn 12, Issue 1, 1999, Pages 41-45

  Schachter, Julius ^a  

^a UNIVERSITY OF CALIFORNIA   (United States)

Author keywords

[No Author keywords available]

Indexed keywords

NUCLEIC ACID;

CHLAMYDIA TRACHOMATIS; CHLAMYDIASIS; DIAGNOSTIC APPROACH ROUTE; GENE AMPLIFICATION; GENETIC TRANSCRIPTION; HEALTH CARE COST; HUMAN; LIGASE CHAIN REACTION; POLYMERASE CHAIN REACTION; REVIEW; TISSUE CULTURE; URINE CULTURE; VAGINA SMEAR;

EID: 0033041646     PISSN: 09517375     EISSN: None     Source Type: Journal    
DOI: 10.1097/00001432-199902000-00008     Document Type: Review

References (31)

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2. Black CM. Current methods of laboratory diagnosis of Chlamydia trachomatis infections. Clin Microbiol Rev 1997; 10:160-184
3. Jaschek G, Gaydos CA, Welsh LE, Quinn TC. Direct detection of Chlamydia trachomatis in urine specimens from symptomatic and asymptomatic men by using a rapid polymerase chain reaction assay. J Clin Microbiol 1993; 31:1209-1212.
4. Chernesky MA, Lee H, Schachter J, Burczak JD, Stamm WE, McCormack WM, et al. Diagnosis of Chlamydia trachomatis urethral infection in symptomatic and asymptomatic men by testing first-void urine in a ligase chain reaction assay. J Infect Dis 1994, 170.1308-1311.
5. Schachter J, Stamm WE, Quinn TC, Andrews WW, Burczak JD, Lee HH. Ligase chain reaction to detect Chlamydia trachomatis infection of the cervix. J Clin Microbiol 1994; 32:2540-2543
6. Reichart CA, Moncada J, Schachter J, Koshakow M, Sedmak G, Reising S, et al. Multicenter evaluation of 'Clearview Chlamydia' for detection of Chlamydia trachomatis in women. 32nd Interscience Conference on Antimicrobial Agents and Chemotherapy, Anaheim, CA; 1992.
7. Woolley PD, Pumphrey J. Application of 'Clearview Chlamydia' for the rapid detection of cervical chlamydial antigen, Int J STD AIDS 1997; 8:257-258. The sensitivity of the Clearview test - approximately 76% - looks good until you realize that it is being compared with an EIA, which is only approximately 80% sensitive when compared with tissue culture, and certainly far less when compared with NAATs.
8. Suchland KL, Counts JM, Stamm WE. Laboratory methods for detection of Chlamydia trachomatis: survey of laboratories in Washington State. J Clin Microbiol 1997; 35:3210-3214. A most disturbing report indicating that it is common for small clinical laboratories to use rapid tests as a matter of convenience to avoid setting up better performing assays that are not suited to small volume operations
9. Bauwens JE, Clark AM, Stamm WE Diagnosis of Chlamydia trachomatis endocervical infections by a commercial polymerase chain reaction assay. J Clin Microbiol 1993; 31:3023-3027.
10. Ostergaard L, Agner T, Krarup E, Johansen UB, Weismann K, Gutschik E, PCR for detection of Chlamydia trachomatis in endocervical, urethral, rectal, and pharyngeal swab samples obtained from patients attending an STD clinic. Genitourin Med 1997; 73:493-497. PCR-posrtive results were obtained from anorectal and pharyngeal swab samples, suggesting that this test may be appropriate for such use. The methods for calculating specificity and sensitivity were inadequate; thus the reliability of tests with these specimens is uncertain.
11. Gaydos CA, Howell MR, Quinn TC, Gaydos JC, McKee Jr KT. Use of ligase chain reaction with urine versus cervical culture for detection of Chlamydia trachomatis in an asymptomatic military population of pregnant and nonpregnant females attending Papanicolaou smear clinics J Clin Microbiol 1998; 36-1300-1304. LCR is a highly sensitive method (more sensitive than culture by 20%) for diagnosing chlamydial infection with urine specimens from women, whether the women are pregnant or not.
12. Stary A, Schuh E, Kerschbaumer M, Gotz B, Lee H Performance of transcription-mediated amplification and ligase chain reaction assays for detection of chlamydial infection in urogenital samples obtained by invasive and noninvasive methods. J Clin Microbiol 1998, 36:2666-2670. A leading proponent of vulval swabs reports a study showing the equivalence of LCR and TMA for male (urine and urethral swab) and female (endocervical and vulval swab) specimens, but TMA was less sensitive with female urine specimens. Both NAATs were far more sensitive than tissue culture.
13. Berg ES, Anestad G, Moi H, Storvold G, Skaug K. False-negative results of a ligase chain reaction assay to detect Chlamydia trachomatis due to inhibitors in urine. Eur J Clin Microbiol Infect Dis 1997; 16-727-731. This study stresses the problem with leaving urine on sediment after centnfugation. Doing so with LCR specimens may cause a false-negative reaction.
14. Chernesky MA, Jang D, Sellors J, Luinstra K, Chong S, Castriciano S, et al. Urinary inhibitors of polymerase chain reaction and ligase chain reaction and testing of multiple specimens may contribute to lower assay sensitivities for diagnosing Chlamydia trachomatis infected women. Mol Cell Probes 1997; 11-243-249. This studies reports the multiple and different inhibitors of PCR and LCR. It also demonstrates that the more different tests on specimens one evaluates, the lower any single assay system's sensitivity will be.
15. Notomi T, Ikeda Y, Okadome A, Nagayama A. The inhibitory effect of phosphate on the ligase chain reaction used for detecting Chlamydia trachomatis. J Clin Pathol 1998; 51:306-308.
16. Ossewaarde JM, van Doornum GJ, Buimer M, Choueiri B, Stary A. Differences in the sensitivity of the Amplicor Chlamydia trachomatis PCR assay. Genrtourin Med 1997, 73:207-211.
17. Carroll KC, Aldeen WE, Morrison M, Anderson R, Lee D, Mottice S Evaluation of the Abbott LCx ligase chain reaction assay for detection of Chlamydia trachomatis and Neisseria gonorrhoeae in urine and genital swab specimens from a sexually transmitted disease clinic population J Clin Microbiol 1998; 36:1630-1633 A direct comparison of LCR (amplified) and non-amplified nucleic acid probe tests showed that the LCR test has a sensitivity of approximately 97% compared with the non-amplified test having a sensitivity of 66%
18. Beck-Sague CM, Farshy CE, Jackson TK, Guillory L, Edelkind D, Bullard JC, et al. Detection of Chlamydia frachomatis cervical infection by urine tests among adolescents clinics J Adolesc Health 1998; 22:197-204. Both PCR and LCR are sensitive and specific for use on urine and cervical specimens from women.
19. Howell WR, Quinn TC, Brathwaite W, Gaydos CA. Screening women for Chlamydia trachomatis in family planning clinics: the cost-effectiveness of DNA amplification assays Sex Transm Dis 1998; 25:108-117. A sophisticated cost-benefit analysis demonstrates that the benefit of preventing complications of chlamydial infection makes screening cost-effective in family planning clinics
20. Paavonen J, Puolakkainen M, Paukku M, Sintonen H Cost-benefit analysis of first-void urine Chlamydia trachomatis screening program. Obstet Gynecol 1998; 92:292-298. A cost-benefit analysis with a first-void urine screening program demonstrates that the use of PCR on urine specimens in family planning clinics would save money when the baseline prevalence of C trachomatis infection exceeds 3.9%.
21. Lee HH, Chernesky MA, Schachter J, Burczak JD, Andrews WW, Muldoon S, et al. Diagnosis of Chlamydia trachomatis genitourinary infection in women by ligase chain reaction assay of urine. Lancet 1995; 345-213-216
22. Schachter J, Moncada J, Whidden R, Shaw H, Bolan G, Burczak JD, et al. Noninvasive tests for diagnosis of Chlamydia trachomatis infection: application of ligase chain reaction to first-catch urine specimens of women. J Infect Dis 1995; 172,1411-1414.
23. Stary A, Najim B, Lee HH Vulval swabs as alternative specimens for ligase chain reaction detection of genital chlamydial infection in women. J Clin Microbiol 1997; 35 836-838. A demonstration that vulval swabs may be used instead of vaginal swabs. This could be of benefit as it requires no insertion of swabs and also probably demonstrates how forgiving this specimen is.
24. Pasternack R, Vuorinen P, Miettinen A. Evaluation of the Gen-Probe Chlamydia trachomatis transcription-mediated amplification assay with urine specimens from women. J Clin Microbiol 1997; 35:676-678. TMA is the least evaluated of any NAAT, but is shown here to be useful with urine specimens from women.
25. Puolakkainen M, Hiltunen-Back E, Reunala T, Suhonen S, Lahteenmaki P, Lehtinen M, et al. Comparison of performances of two commercially available tests, a PCR assay and a ligase chain reaction test, in detection of urogenital Chlamydia trachomatis infection. J Clin Microbiol 1998; 36:1489-1493. Another demonstration that collecting both urethral and cervical swabs increases the sensitivity of tissue culture and lessens the increments seen (but they are still a substantial increments) with NAATs.
26. Hook III EW, Smith K, Mullen C, Stephens J, Rinehardt L, Pate MS, et al. Diagnosis of genitourinary Chlamydia trachomatis infections by using the ligase chain reaction on patient-obtained vaginal swabs. J Clin Microbiol 1997; 35:2133-2135. This study reports the finding that self-collected vaginal swabs are essentially the equivalent of clinician-collected vaginal swabs, and provides comfort for proponents of screening programs in non-traditional medical settings if we do not need pelvic examinations to collect the specimens it will be far cheaper and probably better tolerated by the clients.
27. Schwebke JR, Sadler R, Sutton JM, Hook III EW. Positive screening tests for gonorrhea and chlamydial infection fail to lead consistently to treatment of patients attending a sexually transmitted disease clinic. Sex Transm Dis 1997; 24:181-184. This is an important paper because it forms much of the rationale discussing the need for rapid diagnostic tests, as prompt treatment does not occur with a substantial proportion of women who are screened for chlamydial infection.
28. Pate MS, Dixon PB, Hardy K, Crosby M, Hook III EW. Evaluation of the Biostar Chlamydia OIA assay with specimens from women attending a sexually transmitted disease clinic. J Clin Microbiol 1998; 36:2183-2186. Even using a method of evaluation that overstates sensitivity, one of the best rapid diagnostic tests is only 74% sensitive, whereas PCR and tissue culture are approximately 93% sensitive.
29. Burstein GR, Gaydos CA, Diener-West M, Howell MR, Zenilman JM, Quinn TC. Incident Chlamydia trachomatis infections among inner-city adolescent females. JAMA 1998; 280:521-526. The urine-based screening of sexually active high school students using NAATs finds not only a high prevalence of infection, but follow-up studies show sufficiently high incidence to justify re-screening at 6-12 month intervals.
30. Cohen DA, Nsuami M, Etame RB, Tropez-Sims S, Abdalian S, Farley TA, et al. A school-based Chlamydia control program using DNA amplification technology Pediatrics 1998; 101:E1. High school students' urine screened by PCR/LCR with the finding of more than 9% of girls and 4% of boys having asymptomatic chlamydial infection.
31. Gaydos CA, Howell MR, Pare B, Clark KL, Ellis DA, Hendrix RM, et al. Chlamydia trachomatis infections in female military recruits. N Engl J Med 1998; 339:739-744 The overall prevalence of chlamydial infection in female army recruits was approximately 9% as determined by urine-based screening with LCR.