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A Useful Screening Test for Detecting Sexually Transmitted Disease in the Adolescent Male

Matthew D. Sadof, MD; Elizabeth R. Woods, MD, MPH; S. Jean Emans, MD

JAMA. 1987;258(14):1932-1934.

Abstract
Although sexually active female adolescents are often routinely screened for sexually transmitted diseases, indications for culturing adolescent males for sexually transmitted urethral infections are controversial. A study of 54 sexually active males (14 to 22 years old) was undertaken to assess the reliability of using dipstick leukocyte esterase activity in first-catch urine specimens to detect urethritis caused by Neisseria gonorrhoeae and Chlamydia trachomatis. Eighteen males had sexually transmitted diseases: N gonorrhoeae (nine patients), C trachomatis (eight patients), and N gonorrhoeae and C trachomatis (one patient). First-catch urine specimens with a 1 + (mild) or 2 + (moderate) reaction on dipstick testing had a leukocyte (WBC) count of 10 WBCs per high-power field or greater on microscopic analysis, with an 83% sensitivity, 100% specificity, a 100% positive predictive value, and a 92% negative predictive value for the presence of N gonorrhoeae, C trachomatis, or both. Clinical criteria for screening (urethral discharge, dysuria, or exposure to a sexually transmitted infection) plus a dipstick-positive first-catch urine specimen had a 94% sensitivity, 89% specificity, an 81% positive predictive value, and a 97% negative predictive value.

(JAMA 1987;258:1932-1934)

Author Affiliations
From the Division of Adolescent/Young Adult Medicine, The Children's Hospital, and the Department of Pediatrics, Harvard Medical School, Boston.

Footnotes
Reprint requests to Division of Adolescent/Young Adult Medicine, The Children's Hospital, 300 Longwood Ave, Boston, MA 02115 (Dr Emans).

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