Evaluation of urine-based screening strategies to detect Chlamydia trachomatis among sexually active asymptomatic young males
M. A. Shafer, J. Schachter, J. Moncada, J. Keogh, R. Pantell, L. Gourlay, S. Eyre and C. B. Boyer
Department of Pediatric, University of California, San Francisco 94143.
OBJECTIVE--To evaluate the performances of diagnostic screening tests alone
or in combination to detect asymptomatic chlamydial urethral infection in
young males. DESIGN--Comparisons of the performance profiles of the
following chlamydia screening strategies were done: urethral culture;
identification of polymorphonucleocytes (PMNs) on spun first-void urine
(FVU); urinary leukocyte esterase test (LET) on unspun FVU; chlamydial
enzyme immunoassay (EIA) applied to FVU sediment; combining LET on unspun
FVU followed by EIA with or without direct fluorescent antibody (DFA)
confirmation on FVU sediment; and combining PMNs on spun FVU followed by
EIA with or without DFA confirmation. SETTING--General clinics at a youth
detention center, university-based teen clinic, college health service, and
a military screening clinic. PATIENTS--A total of 618 males aged 12 to 35
years (mean, 17 years) were recruited as a convenience sample; site
participation rates ranged from 50% to 80%. Eligible subjects were sexually
active, denied symptoms of urethritis, and had taken no antibiotics in the
prior 2 weeks. MAIN OUTCOME MEASURES--Sensitivity, specificity, and
positive and negative predictive values of each test strategy's ability to
detect Chlamydia trachomatis infection, and cost to confirm each positive
case. RESULTS--With a 7% prevalence of chlamydial infection, tissue culture
had a sensitivity of only 61%. However, two strategies yielded
significantly better performance profiles compared with the others: EIA
confirmed by DFA test with a sensitivity of 84%, a specificity of 100%, and
a cost to identify each positive case of $434; and PMNs followed by EIA
confirmed by DFA test with a sensitivity of 78%, a specificity of 100%, and
a cost to identify each positive case of $199. The LET followed by EIA-DFA
had a similar performance profile to the PMN test strategies.
CONCLUSIONS--A combination of a nonspecific screening of FVU for PMNs or
LET followed by specific testing with EIA with DFA confirmation has
superior clinical and cost-effective performance for detecting asymptomatic
C trachomatis urethritis in young males compared with other strategies.
However, an evaluation of the medical, fiscal, and psychological benefits
and risks associated with a specific screening strategy for sexually
transmitted diseases must be made before adopting a specific strategy for a
particular population.
Male Genital Tract Chlamydial Infection: Implications for Pathology and Infertility
Cunningham and Beagley
Biol. Reprod. 2008;79:180-189.
ABSTRACT
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Low Sensitivity of the Leukocyte Esterase Test (LET) in Detecting Chlamydia trachomatis Infections in Asymptomatic Men Entering a County Jail
Ratelle et al.
JOURNAL OF CORRECTIONAL HEALTH CARE 2004;10:217-226.
ABSTRACT
The accuracy and efficacy of screening tests for Chlamydia trachomatis: a systematic review
WATSON et al.
J Med Microbiol 2002;51:1021-1031.
ABSTRACT
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Detection of Chlamydia trachomatis in an Australian high school student population
Debattista et al.
Sex. Transm. Infect. 2002;78:194-197.
ABSTRACT
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Chlamydial Serology: Comparative Diagnostic Value of Immunoblotting, Microimmunofluorescence Test, and Immunoassays Using Different Recombinant Proteins as Antigens
Bas et al.
J. Clin. Microbiol. 2001;39:1368-1377.
ABSTRACT
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The prevalence of Chlamydia trachomatis infection in male undergraduates: a postal survey
Rogstad et al.
Sex. Transm. Infect. 2001;77:111-113.
ABSTRACT
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Prevalence of Chlamydia trachomatis in young men in north west London
Pierpoint et al.
Sex. Transm. Infect. 2000;76:273-276.
ABSTRACT
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A School-based Chlamydia Control Program Using DNA Amplification Technology
Cohen et al.
Pediatrics 1998;101
:e1-e1.
ABSTRACT
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Gonococcal and Chlamydial Genitourinary Infections in Symptomatic and Asymptomatic Adolescent Women
Biro et al.
CLIN PEDIATR 1995;34:419-423.
ABSTRACT
SCREENING AND TREATING ASYMPTOMATIC CHLAMYDIA
JWatch General 1993;1993:4-4.
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