Correlation between urine and cervical specimens for the detection of cervical Chlamydia trachomatis and Neisseria gonorrhoeae using ligase chain reaction in a cohort of HIV infected and uninfected adolescents.

Abstract

(a) To examine the concordance between ligase chain reaction (LCR) results from urine and cervical samples for Chlamydia trachomatis and Neisseria gonorrhoeae in HIV infected and uninfected adolescent women, and (b) to examine factors that may influence the concordance of LCR results in this population. Baseline specimens from 269 of 334 female subjects enrolled in a longitudinal study of HIV infection in adolescents were analyzed for C. trachomatis and N. gonorrhoeae using ligase chain reaction (LCR) assays in a central laboratory. Concordance was measured using kappa coefficient with permutation analyses to calculate the difference between HIV status groups. Discordant LCR results were examined for the co-infection with the other microorganism, bacterial vaginosis, or Trichomonas vaginalis. The prevalence of C. trachomatis detected by LCR in the HIV infected and uninfected groups was 19.3% and 12.2%, respectively (p = .16); the prevalence of N. gonorrhoeae was 7.0% and 2.4%, respectively (p = .16). Urine LCR assay sensitivity to detect cervical C. trachomatis infection was 86% (95% CI: 68%-96%) in the HIV infected group and 100% (95% CI: 69%-100%) in the HIV uninfected group. Urine LCR assay sensitivity to detect cervical N. gonorrhoeae infection was 92% (95% CI: 62%-100%) in the HIV infected group. There were only 2 N. gonorrhoeae infections in the HIV uninfected group, and both were urine LCR positive. Differences in sensitivity between HIV infected and HIV uninfected subjects were not statistically significant. Coinfection with N. gonorrhoeae, bacterial vaginosis or Trichomonas vaginalis was not associated with the concordance of urine and cervical LCR results. The relatively high sensitivity of urine LCR testing overall suggests that urine screening may be reasonable for sexually active adolescent females with or without HIV infection in situations in which urine screening may be more acceptable than pelvic examinations.