Point-of-care testing for chlamydia and gonorrhoea: implications for clinical practice.

Lisa Natoli,Belinda Hengel,James Ward,Annie Tangey,Lisa Maher,Steven G Badman,Rebecca J Guy,Mark Shephard,David M Ojcius

doi:10.1371/journal.pone.0100518

Lisa Natoli, Belinda Hengel + Show 7 more

Open Access

https://doi.org/10.1371/journal.pone.0100518

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Abstract

ObjectivesPoint-of-care (POC) testing for chlamydia (CT) and gonorrhoea (NG) offers a new approach to the diagnosis and management of these sexually transmitted infections (STIs) in remote Australian communities and other similar settings. Diagnosis of STIs in remote communities is typically symptom driven, and for those who are asymptomatic, treatment is generally delayed until specimens can be transported to the reference laboratory, results returned and the patient recalled. The objective of this study was to explore the clinical implications of using CT/NG POC tests in routine clinical care in remote settings.MethodsIn-depth qualitative interviews were conducted with a purposively selected group of 18 key informants with a range of sexual health and laboratory expertise.ResultsParticipants highlighted the potential impact POC testing would have on different stages of the current STI management pathway in remote Aboriginal communities and how the pathway would change. They identified implications for offering a POC test, specimen collection, conducting the POC test, syndromic management of STIs, pelvic inflammatory disease diagnosis and management, interpretation and delivery of POC results, provision of treatment, contact tracing, management of client flow and wait time, and re-testing at 3 months after infection.ConclusionsThe introduction of POC testing to improve STI service delivery requires careful consideration of both its advantages and limitations. The findings of this study will inform protocols for the implementation of CT/NG POC testing, and also STI testing and management guidelines.

Highlights

Chlamydia trachomatis (CT) and Neisseria gonorrhoeae (NG) cause sexually transmissible infections (STIs) that are fully curable with single dose treatment but are often asymptomatic for long periods of time [1]
Both infections can lead to serious complications [1] including pelvic inflammatory disease (PID) [2], ectopic pregnancy and tubal factor infertility [3,4], and a range of adverse pregnancy and neonatal outcomes.[5,6]
Participants highlighted the potential impact POC testing would have on different stages of the current STI management pathway in remote Aboriginal communities and how the pathway would change

Summary

Introduction

Chlamydia trachomatis (CT) and Neisseria gonorrhoeae (NG) cause sexually transmissible infections (STIs) that are fully curable with single dose treatment but are often asymptomatic for long periods of time [1]. Both infections can lead to serious complications [1] including pelvic inflammatory disease (PID) [2], ectopic pregnancy and tubal factor infertility [3,4], and a range of adverse pregnancy and neonatal outcomes.[5,6]. In the absence of diagnostic tests for STIs, the World Health Organisation recommends ‘syndromic management’ as the approach to diagnosing and treating common STIs [13]. Remote clinical services undertake syndromic management plus send specimens to laboratories for testing, with asymptomatic patients treated once the results are received from the laboratory

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