Problems and promises for out-of-lab tests for the detection of sexually transmitted diseases

Abstract

Before comprehensive microbiological laboratory services became standard, most doctor's offices had siderooms to examine stool and urinary specimens microscopically and to perform gram stains. In many remote areas of Canada, diagnostic siderooms persist, often run by nurse practitioners. With the development of rapid simple test kits, the doctor's office, the walk-in clinic, or the family planning clinic have the potential to provide rapid diagnostic testing for microbial diseases, particularly sexually transmitted diseases (STDs). Because STDs have high morbidity and, in some cases, mortality, rapid tests have become a target for industrial development (1). I In 1990, STDs represented 49.4% of all communicable diseases reported to the Laboratory Centre for Disease ControlOttawa, with Chlamydia trachomatis infections the most frequent (48,164 cases), followed by gonorrhoea (13,822 cases). The long-term disease burden of bacterial STDs is disproportionately borne by women who may develop sequelae such as pelvic inflammatory disease (PID), ectopic pregnancy, and infertility. Infections may be asymptomatic, especially for chlamydial disease, not becoming apparent until a woman experiences reproductive dysfunction, sometimes years after the initial infection. Asymptomatic STDs in males may also represent a hidden reservoir of transmission. Although syphilis incidence in Canada is not high (304 cases of primary and secondary syphilis in 1990), it remains an important STD because of the severity of untreated disease and the potentially harmful effects on maternal/child health. While the prevalance of viral STDs in Canada also is not as high, AIDS is especially important because it is fatal and because the presence of other STDs increases the risk of transmission of the human immunodeficiency virus (HIV). Genital infections with the human papilloma virus (HPV) have been implicated in cases of cervical cancer.