Use of Urine Ligase Chain Reaction to Identify the Asymptomatic Adolescent Female with Chlamydia Genitourinary Infection

Abstract

<h3>Background</h3> Ligase chain reaction (LCR) is a diagnostic modality with excellent sensitivity for the detection of chlamydia. This study compared urine and endocervical LCR to chlamydia culture, and clinical performance characteristics between those with and without symptoms. <h3>Method</h3> Patients (ages 13–21) were enrolled from an adolescent clinic (N=317) and a pediatric emergency room (N=62). Clinical history was collected prospectively, distinguishing between spontaneous and elicited symptoms. Endocervical specimens were obtained for chlamydia culture, LCR, and slide for confirmation by DFA. Sensitivity and specificity for each of the methods were calculated, and tests results compared by symptom status. <h3>Results</h3> Mean age was 16.6 yrs (± 1.9). The majority of the patients were African-American (N=275, 72.6 %). The total number of those positive by culture was 10.8 %, endocervical LCR 14.5 %, and urine LCR 12.7 %. The sensitivity and specificity of each test follow: culture 72.2 and 99.7; endocervical LCR 92.5 and 98.6; and urine LCR 84.6 and 98.9. A total of 147 (38.8 %) patients were asymptomatic; among these, 112 urine LCR were performed, with chlamydia prevalence of 15% and urine LCR sensitivity 82.4 %. <h3>Conclusions</h3> Both urine and endocervical LCR have superior sensitivity with similar specificity to chlamydia culture. The prevalence among asymptomatic adolescent females was 15 %, and urine LCR detected the majority of asymptomatic infections (82 %). In this study, 32 % of infections occurred among the asymptomatic. Previous studies have documented the likelihood of transmitting an STD (gonorrhea) is greater among the asymptomatic than the symptomatic. Urine LCR is a potentially effective tool to help eliminate the burden of infection among adolescents.