Utility of Urine Nucleic Acid Detection Test for C. Trachomatis and N. Gonorrhoeae in Juvenile Detention Center

Abstract

<h3>Background</h3> This study was undertaken to determine efficacy of a urine based nucleic acid detection test for identification of gonococcal and chlamydial infections in adolescent females and males in detention. <h3>Methods</h3> Subjects were high risk adolescents admitted (May-Dec 1996) to an 80-bed youth detention center located in an urban community with relatively high STD rates. The STD screening was linked to a court-ordered drug screeriing program. A vial of non-sterile voided urine specimen collected at the time of detention for drug screening was used for STD screening. Urine specimens were refrigerated until a verbal consent to participate in the STD screening was obtained (within 72 hours of admission), arisported to the laboratory, and batched for the biweek1y assay for detection of <i>C. trachomatis</i> (Cf) and <i>N. gonorrhoeae</i> (GC) nucleic acids. Ligase chain reaction assay (LCR) was used. The laboratory test results were available within 1–3 days of specimen delivery to the laboratory. Positive cases were treated in the on-site clinic, or if released from the detention before treatment, STD positive subjects were contacted (by phone or mail) to return to a community based adolescent clinic for treatment. <h3>Results</h3> 261 subjects were approached and 4 (1.5%; all males) refused to give a consent. Of 257 participants (l5.6±1.3 y.o.), 15% were females; 82.5% B, 17.5% W; 13% had spent at least one night in group homes or shelters; 79% had Hx of marijuana use; 13% had been in treatment programs for drug use; and 35% were dropped out of school; 48% had no medical care in last one year. 57% of females and 21% of males had a Hx of running away from home; 8% of females and 24% of Males were in a gang; 47% of females and 13% of males had a past Hx of treatment for STD. CT positive rates were 29% (11/38) in females and 9% (20/2/19) in males. GC positive rates were 5.3% (2/38) among females and 3.2% (7/219) in males. Overall, 13.2% (34/257) were positive for GC or CT; 2.3% (6) had both. All positive subjects including those who were released from detention before the laboratory test reports were located and managed according to the standard recommendation for STD treatment of the CDC. <h3>Conclusion</h3> LCR based urine screening linked with drug screening program was extremely effective in identifying and treating unsuspected CT and GC infections in a cohort of high risk adolescents, enabling us to capture an opportunity for STD control that would have been missed otherwise.