Medicine-Pediatrics| October 01 2005 Urine Tests for Detection of C trachomatis and N gonorrhoeae AAP Grand Rounds (2005) 14 (4): 41. https://doi.org/10.1542/gr.14-4-41 Views Icon Views Article contents Figures & tables Video Audio Supplementary Data Peer Review Share Icon Share Facebook Twitter LinkedIn MailTo Tools Icon Tools Get Permissions Cite Icon Cite Search Site Citation Urine Tests for Detection of C trachomatis and N gonorrhoeae. AAP Grand Rounds October 2005; 14 (4): 41. https://doi.org/10.1542/gr.14-4-41 Download citation file: Ris (Zotero) Reference Manager EasyBib Bookends Mendeley Papers EndNote RefWorks BibTex toolbar search toolbar search search input Search input auto suggest filter your search All PublicationsAll JournalsAAP Grand RoundsPediatricsHospital PediatricsPediatrics In ReviewNeoReviewsAAP NewsAll AAP Sites Search Advanced Search Topics: chlamydia trachomatis, neisseria gonorrhoeae, urinalysis, gold standard Source: Cook RL, Hutchison SL, Ostergaard L, et al. Noninvasive testing for Chlamydia trachomatis and Neisseria gonorrhoeae. Ann Intern Med. 2005;142:914–925. Testing for sexually transmitted diseases poses several logistic barriers for the patient, including making an appointment with a provider and undergoing a pelvic examination with cultures or a urethral swab. The authors, from the University of Pittsburgh, performed a meta-analysis after searching 1991 to 2004 MEDLINE literature to locate all studies of urine testing using the currently available commercial nucleic amplification tests for Chlamydia trachomatis and Neisseria gonorrhoeae. The methodologies covered by these amplification tests included polymerase chain reaction (PCR), strand displacement amplification (SDA), and transcription-mediated amplification (TMA). The authors found 29 studies meeting the predetermined minimum standards, which included presenting data separately by gender, obtaining samples for the same assay on both urine and cervical or urethral sites, and using an appropriate reference standard, the so-called “gold standard.” They pooled results from the 29 studies using both qualitative and quantitative methods. In general, the nucleic acid amplification tests currently available had a very high specificity (>95%) and a reasonably high sensitivity (80% to 93%). PCR testing for N gonorrhoeae in women performed poorly, with a sensitivity of 56%. The authors discussed the limitations of their findings, including the fact that current gold standards for detection of these pathogens are imperfect. They also did not attempt to find unpublished data, such as that submitted to the US Food and Drug Administration for test licensure, which might alter their results. Furthermore, amplification tests do not allow testing for antibiotic susceptibility or for detection of other important diseases such as trichomoniasis. Dr. Robbins has disclosed no financial relationships relevant to this commentary. For the adolescent with evolving privacy concerns, any method to break down logistic barriers to health care access is useful. If noninvasive testing for sexually transmitted diseases were not only easily available but also accurate, perhaps adolescents would seek care more readily for these disorders. The authors of this meta-analysis do a nice job of locating and combining all known data comparing nucleic amplification tests of urine samples to the gold standard of direct swab and culture for chlamydia and gonorrhea. The pooled specificity was quite high, which makes these tests useful for “ruling in” disease requiring treatment. The general pediatrician, however, is more interested in “ruling out” these infections in adolescents who present with genital complaints, and this requires a test with high sensitivity. The pooled sensitivities reveal negative likelihood ratios of 0.07 to 0.2, which generally are good enough to rule out disease in patients whose probability of having chlamydia or gonorrhea is no greater than 20% to 30%. (For a review of use of sensitivity and specificity to rule in or rule out a disease, see AAP Grand Rounds, June 2003;9:65.) It is up to the practitioner to decide whether the patient’s likelihood of disease is higher than this. If so, urethral... You do not currently have access to this content.
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