Endocervical Swab Specimens Research Articles

The prevalence of Chlamydia trachomatis and Neisseria gonorrhoeae in the endocervical swab specimens of symptomatic, asymptomatic and infertile women in Turkey

To investigate C. trachomatis and N. gonorrhoeae prevalence in three different female populations in Turkey. A total of 370 women, 170 symptomatic, 100 asymptomatic, and 100 infertile, were included. Of the endocervical specimens collected from all women using a Dacron swab, the first one was taken to Stuart's transport medium to culture, while the second one was transferred onto slides to perform direct fluorescent antibody test (DFA) and Gram staining, and the third specimen was used for Becton Dickinson BDProbeTec ET system (BDPT). C. trachomatis was detected in 5.16% of symptomatic, 1.11% of asymptomatic, and 2.15% of infertile women with BDPT. Sensitivity and specificity of the DFA test were 72.73 and 97.85%, respectively. N. gonorrhoeae was detected in 2.42% of symptomatic and in 1.02% of infertile women. N. gonorrhoeae was not detected in any asymptomatic women. In N. gonorrhoeae-positive patients, sensitivity and specificity of culture were 60 and 100%, respectively, while they were 80 and 100% for BDPT. Prevalence of N. gonorrhoeae and C. trachomatis was detected to be low in Turkish women, and the difference between the groups was not significant. Both agents were more prevalent in subjects over 25 years of age.

APTIMA assay on SurePath liquid-based cervical samples compared to endocervical swab samples facilitated by a real time database

Background:Liquid-based cytology (LBC) cervical samples are increasingly being used to test for pathogens, including: HPV, Chlamydia trachomatis (CT) and Neisseria gonorrhoeae (GC) using nucleic acid amplification tests. Several reports have shown the accuracy of such testing on ThinPrep (TP) LBC samples. Fewer studies have evaluated SurePath (SP) LBC samples, which utilize a different specimen preservative. This study was undertaken to assess the performance of the Aptima Combo 2 Assay (AC2) for CT and GC on SP versus endocervical swab samples in our laboratory.Materials and Methods:The live pathology database of Montefiore Medical Center was searched for patients with AC2 endocervical swab specimens and SP Paps taken the same day. SP samples from CT-and/or GC-positive endocervical swab patients and randomly selected negative patients were studied. In each case, 1.5 ml of the residual SP vial sample, which was in SP preservative and stored at room temperature, was transferred within seven days of collection to APTIMA specimen transfer tubes without any sample or patient identifiers. Blind testing with the AC2 assay was performed on the Tigris DTS System (Gen-probe, San Diego, CA). Finalized SP results were compared with the previously reported endocervical swab results for the entire group and separately for patients 25 years and younger and patients over 25 years.Results:SP specimens from 300 patients were tested. This included 181 swab CT-positive, 12 swab GC-positive, 7 CT and GC positive and 100 randomly selected swab CT and GC negative patients. Using the endocervical swab results as the patient’s infection status, AC2 assay of the SP samples showed: CT sensitivity 89.3%, CT specificity 100.0%; GC sensitivity and specificity 100.0%. CT sensitivity for patients 25 years or younger was 93.1%, versus 80.7% for patients over 25 years, a statistically significant difference (P = 0.02).Conclusions:Our results show that AC2 assay of 1.5 ml SP samples transferred to APTIMA specimen transfer medium within seven days is sufficiently sensitive and specific to be used to screen for CT and GC. CT sensitivity may be somewhat reduced in samples from patients over 25 years. SP specimens retained in the original SP fixative for longer time intervals also may have decreased sensitivity, due to deterioration of RNA, but this was not assessed in this study. The ability to tap the live pathology database is a valuable tool that can useful to conduct clinical studies without a costly prospective clinical trial.

Comparison of APTIMA Trichomonas vaginalis transcription-mediated amplification to wet mount microscopy, culture, and polymerase chain reaction for diagnosis of trichomoniasis in men and women

We evaluated the performance characteristics of APTIMA Trichomonas vaginalis (ATV) transcription-mediated amplification (TMA) for diagnosis of T vaginalis (TV) infection from female vaginal swab, endocervical swab, and urine specimens and from male urethral swab and urine specimens. Performance of ATV TMA was compared with wet mount microscopy, culture, and polymerase chain reaction (PCR). In all, 296 female and 298 male subjects who attended the Jefferson County Health Department sexually transmitted diseases clinic were enrolled in the study and provided specimens for each test. Results were analyzed using 3 interpretative algorithms. For women, vaginal swab ATV TMA was significantly more sensitive than wet mount or culture. In male subjects, urethral swab ATV TMA was significantly more sensitive than culture or PCR. ATV TMA provides a sensitive, commercially available nucleic acid amplification test for improved diagnosis of TV in male and female patients.

Endocervical swabs transported in first void urine as combined specimens in the detection of Mycoplasma genitalium by real-time PCR

The aim of this study was to determine whether a patient's endocervical swab specimen can be transported in first void urine (FVU) as combined specimens for the detection of Mycoplasma genitalium by real-time PCR. The study also compared two different DNA extraction methods for observation of possible PCR inhibition. Three specimens, one endocervical swab specimen transported in 2-SP medium, one endocervical swab specimen transported in FVU and a FVU specimen, were collected from 329 women. All sample types underwent manual DNA extraction whereas in the DNA extraction study, 329 endocervical swab specimens transported in FVU were subjected to both manual Chelex and automated BioRobot M48 DNA extraction. A total of 100 endocervical swab specimens transported in FVU from patients PCR-negative for M. genitalium in the study were used in the PCR inhibition analysis. M. genitalium was detected in 25/329 (7.6 %) women. The endocervical swab specimens transported in 2-SP medium and transported in FVU were positive for M. genitalium in 17/25 (68 %) and 24/25 (96 %) women, respectively. The FVU specimens alone were positive for M. genitalium in 22/25 (88 %) women. In the DNA extraction study, M. genitalium DNA was detected in 24/329 (7.3 %) and 28/329 (8.5 %) of endocervical swab specimens transported in FVU subjected to manual Chelex extraction and automated BioRobot M48 extraction, respectively. Partial PCR inhibition was detected in 6 % of samples subjected to manual Chelex extraction whereas no inhibition was detected with the automated BioRobot M48 extraction. Thus endocervical swab specimens transported in FVU demonstrate higher sensitivity than FVU specimens only and have considerably increased sensitivity compared with endocervical swab specimens transported in 2-SP medium for detection of M. genitalium DNA. Moreover, automated BioRobot M48 extraction was shown to be superior to a crude manual Chelex extraction, leaving no PCR inhibition and giving a slightly higher DNA yield and/or better sensitivity.

Herpes Simplex Virus (HSV)–Suppressive Therapy Decreases Plasma and Genital HIV‐1 Levels in HSV‐2/HIV‐1 Coinfected Women: A Randomized, Placebo‐Controlled, Cross‐Over Trial

A randomized cross-over trial of herpes simplex virus type 2 (HSV-2)-suppressive therapy (valacyclovir, 500 mg twice daily, or placebo for 8 weeks, a 2-week washout period, then the alternative therapy for 8 weeks) was conducted among 20 Peruvian women coinfected with HSV-2 and human immunodeficiency virus type 1 (HIV-1) who were not on antiretroviral therapy. Plasma samples (obtained weekly) and endocervical swab specimens (obtained thrice weekly) were collected for HIV-1 RNA polymerase chain reaction. Plasma HIV-1 level was significantly lower during the valacyclovir arm, compared with the placebo arm (-0.26 log10 copies/mL, a 45% decrease [P < .001]), as was cervical HIV-1 level (-0.35 log10 copies/swab, a 55% decrease [P < .001]). Suppressive HSV-2 therapy has the potential to reduce HIV-1 infectiousness and slow HIV-1 disease progression.

Evaluation of Self-Collected Vaginal Swab, First Void Urine, and Endocervical Swab Specimens for the Detection of Chlamydia Trachomatis and Neisseria Gonorrhoeae in Adolescent Females

Objective To assess the concordance of self-obtained vaginal swabs (SVS), first void urine samples (FVU) and provider-collected endocervical swabs (PES) for the detection of Chlamydia trachomatis (CT) and Neisseria gonorrhea (NG) in adolescents. Methods A total of 342 adolescent women and 1080 baseline and semi-annual visits were analyzed. FVU, SVS and PES were collected at each biannual visit. All specimens were tested by BDProbeTec ET ™ Amplified DNA Assay. Sensitivity, specificity, positive predictive value (PPV) negative predictive value (NPV) and kappa coefficient were calculated to evaluate the ability to identify possible infected cases using samples from three anatomic sites and the test agreement between any two of these three specimen types. Positive results from at least two of the three specimens collected from same subject at the same study visit was considered true positive. Results The positivity rates for CT and NG were 26.6 and 11.7 per 100 women respectively. The sensitivities of SVS, FVU and PES for detecting CT were 97.3%, 89.2% and 90.1% respectively. For the detection of NG, the sensitivities of the three sampling methods were 100%, 88.6% and 95.5% respectively. The specificities were between 94.7% and 99.7% for both CT and NG. Kappa coefficients of CT test results were 0.89, 0.88 and 0.83 for specimen pairs SVS vs PES, SVS vs FVU and PES vs FVU respectively. For the detection of NG, kappa coefficients were 0.91, 0.87 and 0.91 for these three pairs (all P < 0.0001). Kappa > 0.75 is considered excellent agreement between specimens. Conclusion There were strong agreements among SVS, PES and FVU specimens on the detection of CT and NG infections in adolescent females using nucleic acid amplification test. SVS represented as high as or more sensitive an approach for detecting both CT and NG compared to PES. Although FVU was the least sensitive sampling method, it is also the least invasive method. Thus SVS and FVU may provide a reliable alternative to endocervical specimens for CT and NG screening.

Comparación de medios de cultivos y procedimientos para detectar colonización por Streptococcus agalactiae en mujeres embarazadas

Detection of Streptococcus agalactiae in pregnant women's vagina and rectum and intrapartum antibiotic prophylaxis administered to colonized women are currently recommended to prevent neonatal precocious infections by this organism. In turn, it is very important to select the culture media and adequate sample collection site for S. agalactiae detection in colonized women. To standardize this methods in laboratory, different culture media and procedures for S. agalactiae recovery in pregnant women with obstetric and gynecologic complications were compared. Vaginorectal and endocervical swab specimens were collected from 60 pregnant women. The first sample was placed onto selective Columbia blood agar directly and onto selective Todd-Hewitt broth incubated at 37 degrees C and subcultured onto selective Columbia blood agar at 4 and 18 hours. The second sample was cultured on selective Columbia blood agar. Both culture media were incubated in a microaerophilic atmosphere at 37 degrees C from 24 to 48 hours. S. agalactiae was identified using conventional tests. 21 patients colonized with S. agalactiae were detected using vaginoanorectal samples. 19 (31.7%) patients tested positive for S. agalactiae through the culture of specimens directly onto selective Columbia blood agar; 21 (35%) and 20 (33%) patients were found to be positive for S. agalactiae by the selective Todd-Hewitt broth at 4 and 18 hours, respectively. Only one patient tested positive for S. agalactiae in the endocervical tract. The results show that the three procedures followed for S. agalactiae recovery are effective. Nevertheless, the procedure in which the sample was placed directly onto selective Columbia blood agar permits reducing costs and the time for bacteria identification. On the other hand, the vaginoanorectal swab was the best sample to detect colonization by S. agalactiae in pregnant women.

Hormonal contraception and the risks of STI acquisition: results of a feasibility study to plan a future randomized trial

Background Because of limitations in observational studies, a randomized controlled trial (RCT) would help clarify whether hormonal contraception increases the risks of acquiring a sexually transmitted infection (STI). However, the feasibility of such a trial is uncertain. Study Design We conducted a study to assess the feasibility of conducting a RCT that would compare the acquisition risk for Chlamydia trachomatis and Neisseria gonorrhoeae in women randomized to an intrauterine device (IUD) or depot medroxyprogesterone acetate (DMPA). In our cross-sectional survey conducted at three clinics, we gave information on a potential RCT to clients, asked them questions to assess comprehensibility and finally asked respondents whether they would consider enrolling in such a trial. In addition, the 190 participants provided urine or endocervical swab specimens so we could estimate the prevalence of STIs. Results Overall, 70% of participants stated that they would take part in a future trial and accept randomization to either the IUD or DMPA. Participant understanding of the trial requirements was high. Twenty-nine percent of the participants were infected with either N. gonorrhoeae or C. trachomatis. Conclusion With a high prevalence of STI in this population and the apparent willingness of appropriate candidates to participate, an RCT to measure risks of incident STI infection from hormonal contraception appears feasible.

External Quality Assessment for Detection of Chlamydia trachomatis

The use of molecular methods for detection of Chlamydia trachomatis is increasing in clinical laboratories. External quality assessment enables unbiased monitoring of the performance of laboratories in the detection of specific pathogens. This study details the results of molecular and enzyme immunosorbent assay (EIA) testing for C. trachomatis detection in simulated endocervical swab specimens recently distributed internationally by United Kingdom National External Quality Assessment Scheme for Microbiology (UK NEQAS for Microbiology) external quality assessment panels. The frequency of accurate detection of C. trachomatis in the panels ranged from 32 to 100%. Participants using molecular methods were significantly more likely to detect C. trachomatis in specimens than those using an EIA. Two strains were distributed with the panels: an L2 laboratory-adapted strain and an uncharacterized primary isolate. Further analysis indicated a difference in detection of C. trachomatis between specific methods only with the L2 strain at lower concentrations. In addition, eight negative specimens were distributed, and false positives were found to be rare by all methods included in the study.

Prevalence of Chlamydia trachomatis infection among women in a Middle Eastern community.

BackgroundCommon vaginal infections that manifest in women are usually easily diagnosed. However, Chlamydia infection is often asymptomatic, leading to infertility before it is detected. If it occurs in pregnancy, it could lead to significant neonatal morbidity. It may also play a role with other viral infections for e.g. Human Papilloma Virus in the development of cervical cancer. The objective of this study was to determine the prevalence of Chlamydia infection in women undergoing screening for cervical abnormalities as a part of a research project in primary and secondary care institutions in the United Arab Emirates.MethodsIn this cross sectional study married women attending primary and secondary care participating in a large nationwide cervical abnormalities screening survey were offered Chlamydia testing using a commercially available test kit. This kit uses a rapid immunoassay for the direct detection of Chlamydia trachomatis antigen in endocervical swab specimens. As this study was performed in a traditional Islamic country, unmarried women were excluded from testing, as the management of any positive cases would create legal and social problems. All married women consenting to take part in the study were included irrespective of age.ResultsOf 1039 women approached over a period of eight months 919 (88.5%) agreed to participate. The number of women in the 16 to 19 years was small (0.01%) and 30% were aged over 40 years. The prevalence of Chlamydia infection in this study was 2.6% (95% confidence interval 1.2–3.3%), which was marginally higher in women screened in secondary care (p = 0.05).ConclusionThis is one of the few reports on the prevalence of Chlamydia infection in women from the Middle East. Due to cultural and social constraints this study excluded a large proportion of women aged less than 19 years of age. Hence no direct comparisons on prevalence could be made with studies from the West, which all included younger women at high risk of Chlamydia. However this study emphasizes the importance of cultural factors while interpreting results of studies from different cultures and communities.

Assessment of Chlamydia trachomatis Prevalence by Cell Culture and Transcription-Mediated Amplification in Symptomatic Women

Objective: The frequency of Chlamydia trachomatis in women with mucopurulent discharge was determined by a cell culture technique and a transcription-mediated amplification (TMA) assay in endocervical swab specimens. Subjects and Methods: Endocervical swab specimens were obtained from 116 symptomatic patients with genitourinary complaints or abdominal pain. All of the women were married, with an age range of between 19 and 44 (median 29) years. The cell culture assay was used in all specimens. For 75 specimens the TMA assay was also performed. Results: Positive cell culture test results were obtained in 6 (5.2%) patients. Among 75 specimens, 2 were positive by both TMA and culture assays, while 1 specimen was positive only by the culture assay. Of those positive for C. trachomatis, 5 were in the 19- to 25-year age group, and 1 was in the >25-year age group. All of the patients with positive results were of low socioeconomic status. Conclusions: This study revealed a relatively low rate of C. trachomatis infections in symptomatic married women in Turkey. A commercial TMA assay failed to identfy all positive patients, in contrast to a ‘gold standard’ culture assay used in patients having such infections.

Sociodemographic dynamics and sexually transmitted infections in female sex workers at the Mexican-Guatemalan border.

If the predominant means of HIV transmission is heterosexual in the Soconusco region of Mexico, then the female sex workers (FSWs) from Central America who work in this region may be playing a significant role in the heterosexual transmission of HIV. The goal was to estimate the prevalence of several sexually transmitted infections (STIs), including HIV infection, and to evaluate the population mobility of Mexican and Central American FSWs in the Soconusco region in Chiapas State, Mexico. A cross-sectional study was conducted upon the construction of a sampling frame of sex work-related bars in the municipalities of the Soconusco region. Consenting participants answered a questionnaire that recorded sociodemographic characteristics, previous and current experience in commercial sex, and risk indicators for STI. Women also provided blood and endocervical swab specimens to be analyzed. A sample of 484 women were enrolled, who were characterized as follows: the average age was 25.6 years, and a high proportion had children, were single, had started sexual activity at an early age, and had a low level of education and low earnings. The global prevalences of infections with Treponema pallidum, HSV-2, HIV, Neisseria gonorrhoeae, and Chlamydia trachomatis were 9.4%, 85.7%, 0.6%, 11.6%, and 14.4%, respectively. Frequencies of HBcAb and HBsAg hepatitis B markers were 17.7% and 1.3%. The cumulative prevalence of treatable gonorrhea, chlamydia, and syphilis was 27.4%. The data on women's mobility illustrate that the Soconusco region attracts Central American women to enter the commercial sex trade. The women's sociodemographic characteristics were consistent with high prevalences of STI, except HIV infection. The low frequency of HIV infection suggests that this population may have had little contact with HIV core groups in Central America and in the Soconusco and no history of blood transfusion or intravenous drug use.

What sexually transmitted disease screening method does the adolescent prefer? Adolescents' attitudes toward first-void urine, self-collected vaginal swab, and pelvic examination.

To assess sexually active adolescents' attitudes toward 3 screening collection techniques for detection of Chlamydia trachomatis, Neisseria gonorrhoeae, and Trichomonas vaginalis using first-void urine (FVU), self-collected vaginal swab specimens, and pelvic examination with clinician-collected endocervical swab specimens. Participants completed a preexamination health survey, provided FVU and self-collected vaginal swab samples, and had a pelvic examination with endocervical swab specimen collection. In a confidential postexamination interview, patients ranked the 3 screening techniques according to preference and responded to qualitative positive and negative descriptors to evaluate each technique. San Francisco area health maintenance organization and university clinics. A convenience sample of 155 ethnically diverse females aged 12 to 21 years, who were sexually active and were to have a pelvic examination. Adolescents' preferences for and evaluations of 3 sexually transmitted disease screening techniques. Participants preferred the FVU test for sexually transmitted disease screening over the pelvic examination and the self-administered vaginal swab test (P<.001). These results were consistent when controlling for potentially mitigating experiences, including previous pelvic examination, tampon or condom use, and prior pregnancy. In evaluating what they liked and disliked about each of the 3 screening methods, participants described the FVU most positively, the pelvic examination most negatively, and the vaginal swab technique slightly less positively than the FVU. Most sexually active adolescents attending clinics for pelvic examination prefer to be screened for sexually transmitted diseases first by the FVU, second by the self-collected vaginal swab test, and last by the pelvic examination.

PreservCyt transport medium used for the ThinPrep Pap test is a suitable medium for detection of Chlamydia trachomatis by the COBAS Amplicor CT/NG test: results of a preliminary study and future implications.

The commercial COBAS Amplicor CT/NG test (Roche Diagnostic Systems, Meylan, France) is a sensitive and specific method for detection of Chlamydia trachomatis infections. This test currently consists of using a nucleic acid amplification method to detect C. trachomatis in first-void urine specimens and in endocervical swabs collected in 2-sucrose-phosphate (2SP) transport medium. We conducted a prospective study to determine whether the automated COBAS Amplicor CT/NG test can detect C. trachomatis in cervical specimens collected in PreservCyt transport medium (ThinPrep Pap Test; Cytyc Corporation, Boxborough, Mass.). PreservCyt medium is used to preserve cervical samples before the preparation of ThinPrep slides. We collected 1,000 cervical specimens from young women (age range, 15 to 25 years) during routine Pap smear tests. Only specimens with normal cytology and in which the gynecologist found no clinical evidence of urogenital infections were selected. The samples were stored in PreservCyt transport medium at 15 to 20 degrees C. C. trachomatis was detected in 22 of the 1,000 cervical specimens that had been stored in PreservCyt. To confirm the positive samples, the test was repeated on new endocervical swab specimens collected in 2SP transport medium. Only 9 of the 22 positive patients agreed to undergo this control, but all 9 retested positive. To evaluate the influence of storage conditions on the sensitivity of the C. trachomatis PCR test, all of the positive samples were stored at 15 to 20 degrees C in PreservCyt transport medium and were retested every 2 weeks for 6 weeks. C. trachomatis was successfully amplified from all 22 specimens for the whole 6-week period. The prevalence of C. trachomatis infection was 2.2% in our study population. These results demonstrate that PreservCyt transport medium is a suitable transport medium for detection of C. trachomatis by the COBAS Amplicor CT/NG test. The ThinPrep Pap Test may enable gynecologists to monitor for both cervical lesions and C. trachomatis infections with a single endocervical specimen.

Screening for chlamydial infection

Objectives: To examine data on the effectiveness of screening for chlamydial infection by a physician or other health care professional. Specifically, we examine the evidence that early treatment of chlamydial infection improves health outcomes, as well as evidence of the effectiveness of screening strategies in nonpregnant women, pregnant women, and men, and the accuracy of tests used for screening. This review updates the literature since the last recommendation of the U.S. Preventive Services Task Force published in 1996. Search Strategy: We searched the topic of chlamydia in the MEDLINE, HealthSTAR, and Cochrane Library databases from January 1994 to July 2000, supplemented by reference lists of relevant articles and from experts in the field. Articles published prior to 1994 and research abstracts were cited if particularly important to the key questions or to the interpretation of included articles. Selection Criteria: A single reader reviewed all English abstracts. Articles were selected for full review if they were about Chlamydia trachomatis genitourinary infections in nonpregnant women, pregnant women, or men and were relevant to key questions in the analytic framework. Investigators read the full-text version of the retrieved articles and applied additional eligibility criteria. For all topics, we excluded articles if they did not provide sufficient information to determine the methods for selecting subjects and for analyzing data. Data Collection and Analysis: We systematically reviewed three types of studies about screening in nonpregnant women that relate to three key questions: (1) studies about the effectiveness of screening programs in reducing prevalence rates of infection, (2) studies about risk factors for chlamydial infection in women, and (3) studies about chlamydial screening tests in women. Our search found too few studies on pregnant women to systematically review, although pertinent studies are described. We systematically reviewed two types of studies about screening in men: (1) studies about prevalence rates and risk factors for chlamydial infection in men and (2) studies about chlamydial screening tests in men. Main Results: Nonpregnant women. The results of a randomized controlled trial conducted in a large health maintenance organization indicate that screening women selected by a set of risk factors reduces the incidence of pelvic inflammatory disease (PID) over a 1-year period. Changes in population prevalence rates have not been well documented because few studies have employed a representative population sample. Age continues to be the best predictor of chlamydial infection in women, with most studies evaluating cut-offs at age younger than 25 years. Other risk factors may be useful predictors, but these are likely to be population specific. To determine the accuracy of screening tests for women, we retrieved and critically reviewed 34 articles on test performance. Results indicate that endocervical swab specimens and first-void urine specimens have similar performance when using DNA amplification tests and have better sensitivity than endocervical culture. Recurrent chlamydial infections in women have been associated with increased risks for PID and ectopic pregnancies. Pregnant women. The Second Task Force recommendations for screening pregnant women were based on two major studies demonstrating improved pregnancy outcomes following treatment of chlamydial infection. We identified no recent studies on this topic in our literature search. Very few studies describe risk factors for chlamydial infection in pregnant women. Nonculture testing techniques appear to perform well in pregnant women, although studies are limited. Men. No studies described the effectiveness of screening or early treatment for men in reducing transmission to women or in preventing acute infections or complications in men. Studies of prevalence rates and risk factors for chlamydial infection in men are limited. Age lower than 25 years is the strongest known risk factor cited so far. Results of urethral swab specimens compared to first-void urine specimens were similar for DNA amplification tests. DNA amplification techniques are more sensitive than culture. Conclusions: Screening women for Chlamydia trachomatis reduces the incidence of PID, and it is associated with reductions in prevalence of infection in uncontrolled studies. No studies were found to determine whether screening asymptomatic men would reduce transmission or prevent acute infections or complications. Age is the strongest risk factor for men and women. A variety of tests can detect chlamydial infection with acceptable sensitivity and specificity, including new DNA amplification tests that use either endocervical swabs in women, urethral swabs in men, or first-void urine specimens from men and women.

Evaluation of a new amplified enzyme immunoassay (EIA) for the detection of Chlamydia trachomatis in male urine, female endocervical swab, and patient obtained vaginal swab specimens

Aims—To compare the performance of a new generation dual amplified enzyme immunoassay (EIA) with a molecular method for the diagnosis of Chlamydia trachomatis, using a range of urogenital samples, and...

Bacterial vaginosis and past chlamydial infection are strongly and independently associated with tubal infertility but do not affect in vitro fertilization success rates

Objective: To determine the incidence of active vaginal infection in women undergoing IVF, relate it to the cause of infertility, and investigate a relation with the outcome of fresh ET. Design: Cross-sectional study. Setting: Tertiary care infertility referral center. Patient(s): Two hundred eighty-six women who underwent 344 oocyte recovery procedures for IVF cycles between March 1997 and January 1998. Intervention(s): High vaginal swab specimens and endocervical swab specimens were obtained and ELISA serology was performed for detection of Chlamydia species on samples taken immediately before oocyte recovery. The results were related to the cause of infertility and the outcome parameters. Main Outcome Measure(s): Pregnancy rates. Result(s): Seropositivity for Chlamydia species and the presence of bacterial vaginosis both were strongly and independently associated with tubal disease. There was no difference in pregnancy rates in any of the groups regardless of their serologic status for chlamydial infection or current infection with bacterial vaginosis. Conclusion(s): This study provides further evidence of the pelvic pathogenicity of bacterial vaginosis. However, it shows that women who have bacterial vaginosis or who have been treated for chlamydial infection in the past achieve pregnancy rates with IVF treatment similar to those of women who have no evidence of such infections.

Multicenter evaluation of the fully automated COBAS AMPLICOR PCR test for detection of Chlamydia trachomatis in urogenital specimens.

The fully automated COBAS AMPLICOR CT/NG test for the detection of Chlamydia trachomatis was evaluated in a multicenter trial. Test performance was evaluated for 2,014 endocervical swab and 1,278 urine specimens obtained from women and for 373 urethral swab and 254 urine specimens obtained from men. Culture served as the reference test. Culture-negative, COBAS AMPLICOR-positive specimens that tested positive in a confirmatory PCR test for an alternative target sequence within the C. trachomatis major outer membrane protein gene were resolved as true positives. The overall prevalence of chlamydia was 4.3% in cervical swabs and 11.0% in urethral swabs from men. When the results for each specimen type were considered separately, the resolved sensitivities were 96.5% (83 of 86) for endocervical swab specimens, 95.1% (39 of 41) for urine specimens from women, 100.0% (41 of 41) for urethral swab specimens from men, and 94.4% (17 of 18) for urine specimens from men; the resolved specificities were 99.4% (1,912 of 1,924) for endocervical swab specimens, 99.8% (1,204 of 1,207) for urine specimens from women, 98. 5% (325 of 330) for urethral swab specimens from men, and 100.0% (236 of 236) for urine specimens from men. For the subset of patients from whom both swab and urine specimens were collected, the combined results for both specimen types were used to identify all infected patients. Using these combined reslts as criteria, the resolved sensitivities for the COBAS AMPLICOR test were 82.6% (38 of 46) for endocervical swab specimens, 84.4% (38 of 45) for urine specimens from women, 84.2% (16 of 19) for urethral swab specimens from men, and 89.5% (17 of 19) for urine specimens from men. In comparison, the sensitivity of culture was only 56.5% (26 of 46) for endocervical specimens and 63.2% (12 of 19) for urethral specimens from men. The internal control provided in the COBAS AMPLICOR test revealed that 2.9% of specimens were inhibitory when they were initially tested. Nevertheless, valid results were obtained for 99. 1% of specimens because 68.7% of the inhibitory specimens were not inhibitory when a second aliquot of the original sample was tested. Two additional COBAS AMPLICOR-positive specimens were detected by retesting inhibitory specimens. The COBAS AMPLICOR CT/NG test for the detection of C. trachomatis exhibited equally high sensitivities and specificities with both urogenital swab and urine specimens and, thus, is well-suited for use in screening.

Detection of Chlamydia trachomatis in vaginal specimens from female commercial sex workers using a new improved enzyme immunoassay.

OBJECTIVE: To evaluate the performance of a new improved enzyme immunoassay (EIA) kit for the detection of Chlamydia trachomatis in vaginal swab and endocervical swab specimens from female commercial sex...

Evaluation of the abbott LCx assay for detection of Neisseria gonorrhoeae in endocervical swab specimens from females.

The Abbott LCx Neisseria gonorrhoeae assay (Abbott Laboratories, Abbott Park, Ill.) uses a ligase chain reaction (LCR) amplification in the LCx probe system for detection of a specific nucleotide sequence in the Opa-encoding gene of N. gonorrhoeae. We evaluated the LCx assay in a comparison with conventional culture employing modified Thayer-Martin media for the detection of N. gonorrhoeae from female endocervical specimens obtained from patients attending a sexually transmitted disease clinic. Discordantly LCR-positive and culture-negative specimens were further evaluated by testing with another LCR assay which used an N. gonorrhoeae-specific pilin probe. Specimens positive by both LCR assays were considered confirmed LCx-positive specimens. A specimen was considered to contain N. gonorrhoeae when it was either culture positive or culture negative and confirmed LCx positive. A total of 403 female endocervical specimens were evaluated. The prevalence of N. gonorrhoeae in this population was 8.7%. The sensitivity and specificity of the LCx assay were 94.3 and 99.4%, and those of culture were 77.1 and 100%, respectively. The Abbott LCx assay is a rapid, sensitive method for detection of N. gonorrhoeae in female endocervical specimens.