Ligase Chain Reaction Testing Research Articles

Bacterial Vaginosis and Spontaneous Clearance of Chlamydia trachomatis in the Longitudinal Study of Vaginal Flora.

Up to 26% of urogenital Chlamydia trachomatis infections spontaneously resolve between detection and treatment. Mechanisms governing natural resolution are unknown. We examined whether bacterial vaginosis (BV) was associated with greater chlamydia persistence versus spontaneous clearance in a large, longitudinal study. Between 1999 and 2003, the Longitudinal Study of Vaginal Flora followed reproductive-age women quarterly for 1 year. Baseline chlamydia screening and treatment were initiated after ligase chain reaction testing became available midstudy, and unscreened endocervical samples were tested after study completion. Chlamydia clearance and persistence were defined between consecutive visits without chlamydia-active antibiotics (n = 320 persistence/n = 310 clearance). Associations between Nugent score (0-3, no BV; 4-10, intermediate/BV), Amsel-BV, and chlamydia persistence versus clearance were modeled with alternating and conditional logistic regression. Of chlamydia cases, 48% spontaneously cleared by the next visit (310/630). Nugent-intermediate/BV was associated with higher odds of chlamydia persistence (adjusted odds ratio [aOR] = 1.89; 95% confidence interval [CI], 1.30-2.74), and the findings were similar for Amsel-BV (aOR 1.39; 95% CI, .99-1.96). The association between Nugent-intermediate/BV and chlamydia persistence was stronger in a within-participant analysis of 67 participants with both clearance/persistence intervals (aOR = 4.77; 95% CI, 1.39-16.35). BV symptoms did not affect any results. BV is associated with greater chlamydia persistence. Optimizing the vaginal microbiome may promote chlamydia clearance.

Cytopathological Examination and Epidemiological Study of Cervicitis in Commercial Sex Workers (CSWs) in Coal City (Enugu), Nigeria.

llicit sexual behavior by commercial sex workers (CSW) may have a disproportionate impact on the reproductive health of a woman that often leads to cervicitis. This study aimed at examining the cytopathology, patterns, prevalence and burden of cervicitis in CSW in Enugu metropolis, Nigeria. Cervical smear was collected from the endocervix of about one hundred and eighteen (n=118) CSWs between November, 2014 and February, 2015 using the liquid-based cytology (LBC) method. Smears were processed and stained by the modified Papanicolaou method. Leftover samples were tested for sexually transmitted diseases, especially N. gonorrhea, and C. trachomatis using ligase chain reaction and nucleic acid amplification test. A randomized sampling design was used for data collection. Cytopathological examination of cervicitis in CSWs showed a moderate infection, and moderately severe to chronic inflammatory cells. The epidemiological study revealed that acute cervicitis are predominant 7(5.9%) and 2(1.7%) are chronic cervicitis. The prevalence of CSWs living with cervicitis in Enugu, Nigeria (7.6%), is significantly affected by age and working duration as CSWs. Also, Chlamydia trachomatis is the solely associated pathogen implicated in cervicitis group (n=9). Candidiasis infection (n=12) and T. vaginalis (n=3) are observed in non-cervicitis group (n=109) while the association between C. trachomatis and cervicitis infection is statistically significant (P= 0.0221). Acute cervicitis was prevalent with a preponderance of 4:1 in CSWs in Enugu, Nigeria. C. trachomatis infection was the most prevalent etiologic agent of cervicitis in this study. Further molecular study of LBC smears from CSWs using PCR is strongly recommended.

Prevalence of antibodies against Chlamydia trachomatis and incidence of C. trachomatis-induced reactive arthritis in an early arthritis series in Finland in 2000

Objective: To study the prevalence of different serotypes of Chlamydia trachomatis antibodies and the incidence of C. trachomatis-induced reactive arthritis (ReA) among patients with early arthritis in a defined population.Methods: Serum samples were collected from a cohort of 122 adult patients in the age group 18–65 years included in the Kuopio 2000 Arthritis Survey. Antibodies against C. trachomatis serotypes C, E, and G were studied using enzyme immunoassay (EIA) tests among patients and in a control cohort of 78 adults without any joint symptoms. The incidence assessment for Chlamydia-induced ReA was based on a ligase chain reaction (LCR) test in urine and clinical symptoms and signs appropriate for ReA.Results: Of 122 patients, with the baseline diagnosis of rheumatoid arthritis (RA) in 11, spondyloarthropathy (SpA) in 28, and undifferentiated arthritis (UA) in 83 cases, 42 (34%) showed immunoglobulin (Ig)G or IgA antibodies against at least one serotype C, E, or G. Among the patients with UA the prevalence was significantly increased compared with the controls (p = 0.010). C. trachomatis-induced ReA arthritis was diagnosed in only three patients with the LCR test. On this basis the incidence of C. trachomatis-induced arthritis was 5.4/100 000 [95% confidence interval (CI) 1.1–15.7] in the age group 18–65 years.Conclusion. Antibodies against C. trachomatis were most common in patients with UA reflecting the fact that cases with chlamydia-induced ReA are included in this subgroup.

A trial of the validity of genital smears and cultures with gonococcal vaccine provocation in diagnosing genital gonorrhoea in women

In Russia the diagnosis of gonorrhoea in women relied on microscopy, justified by the hypothesis that sensitivity increases using 'provocation' techniques. The aim was to test the value of Gonovaccine as provocation in women who would have received it normally. Cervical specimens from 204 women were tested by culture and a ligase chain reaction (LCR) assay before the women were randomized to receive provocation or not. Further cervical specimens were obtained 24, 48 and 72 hours later for microscopy, culture and LCR tests. In both provocation and non-provocation arms, 24 women were positive for gonorrhoea by the LCR assay. Test-by-test, sensitivity of microscopy was 30% in the provocation arm and 13% in the control arm (P = 0.0407, Fisher's exact test). Patient-by-patient, sensitivity of microscopy was 50% in the provocation arm, but only 25% in the control arm (P = 0.0675, Fisher's exact test). The cost per case was greater ($214) using provocation with microscopy than culture and microscopy at the first visit ($150). Thus, although Gonovaccine provocation doubled the sensitivity of microscopy in detecting gonococci, the internationally recommended protocol of microscopy and culture at first visit should be adopted as routine practice in Russia. The findings raise questions about the pathogenesis and natural history of gonorrhoea.

Chlamydia trachomatis in cervical and vaginal swabs and urine specimens from women undergoing termination of pregnancy

The study was devised to assess the prevalence of Chlamydia trachomatis in endocervical and vaginal swabs and first pass urine specimens from women presenting for termination of pregnancy (TOP) and to evaluate the performance of the tests used, namely the ligase chain reaction (LCR) and the direct fluorescence antibody (DFA) test. Eight hundred and sixty three (91%) of 948 women invited to participate agreed to do so; a complete set of results for all test-site combinations was achieved for 793 (92%). The overall prevalence of C. trachomatis was 8.54% (95% confidence interval [CI]: 7.6-10.5%) with a significant negative association with age. The sensitivity (95% CI) of the LCR test for cervical, vaginal and urine specimens was 97% (93-99%); 94% (88-99%) and 83% (75-92%), respectively. The sensitivity (95% CI) of the DFA test for cervical, vaginal and urine specimens was 93% (87-99%); 92% (86-99%) and 78% (68-88%), respectively. Concordance between the LCR and DFA test results was very high for specimens from the same site. The results indicate that nucleic acid amplification tests are appropriate for screening women seeking TOP and, indeed, other women in early pregnancy. The sensitivity of the LCR test for urine specimens was less, but the high levels of concordance observed between the LCR and DFA test results for urine specimens indicates that this was due to a lower organism load rather than inhibition of the LCR.

Spontaneous Resolution of Asymptomatic Chlamydia trachomatis in Pregnancy

We sought to estimate the rate of spontaneous resolution of asymptomatic Chlamydia trachomatis in pregnancy and to evaluate factors associated with its resolution. A cohort of women enrolled in a large multicenter randomized bacterial vaginosis antibiotic trial (metronidazole versus placebo) that, when randomly allocated, had asymptomatic C trachomatis diagnosed by urine ligase chain reaction (from frozen archival specimens) between 16(0/7) and 23(6/7) weeks were included. The urine ligase chain reaction is a highly accurate predictor of genital tract chlamydial infection. A follow-up ligase chain reaction was performed between 24(0/7) and 29(6/7) weeks. A total of 1,953 women were enrolled in the original antibiotic trial; 1,547 (79%) had ligase chain reaction performed both at randomization and follow-up. Women receiving antibiotics effective against Chlamydia between randomization and follow-up or having symptomatic Chlamydia infection were excluded (26 women). Of the 140 women (9%) who were diagnosed as positive via the initial ligase chain reaction assay, 61 (44%) had spontaneous resolution of Chlamydia by the follow-up ligase chain reaction assay. Factors associated with spontaneous resolution included older age (P = .02), more than 5 weeks from randomization to follow-up (P = .02), and a greater number of lifetime sexual partners (P = .02). Using a logistic regression model, maternal age and a greater-than-5-week follow-up interval remained significant; for every 5-year increase in maternal age, the odds of a positive result on the ligase chain reaction test at follow-up decreased by 40% (odds ratio 0.6; 95% confidence interval 0.4-0.9). Race, substance abuse, parity, and treatment with metronidazole were not associated with spontaneous resolution. Gram stain score and vaginal pH at randomization and follow-up also were not associated. The prevalence of asymptomatic C trachomatis in pregnancy was 9%; infection resolved spontaneously in almost half of these women. The association of older age and increasing time interval to spontaneous resolution of Chlamydia is consistent with a host immune-response mechanism.

Scrotal mass with fever and generalized lymphadenopathy in a young man secondary to Chlamydia trachomatis infection

A young man presented with systemic upset and generalised lymphadenopathy. Later, it transpired that he was under investigation for a scrotal mass. Investigations were carried out to ascertain the cause of his symptoms including lymph node biopsy. Because of the presence of a scrotal mass in a sexually active male, a urinary Chlamydia ligase chain reaction (LCR) test was carried out. The result was positive and he was treated with doxycycline for 2 weeks. His symptoms settled and further, the urinary LCR was negative. We propose that Chlamydia trachomatis infection caused his illness and that urine PCR or LCR tests for Chlamydia is a convenient and useful investigation in sexually active males with generalised lymphadenopathy and fever of unknown origin.

Comparison of nucleic acid amplification tests and culture techniques in the detection of Neisseria gonorrhoeae and Chlamydia trachomatis in victims of suspected child sexual abuse

Study objectives (1) To identify factors predictive for gonorrhea and chlamydia positivity by LCR testing based on history and physical findings encountered during the sexual abuse evaluations. (2) To compare Ligase Chain Reaction (LCR), Polymerase Chain Reaction (PCR), and culture methods in the detection of chlamydia and gonorrhea infection among prepubertal and adolescent girls referred for sexual abuse evaluations. Design Prevalence odds ratios and logistic regression analysis were used to identify factors among patients' physical symptoms and signs, history of sexual activity, and abuse characteristics that were associated with positive test results for gonorrhea and chlamydia. The Kappa statistic was used to perform pairwise comparisons of LCR, PCR, and culture identification of gonorrhea and chlamydia infection. Setting A specialized sexual abuse clinic in San Antonio, Texas. Participants A consecutive sample of 229 girls between the ages of 6 and 20 who reported, or had indicators of, abusive genital-genital or genital-anal contact. Main outcome measures Patients' history and physical findings predicting positive test results for gonorrhea and chlamydia infection; and relative sensitivity of testing sites (vaginal swab and urine) and methodologies (LCR, PCR, and culture) in identifying gonorrhea and chlamydia infection. Results (1) Gonorrhea infection: 3.2% of subjects were positive for gonorrhea by LCR at one or more sites; 2.4% had positive gonorrhea cultures. There was excellent agreement between vaginal swab LCR and PCR; agreement between urine samples was limited by the small number of positive tests. The sole factor that predicted gonorrhea positivity was increased number of white blood cells seen on wet mount. (2) Chlamydia infection: 11.1% of subjects were positive for chlamydia by at least one LCR test; only 0.8% had positive chlamydia cultures. Both urine and vaginal swab testing showed good agreement between PCR and LCR but not between culture and either of the newer methodologies. Factors that predicted chlamydia positivity were: patient history of consensual sexual contact, patient history of vaginal discharge, and the presence of concerning or definitive findings of genital trauma. Conclusions While LCR, PCR, and culture techniques appeared comparable for detecting gonorrhea, LCR techniques detected significantly more patients with chlamydia infection when compared with the culture technique. PCR was comparable to LCR in detecting chlamydia infection. The LCR vaginal swab detected more patients with chlamydia and gonorrhea than the LCR urine sample. Risk factors for chlamydia and gonorrhea infection were present in most, but not all, of the children with positive LCR findings. LCR and PCR appear to detect more chlamydial and gonorrheal infections than do cultures.

Limitations of Screening Tests for the Detection of Chlamydia trachomatis in Asymptomatic Adolescent and Young Adult Women

One hundred sexually active women aged 16 to 25 years who were being seen for a routine gynecologic examination were recruited to participate in this investigation of screening for chlamydial infection in asymptomatic patients. Before clinical examination, the women performed a self-collected screening technique using 2 Dacron swabs, which they inserted approximately 2 inches into their own vagina, swirled, and placed in a transport media for polymerase chain reaction (PCR). They also provided a urine specimen consisting of the first 30 mL of voided urine collected in a sterile container for PCR and ligase chain reaction (LCR). The clinician collected urethral, vaginal, and endocervical swabs, which were cultured and analyzed with PCR, LCR, and nucleic acid amplification tests. Results were available for 139 participants, who had a mean age of 19.1 years and a mean of 10 days since their last sexual encounter. Twenty-two women had a history of chlamydial infection and 8 had a history of other sexually transmitted disease. During clinical examination of these asymptomatic patients, 34% were found to have a vaginal discharge, and 22% had other cervical abnormalities (discharge, mucopus, lesions, friability, inflammation). Chlamydia trachomatis was diagnosed in 30 (22%) women. Among these women, there were 27 (21%) with true C. trachomatis. One hundred twenty-six study subjects had complete results from all 9 clinical tests. Test measures included urethral culture and PCR, self-collected vaginal PCR, clinician-collected vaginal PCR, endocervical culture, PCR, LCR, and urine PCR and LCR. Four patients were positive for all 9 tests, 8 had a single positive test (confirmed by nested PCR testing), and 15 had between 2 and 8 positive results. The characteristics of various tests and different collection sites are shown in Table 1. Both PCR and LCR yielded more positive results than culture. They were also more sensitive than culture, although some LCR had a lower specificity than either of the other tests. The positive and negative predictive values were high for all tests. When 2 tests were combined, urine LCR plus endocervical LCR proved the most sensitive but had a somewhat lower specificity than other combination strategies.

Preference among female Army recruits for use of self-administrated vaginal swabs or urine to screen for Chlamydia trachomatis genital infections.

Use of self-administered vaginal swabs (SAS) for the detection of Chlamydia trachomatis by nucleic acid amplification tests simplifies specimen collection and transport, especially for women in nonclinical settings. We investigated the preference and comfort level of military women for the collection of SAS, compared with urine, for the diagnosis of genital chlamydial infections. During March through August 1999, female Army recruits in basic training at Fort Jackson, South Carolina, were invited to participate in the study. Participants were requested to complete a questionnaire after providing both first-void urine (FVU) and SAS specimens. Participant characteristics, preferences, and comfort levels were assessed using multivariate logistic regression. From 4496 eligible female recruits, 1403 (31%) completed questionnaires and 1382 provided both specimens; 11.8% (166 of 1403) of participants were infected with chlamydia. The relative sensitivity and specificity of the C. trachomatis Ligase Chain Reaction test on SAS in 1382 matched pairs was 81.1% and 98.6%, respectively, using the test result on urine specimens as the comparison standard. Most of the participants (90.8%) reported that they felt comfortable collecting the FVU specimen, and 69.6% indicated that they felt comfortable collecting SAS. Either specimen collection type received high acceptability at home and in the field, and more women reported that they would collect FVU than reported they would collect SAS in the future (in the field: FVU: 79.4%, SAS: 68.8%, P <0.001); at home: FVU: 90.9%, SAS: 82.9%, P <0.001). When questioned about ease of use, 60.4% of women reported that urine was the easier method. Preferences for SAS were associated with being white and having had sexual risk behaviors in the past 3 months. A study of preferences for urine versus self-administered vaginal swabs for the detection of C. trachomatis in military women showed that women generally found SAS acceptable. SAS should be a feasible alternative to urine collection in situations in which specimen storage or transport is an issue.

Adolescent women underestimate their susceptibility to sexually transmitted infections

Objectives: Adolescent females are at significant risk for sexually transmitted infections (STI) and may not accurately incorporate indicators of risk into their perceptions of susceptibility. The objectives of the current...

Urinary Tract Infection and Chlamydia Infection in Adolescent Females

Study Objective: To examine whether clinical or laboratory findings could distinguish Chlamydia trachomatis (CT) from urinary tract infection (UTI) among adolescent females in whom providers tested for both.Design, Setting, Participants: A laboratory database at an urban teen health center was reviewed to identify females who had both urine culture and ligase chain reaction (LCR) test for CT ordered at the same visit. History and physical findings were abstracted from the medical record. There were 81 visits with retrievable laboratory results and chart documentation.Main Outcome Measures: UTI was defined as >1000 colony-forming units on culture, and CT was defined as positive LCR test. Pearson's Chi-squared test was used to assess strength of the hypothesized associations.Results: UTI was diagnosed in 20 (24%) and CT in 18 (22%) of 82 visits. Concurrent CT was diagnosed in 6 of 20 subjects with UTI. Symptoms and physical signs did not differentiate UTI from CT. Positive urinary nitrites were associated with UTI, but did not exclude CT. Similarly, wet prep evidence of trichomonas or white blood cells was associated with CT, but did not exclude UTI. Clinical diagnosis of CT or UTI was 50% sensitive and 70% specific.Conclusions: Adolescent females who are screened for both CT and UTI have high rates of concurrent disease. Urinary or vaginal symptoms do not differentiate well between these infections. Clinical diagnosis is imprecise, suggesting that adolescent females with vaginal or urinary symptoms should be tested for both CT and UTI.

Prevalence and factors associated with gonorrhea and chlamydial infection in at-risk females presenting to an urban emergency department.

Patients without a regular healthcare source are less likely to be tested, diagnosed, and treated effectively for sexually transmitted diseases (STDs). Emergency departments (EDs) are a major healthcare source for patients without health insurance or primary care providers. This study evaluated the prevalence of Chlamydia trachomatis and Neisseria gonorrhoeae in women aged 15 to 35 years presenting to a metropolitan ED with genitourinary or pregnancy-related complaints and the frequency with which patients were effectively treated for these infections during routine ED care. Women completed an interviewer-administered questionnaire and submitted urine for ligase chain reaction (LCR) testing for C trachomatis and N gonorrhoeae. The combined prevalence of gonorrhea and chlamydia was 16.4% (n = 62), and factors associated with infection included younger age and greater numbers of sex partners over 30 days. Problem-oriented care failed to detect infection in most cases, and 58% of infected women left the ED without effective therapy. Through a close working relationship with the local health department, we documented that 92% had received effective follow-up therapy. Continued efforts to refine and develop tools for the diagnosis and management of cervical infections for at-risk women seen in EDs are warranted.

Screening for sexually transmitted infections in substance abuse treatment programs

Objectives: We evaluated the prevalence of the sexually transmitted infections (STIs) chlamydia and gonorrhea in clients at a methadone maintenance program and a residential detoxification program. Methods: We collected urine specimens for chlamydia and gonorrhea ligase chain reaction testing and assessed sexual, substance abuse and STI histories. Results: Of 700 subject assessments, 490 occurred among detoxification clients and 210 in methadone maintenance. Chlamydia trachomatis was detected in 5/700 (0.9, 95% CI=0.1–1.8%) and Neisseria gonorrhoeae in none. All chlamydia infected subjects were recruited from the detoxification program. Subjects reported high risk sexual behavior: 17% reported commercial sex exchange, and 22% reported inconsistent condom use with multiple sexual partners during the prior 2 months. Conclusion: Based on prevalence in Boston, MA, universal screening for STI in substance abuse treatments programs is not warranted. However, routine screening for younger substance abusers and in communities with high prevalence should be considered.

Pregnant adolescents at risk: Sexual behaviors and sexually transmitted disease prevalence

Objective: The purpose of this study was to determine the level of high-risk sexual behaviors and the prevalence of chlamydia and gonorrhea among pregnant adolescents. Study Design: These analyses used data from 203 pregnant and 209 nonpregnant adolescents who were recruited from public health clinics. Data sources included interviewer-administered questionnaires, ligase chain reaction tests for chlamydia/gonorrhea in the third trimester of pregnancy, and state health department reports of chlamydia/gonorrhea. Statistical analyses included logistic regression. Results: Pregnant adolescents were significantly more likely to have not used condoms during sexual intercourse in the past 30 days compared with nonpregnant adolescents, although other sexual risk behaviors were reduced. Nineteen percent of pregnant adolescents had chlamydia or gonorrhea diagnosed during the pregnancy. Conclusion: Pregnant adolescents have high levels of sexually transmitted diseases during pregnancy, and many adolescents use condoms inconsistently. Prenatal care providers may be in a unique position to decrease sexually transmitted diseases among pregnant adolescents by encouraging the reduction of risk behaviors and aggressively screening for sexually transmitted diseases as part of routine prenatal care. (Am J Obstet Gynecol 2003;188:63-70.)

When and where do youths have sex? The potential role of adult supervision.

Interventions to reduce high-risk behaviors such as sex and substance use among youths have focused mainly on promoting abstinence, refusal skills, and negotiation skills, yet the frequency of high-risk behaviors among youths may also be influenced by opportunity, particularly the amount of time during which they are not supervised by adults. In this study, we examined when and where youths have sex and whether there is a relationship between unsupervised time and sex, sexually transmitted diseases (STDs), and substance use. A cross-sectional survey was conducted in 6 public high schools in an urban school district. Participants were 1065 boys and 969 girls from a school-based STD screening program. Ninety-eight percent of students were black, and 79% were in the free or reduced lunch program. Most students reported living with 1 parent only, primarily the mother (52%); only 27% lived in 2-parent families. Sexual activity, substance use, and the prevalence of gonorrhea or chlamydia as determined by a ligase-chain reaction test on a urine sample were measured. Fifty-six percent reported being home without an adult present 4 or more hours per day after school. There was no difference in the number of unsupervised after-school hours between children in 1- and 2-parent families. Fifty-five percent of boys and 41% of girls were participating in or planned to participate in after-school activities during the school year. Boys were more likely than girls to report having had sex for the first time before age 14 (42% vs 9%) and had a greater number of lifetime sex partners (mean: 4.2 vs 2.4 partners). Among the respondents who had had intercourse, 91% said that the last time had been in a home setting, including their own home (37%), their partner's home (43%), and a friend's home (12%), usually after school. Boys were more likely than girls to report having had sex in their own homes (43% vs 28%) and less likely than girls to report having had sex in their partner's homes (30% vs 59%). Fifty-six percent of youths who had had intercourse reported that the last time was on a weekday: 18% before 3:00, 17% between 3:00 and 6:00, and 21% after 6:00. There were no gender differences in the day of the week or time of day during which students reported having had intercourse. Youths who were unsupervised for 30 or more hours per week were more likely to be sexually active compared with those who were unsupervised for 5 hours a week or less (80% vs 68%). In addition, for boys, the greater the amount of unsupervised time, the higher the number of lifetime sex partners. Among girls but not among boys, sexual activity was associated with nonparticipation in after-school programs; 71% of those who were not participating in an after-school activity were sexually active compared with 59% of those who were participating. Tobacco and alcohol use were associated with unsupervised time among boys but not among girls. Boys who were unsupervised >5 hours per week after school were twice as likely to have gonorrhea or chlamydial infection as boys who were unsupervised for 5 hours or less. We found that substantial numbers of youths currently spend long periods of time without adult supervision and have limited opportunities to participate in after-school activities. More than half of sexually active youths reported that they had sex at home after school, and, particularly for boys, sexual-and drug-related risks increased as the amount of unsupervised time increased. As youths come of age, parents probably believe that it is appropriate to leave them increasingly on their own, and, accordingly, prevention approaches have concentrated on providing information and motivation for abstinence or safer sex. However, given the independent association between the amount of unsupervised time and sexual behaviors (with STD rates suggestive of particularly risky sexual behaviors) and substance use behaviors, it is worth considering increasing youth supervision, if not by parents, then by programs organized at schools organized at school or other community settings. Parents and community members should consider increasing opportunities for supervised activities to determine whether this will reduce risk-taking among youths.

Screening for Chlamydia trachomatis infection is indicated for women under 30 using emergency contraception

A total of 838 women attending a large family planning clinic in Scotland for emergency contraception were offered screening for Chlamydia trachomatis infection. 569 were screened using ligase chain reaction test in first void urine at the time of presenting for emergency contraception and were retested 1 or 2 weeks later. Women aged under 20 and over 30 years were significantly more likely to decline to be tested than women aged 20 to 30. The prevalence of chlamydia was 7.6% in woman aged 24 or less, 5.3% in women aged 25 to 29, and 1.2% in women aged 30 or more. Only two women (< 1%) who tested negative at the time of using EC were positive 1 or 2 weeks later. Women under age 30 who use EC should be offered screening for chlamydia infection and testing at the time they attend for EC is adequate to detect the great majority of infected women.

Duration of persistence of gonococcal DNA detected by ligase chain reaction in men and women following recommended therapy for uncomplicated gonorrhea.

Neisseria gonorrhoeae infection remains relatively common in the United States, representing a public health challenge. Ligase chain reaction (LCR) is both highly sensitive and specific for the detection of N. gonorrhoeae in urine and patient-obtained vaginal swab specimens. Because of the LCR test's exquisite sensitivity, it may potentially detect DNA from nonviable organisms following effective therapy, leading to false-positive test results and unnecessary additional treatment. The purpose of the present study was to determine the duration that gonococcal DNA is detectable by LCR following therapy for uncomplicated gonococcal infection. One hundred thirty men and women between the ages of 16 and 50 years presenting to a sexually transmitted disease clinic with urogenital gonorrhea were enrolled. After the standard history was taken and a genital examination was done, the patients were asked to submit either a urine specimen (men) or a urine specimen plus a self-obtained vaginal swab specimen (women) for N. gonorrhoeae testing by LCR at the initial visit and each day during the study period. At enrollment, patients were treated with single doses of ofloxacin, cefixime, or ceftriaxone. The median time to a negative urine LCR test result was 1 day for the men (mean, 1.6 +/- 0.14 days) and 2 days for the women (mean, 1.7 +/- 0.19 days). Among the women the clearance time was significantly longer for vaginal specimens (mean, 2.8 +/- 0.30 days) than for urine specimens (mean, 1.7 +/- 0.11 days). Irrespective of patient gender and specimen type, gonococcal DNA can be expected to be absent from urogenital specimens within 2 weeks following successful therapy.

Mass media as a population-level intervention tool for Chlamydia trachomatis screening: report of a pilot study.

To determine the feasibility and affect of mass media use in a population-level intervention for chlamydia screening promotion. A population-level chlamydia intervention protocol was field tested. The intervention, targeting 15-25-year-old individuals, was designed to: (a) increase awareness of personal risk for chlamydial infection; (b) facilitate dissemination of chlamydia knowledge by use of a telephone hot line; and (c) promote care-seeking behavior (report for a chlamydia screening program). The intervention activities included: (a) mail outreach, (b) a television and radio campaign, (c) a prerecorded Check-It-Out chlamydia hot line, (d) a staffed chlamydia Options information line, and (e) a free confidential urine ligase chain reaction (LCR) test for chlamydia. Mass mailings were scheduled at intervals, starting two-weeks before the beginning of the television advertisement. The 30-second television advertisement was aired on local television stations 130 times in a 6-week period. The outcome measures were quantity and characteristics of incoming calls to the automated hot line and staffed chlamydia information phone line in response to the chlamydia campaign, and response to the urine screening program. Descriptive and bivariate analyses were used to evaluate the outcomes. The hot line was called 642 times during the monitoring period (November 1, 1999 to March 8, 2000), the majority (92%) during the 6 weeks of television advertisement, with an average of 99 calls per week, compared with an average of 9 calls per week after the commercial ended. Each bulk mailing was accompanied by a boost in the incoming hot line calls. The research staff triaged 133 calls to the "Options" phone line, 81% in the 6 weeks of the TV ad. The mean age of the 133 callers was 23.9 +/- 7.7 years (range 14-49 years). A majority called for screening information; 67% of callers were females and 84% of female callers were under age 26 years. Five percent of callers identified themselves as a parent of a teenager. The majority credited the TV ad as their source of the hot line number. Thirty-one individuals reported for a confidential chlamydia screening, 27 of 31 (87%) during the 6 weeks of TV advertising. No negative responses regarding the chlamydia campaign were encountered. This report describes strategies used to implement and measure the effectiveness of a mass media campaign and demonstrates evidence that mass media is effective in delivering STD intervention messages to young people.

Chlamydia trachomatis infection and non-gonococcal urethritis in homosexual and heterosexual men in Edinburgh.

In 1998, when ligase chain reaction testing for chlamydial infection was introduced in our clinic in Edinburgh, routine clinic protocol included the testing of all heterosexual, but not homosexual, men for urethral chlamydial infection. We audited all new homosexual and bisexual male attendees with a diagnosis of chlamydial infection or non-gonococcal urethritis (NGU) in 1999, together with heterosexual men with the same diagnoses attending in alternate months of the same year. Urethral Chlamydia trachomatis infection was detected in 14.6% (350/2402) of heterosexual men and 2.4% (11/465) of homosexual men tested. Fifty percent of chlamydial infections were asymptomatic. In this population 44% (84/190) of NGU in heterosexual men is attributable to C. trachomatis as opposed to only 10% (6/59) of that in homosexual men. These rates of chlamydial infection differ from previous reports in Scotland and recent studies from the USA. Our clinic protocol has been revised to include routine testing for chlamydial infection in all men.