Screening For Chlamydia Trachomatis Infection Research Articles

Molecular Diagnosis of Chlamydia trachomatis in Women with Frequent Abortions

Background: Chlamydia trachomatis is the commonest cause of bacterial sexually transmitted infections. This research aimed at scrutinizing the Chlamydia trachomatis screening tests with vaginal samples and at investigating the correlation between Chlamydia trachomatis infection and the abortion incidence. Methods: The current Cross sectional study was done at gynecology clinic of Razi Hospital in Chalus, Iran between August 2017 and January 2018. Fifty vaginal swabs were collected and detecting C. trachomatis DNA was done. Chi-square test and Independent t-test compared the variables. P <0.001 was significant Results: The total C. trachomatis infection prevalence was 5(10%) in endocervical swabs. A significant difference was found between duration of sexual activity and Chlamydia infection. No significant difference was detected between detection of Chlamydia l and abnormal vaginal discharged. Conclusion: Screening for Chlamydia trachomatis infection of the women experiencing a miscarriage should be done and, if positive, they should be treated to inhibit recurrent miscarriages.

Is an Antenatal Screening for Chlamydia trachomatis Necessary in the Current Society?

A screening of Chlamydia trachomatis infection in young pregnant women (≤25 years old) and their newborns was conducted. A total of 136 women were tested with urine samples in the immediate postpartum period. The prevalence was 18.4% (95% confidence interval [CI]: 11.9-24.9%) (25/136) and the rate of perinatal transmission was 35% (7/20). These results support the need for antenatal screening programs in high-risk women in Madrid (Spain).

Prevalence and risk factors of Chlamydia trachomatis genital infection among military personnel of the Armed Forces of Serbia: A cross-sectional study

Background/Aim. Chlamydia trachomatis infection (CTI) is an increasing public health problem worldwide and is the most frequent sexually transmitted infection. Studies conducted in many armed forces worldwide showed that CTI is common within military population and generate significant healthcare costs. The aim of this study was to estimate the prevalence of CTI among members of the Serbian Armed Forces (SAF) and to determine risk factors for this infection. Methods. The study was designed as a cross-sectional survey and consisted of completing a questionnaire and chlamydial testing. The questionnaire was divided into two question groups: one was about demographic/service related characteristics and the other was about behavioral patterns/ habits. Chlamydia trachomatis real time polymerase chain reaction (Real-TM PCR) was used for detection of pathogen genome specific sequence in the male urethral swabs and in the female endocervical swabs. All data collected were used to compare military personnel with and without CTI. Risk factors independently associated with CTI were identified by the stepwise multivariate logistic regression analysis (MLRA) of variables selected by the univariate logistic regression analysis (ULRA), with a limit for entering and removing variables from the model at 0.05. Results. The overall prevalence of CTI was 55 of 356 respondents (15.4%; 95% CI 0.5?2.7%). The ULRA identified that CTI was significantly associated with several characteristics: number of sexual partners during previous year (p = 0.008), knowledge about symptoms of CTI (p = 0.035), tattooing (p = 0.035) and married or in stable relationship (p = 0.022). The MLRA revealed that number of different sexual partners during last year was independent risk factor of CTI (p = 0.026; OR : 0.344; 95% CI: 0.13?0.88). Conclusion. CTI is significant problem in male and female military personnel in the SAF. The number of different sexual partners during previous year was independently associated with CTI. These finding indicates that screening for CTI should be undertaken in the SAF, to reduce rates of CTI in the SAF and to prevent morbidity due to this infection.

Screening for asymptomatic urogenital Chlamydia trachomatis infection at a large Dublin maternity hospital: results of a pilot study.

There are currently no Irish guidelines on screening for Chlamydia trachomatis infection in pregnancy. Prevalence rates in the antenatal population are not known which has prevented the development of screening recommendations for this group. The objective of this study was to determine the prevalence of asymptomatic urogenital C. trachomatis infection in young women attending for care at a large maternity hospital. All patients aged 25years and under attending the Hospital between December 2011 and December 2013 were offered screening for urogenital C. trachomatis infection. Nucleic acid amplification testing of the C. trachomatis cryptic plasmid was performed on either endocervical swabs or first void urine samples. There were 2687 women tested for C. trachomatis infection, 83.4% (2241/2687) through the antenatal clinics, 7.1% (193/2687) through the gynaecology clinic, and 9.4% (253/2687) through the emergency department. The rate of a positive test result was 5.6% (151/2687) overall. The rates in women ages 16-18, 19-21 and 22-25years were 9.1% (31/340), 6.5% (50/774) and 4.4% (69/1561), respectively. A positive test result was more likely in those who were unemployed (p=0.04), those who were Irish (p=0.03) and those who were unmarried (p<0.01). There were no cases of neonatal C. trachomatis infection in babies born to mothers who were screened in early pregnancy. The prevalence rate of detected C. trachomatis infection was 5.6% in the study population. Screening of antenatal patients may have a role in preventing vertical transmission of infection to the neonate.

Optimization of candidate proteins for serological screening of Chlamydia trachomatis infection.

The aim of this study was to optimize candidate antigen proteins for serological screening of Chlamydia trachomatis infection. C. trachomatis positive serum and swabs of genital secretions were collected from 50 patients in the Tianjin Medical University General Hospital, as well as from 30 patients negative for C. trachomatis. Samples were assessed by colloidal gold assay in a sexually transmitted disease clinic as follows: serum antibodies for eight kinds of C. trachomatis immunodominant proteins (Pgp3, CPAF, CT143, CT101, CT694, CT875, CT813, and IncA) were detected, and two traditional gold standards, immunofluorescence and C. trachomatis cell culture of genital secretions, were used for comparison in order to determine the antigen protein combinations with the highest sensitivity and specificity. Of the 50 samples that tested positive for C. trachomatis infection by colloidal gold assay, 44 tested positive by micro-immunofluorescence, whereas 6 tested negative. In contrast, 14 samples tested positive by cell culture, whereas 36 tested negative. Serological results of the immunodominant protein combination of Pgp3, CT694, and CT875 shared positive coincidence rates of 97.73 and 92.86% with C. trachomatis micro-immunofluorescence and cell culture, respectively. No antibodies of the three proteins were detected in the 30 C. trachomatis samples that tested negative by colloidal gold assay; these samples also tested negative in C. trachomatis genital secretion culture. Overall, the combination of the three immunodominant proteins Pgp3, CT694, and CT875 had good sensitivity and specificity for serological screening of C. trachomatis infection, and the process was simple and easy to apply.

Current Status of the Screening of Chlamydia trachomatis Infection Among Japanese Pregnant Women.

Chlamydia trachomatis (CT) infection in pregnancy can cause maternal disease, adverse pregnancy outcomes, and neonatal disease [1-6]. In general, approximately 80% of CT infected women are asymptomatic or minimally symptomatic. There-fore, screening is the only means to effectively identify infec-tions [2]. In Japan, pregnant women are routinely tested for CT with the Japanese public funds. According to the guide-lines for obstetrical practice in Japan [7], Japanese obstetri-cians must provide a test for the detection of CT for the pre-vention of neonatal CT infection and diagnose urogenital CT infection when CT is detected using polymerase chain reac-tion (PCR), strand displacement amplification, transcription mediated amplification, an enzyme immunoassay, or culture methods in specimens obtained from the uterine cervix (CT nucleic acid detection tests). However, CT antibody detection by IgA tests has been substituted for these methods by some of obstetricians.On October 2014, we requested 2,544 obstetrical facilities that are members of Japan Association of Obstetricians and Gynecologists (JAOG) to provide information of CT screen-ing tests in pregnant women between October 2013 and March 2014. A total of 1,644 (64.6%) of 2,544 obstetrical facilities responded with possible statistical analysis information on a total of 328,788 women, accounting for approximately 65% of all deliveries that occurred in Japan during the study period. Of the 1,644 obstetrical facilities, CT nucleic acid detection PCR tests, CT nucleic acid detection tests except PCR and CT antibody detection tests were performed in 1,221 (74.3%), 408 (24.8%) and 15 (0.9%) facilities, respectively.Table 1 shows the maternal age distribution under the three CT screening tests (CT nucleic acid detection tests with and without PCR and CT antibody detection tests). There were no significant differences in the maternal age distribution among the three CT screening tests groups.Table 2 shows the results of CT screening tests (CT nucle-ic acid detection tests with and without PCR and CT antibody detection tests) of the study population by age. There were no significant differences in the rate of positive CT between the two groups of CT nucleic acid detection screening tests with and without PCR. However, the positive rate by the CT anti-body detection tests was significantly higher than those by the two CT nucleic acid detection tests with and without PCR (P < 0.01 by X

Screening of Chlamydia trachomatis Infection in Men, Is It Necessary in Iran?

Background: Chlamydia trachomatis is one of the most prevalent causative bacteria in sexually transmitted infections with adverse effects, which almost remain asymptomatic in society. Objectives: This project designed to determine the prevalence of Chlamydial infection in men and comparing the related risk factors in two groups of referrals based on the study inclusion criteria. Materials and Methods: Two hundreds of men who attended in the Mehrad hospital in Tehran Iran were selected and classified into two groups (symptomatic and asymptomatic). 10 mL of first void urine from each person collected and tested by polymerase chain reaction for the presence of C. trachomatis cryptic plasmid gene. association between condom usage as a variable and infection in asymptomatic group (P � 0.05). Results: In total, 8.5 of all subjects were positive (11 of symptomatic and 6 of asymptomatic men). Statistical analysis revealed an Conclusions: Findings of this study show that Chlamydial infection screening especially in males with urogenital symptoms is necessary (at least in Tehran) and we recommend more epidemiological studies in other cities of Iran. © 2013, Ahvaz Jundishapur University of Medical Sciences.

Screening for Chlamydia trachomatis infection among infertile women in Saudi Arabia.

BackgroundChlamydia trachomatis infection is a worldwide-distributed sexually transmitted infection that may lead to infertility.ObjectivesThis study aims to report the prevalence of Chlamydia trachomatis infection among infertile women in Saudi Arabia.Patients and methodsA community-based study carried out at the obstetrics and gynecology clinic at Jazan General Hospital, Saudi Arabia. The study group included 640 Saudi infertile women who were aged between 18 and 40 years and who attended the gynecology clinic for infertility examination throughout 1 year of study (from July 1, 2011 to June 30, 2012). The randomized control group included 100 Saudi fertile women who attended the obstetrics clinic for routine antenatal care. All recruited women were screened for chlamydia infection by enzyme-linked immunosorbent assay (ELISA) for detection of serum-specific antibodies and then retested by the McCoy cell culture technique.ResultsThe prevalence of Chlamydia trachomatis infection among infertile women was high, at 15.0%. The rate of chlamydia infection detected by ELISA was 9.84%, and it was 12.03% by the culture method (P = 0.2443).ConclusionThe high prevalence of Chlamydia trachomatis infection among Saudi infertile women demands a national screening program for early detection among infertile couples. ELISA is available as a simple screening test alternative to the culture method.

Rapid screening for Chlamydia trachomatis infection by detecting α-mannosidase activity in urogenital tract specimens

BackgroundChlamydia trachomatis may cause multiple different urogenital tract disorders, but current non-culture assays for rapid screening of C. trachomatis typically use immunochromatography-based methods. We established another new rapid non-culture method for detection of C. trachomatis based on the measurement of α-mannosidase enzymatic activity in urogenital tract specimens.MethodTo evaluate the performance of this method, α-mannosidase activities of C. trachomatis serotype D strain 、 and 29 standard strains related to clinical urogenital pathogens were investigated. Furthermore, 553 urogenital tract specimens were used for clinical assays via cell culture method and ligase chain reaction method (LCR), adopting an expanded gold standard.ResultsOnly C. trachomatis was positive for α-mannosidase activity among different types of microbes tested in the research. When prostate fluid specimens, which have some interfering activity, were excluded, the sensitivity and specificity of the enzymatic method were 91.8% (78/85) and 98.3% (409/416), respectively. There were no significant differences (P > 0.05).ConclusionsThese results showed that α-mannosidase activity could be utilised as a screening marker of C. trachomatis infection.

Screening for Chlamydia trachomatis Infection Using Direct Fluorescein Antibody Method in Female Sex Workers Registered in Ankara, Turkey: Pros and Cons

Aim: This study aimed to screen for Chlamydia trachomatis infection by direct fluorescein antibody (DFA) method in a high-risk population, registered female sex workers (FSWs) in Ankara, Turkey, to investigate the advantages and disadvantages of using this method in a routine screening program of the FSW population. Materials and Methods: All registered FSWs (n = 152) in Ankara were enrolled in the study. None of them were showing any genital signs or symptoms of sexually transmitted infections (STIs). Endocervical swabs were collected and examined for C. trachomatis by DFA method (Fluorotect Chlamydia, Omega Diagnostics, UK). Cellular adequacy of the specimens was examined for the presence of at least five columnar epithelial cells per X400 field. A positive diagnosis was made when fixed and stained specimens showed at least 10 chlamydial bodies under the fluorescein microscope. A positive control slide was also stained and examined on each study day. Results: Of the 152 specimens, only 112 (73.7%) were adequate; it was not possible to obtain adequate specimen from the remainder of the women because the cervical os was too tight to insert the swab. Of the 112 adequate specimens, 3.6% (4/112) were positive for C. trachomatis serotype-specific major outer membrane proteins (MOMP), based on DFA method. Conclusions: C. trachomatis infection rate of 3.6% was relatively low in this group of women compared to a priori expectations, yet still remarkable. A significant level of ´´inadequacy´´ in obtaining endocervical specimens (in 26.3% of FSWs) could have limited the external validity of the prevalence rate estimation in this population and the practicality of DFA use for C. trachomatis screening. C. trachomatis screening should be integrated in the STI control program for sex workers in Turkey. However, further research is warranted to optimize the method to be used in screening and/or diagnosis in such high-risk groups.

A novel real-time PCR to detect Chlamydia trachomatis in first-void urine or genital swabs

Screening for Chlamydia trachomatis infections can be performed on urine samples and genital swabs using molecular techniques. A novel approach was developed that combined an automated extraction procedure, an automated liquid-handling system and real-time PCR to detect C. trachomatis from urine or swabs. This novel real-time PCR approach was compared to the commercial Cobas Amplicor system on 628 specimens. In a retrospective analysis, 51 samples that tested positive using the Cobas assay were also positive with the real-time PCR, whereas the 49 samples negative with Cobas were also negative with the real-time PCR, for an overall agreement of 100 %. Among 528 prospective samples consecutively received at the authors' laboratory with a request for C. trachomatis PCR, five PCR reactions were inhibited when tested with Cobas. These five inhibited samples were found negative with the real-time PCR. Among the remaining 523 samples, 45 (8.6 %) were positive with both methods, 476 (91 %) were negative with both methods, and 2 (0.4 %) were positive with Cobas but negative with the real-time PCR. Thus, when considering Cobas as the gold standard, the overall agreement was 99.6 %, the sensitivity of the real-time PCR was 95.7 % and the specificity was 100 %. The two discrepant samples were retested in parallel and were found negative with both methods. When testing a batch of 25 samples, both reagent costs and laboratory technician time were reduced with the new technique (7.30 euros per sample and 134 min) compared to Cobas (11.20 euros per sample and 232 min). Moreover, due to reduced organizational constraints, the median time from sample reception to result was only 24 h using the automated platform. Overall, this novel real-time PCR approach exhibited an excellent specificity and a sensitivity similar to that of Cobas Amplicor PCR for the detection of C. trachomatis. Given its high throughput potential and low costs/laboratory technician time requirement, it may be useful for future use in large C. trachomatis screening programs.

Population screening for Chlamydia trachomatis infection in the UK: a qualitative study of the experiences of those screened

Screening for Chlamydia trachomatis in selected health care settings is underway in the UK despite insufficient evidence about the personal impact of screening. To describe men and women's experiences of being screened for chlamydia as part of the Chlamydia Screening Studies (ClaSS) project, a population-based UK study of postal screening for chlamydia. We conducted in-depth interviews with 45 purposively sampled participants in the ClaSS project using a checklist of topics relating to their experiences of the screening process. Interviews were audio-tape recorded, transcribed verbatim and analysed using the constant comparison method. Four main themes emerged: initial discomfort with screening arising from an unease with sexual health issues; anxiety, especially after receiving a positive test result, due to the fear of informing sexual partners, the risk of infertility and the possibility of having other undetected infections; women's concern about being stigmatised for having been infected with chlamydia, which affected how they felt about themselves and how they thought others would perceive them; and recognising the need to balance the harms of screening with the benefits. Despite some reported adverse effects, no one regretted their decision to be screened. Public education and discussion of sexually transmitted infections should help to increase the acceptability of chlamydia screening and destigmatise a diagnosis of chlamydia. Those working in primary care settings are likely to become increasingly involved in chlamydia screening and so must be suitably trained to inform individuals of the potential adverse effects and to deal with their consequences.

Reinfections, Persistent Infections, and New Infections After General Population Screening for Chlamydia trachomatis Infection in The Netherlands

The objectives of this study were to determine the rate of new infections and reinfections or persistent infections with Chlamydia trachomatis to define appropriate screening intervals and to identify risk factors for reinfection. This was a cross-sectional study among a subsample of participants in a population-based screening. This study was conducted in urban and rural areas in The Netherlands. A total of 21,000 15- to 29-year-old women and men were invited for home-based urine testing. One year after the study, a subsample of 299 participants were offered retesting. The authors studied the rate of infection with C. trachomatis. Serovar determination was used to potentially discriminate between new infections and reinfections or persistent infections. Nine C. trachomatis infections were found among 187 responders (4.8% confidence interval, 1.7-7.9). The prevalence was 10.4% (5 of 48) in previous positives and 2.9% (4 of 139) in negatives. Three of 5 repeatedly positive participants were infected with a different C. trachomatis serovar. Our study indicates that infected persons found in a systematic, population-based screening should be re-screened within 1 year. Optimal screening intervals still need to be determined.

Screening of Chlamydia trachomatis urogenital infections among the male and female population of the Republic of Macedonia

Noninvasive urine screening for Chlamydia trachomatis infections offers a valuable public health tool, that could be of vast importance in Chlamydia control programs. The goal was to determine the prevalence of C. trachomatis infections among a sexually active population, to define the epidemiological factors associated with it, and to develop potential selective screening strategies among asymptomatic individuals in the Republic of Macedonia, using a highly sensitive and specific DNA amplification method for C. trachomatis. A total of 1435 urine samples, divided into two main groups: asymptomatic individuals (n = 1210) and symptomatic patients (n = 225), were tested. Samples from the asymptomatic group were collected during routine screening programs, while the symptomatic group consisted of patients with symptoms of urogenital tract infection, attending sexually transmitted diseases (STD) clinics. The presence of C. trachomatis was determined using commercial AMPLICOR C. trachomatis Assay (Roche Diagnostic Systems, Inc., Branchburg, NJ, USA). The prevalence of C. trachomatis infections among different groups was: recruits 0%, soldiers 0.4%, policemen 3.5%, clerks 4.6%, pregnant women 4%, and students 4.4%. The average prevalence for both groups (asymptomatic and symptomatic) was 2.3%[95% confidence interval (CI): 1.5-3.1%]. The average prevalence for the asymptomatic group was 1.6% (95% CI: 0.8-2.4%), while the average prevalence for the symptomatic group was 6.2% (95% CI: 3.1-9.3%) which were significantly different (P = 0.00003). Testing first void urine specimens by AMPLICOR C. trachomatis assay is a highly sensitive and specific method for diagnosing C. trachomatis infections in men and women. This method provides health care workers and public health officials with a new molecular amplification assay that uses noninvasive urine specimens for population-based screening purposes. The prevalence of C. trachomatis was relatively low among asymptomatic individuals. However, selective screening strategies are highly recommended for testing the student population in the Republic of Macedonia.

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.

General practitioners' views on the screening for genital Chlamydia trachomatis infection and partner notification.

A postal survey of general practitioners (GPs) in the East Riding of Yorkshire was undertaken to find out their views about screening for Chlamydia trachomatis infection, the reasons for their inability to screen the high-risk population, facilities available for screening in the primary care setting, treatment regimen and the views about partner notification. Although all GPs had the facilities for chlamydial testing, their views on chlamydial screening differed widely and very few offered opportunistic screening. Most of the GPs would prefer the sexual health clinics (genitourinary medicine [GUM] clinics) to undertake partner notification. Less than half of the GPs surveyed offered the ideal antimicrobial therapy against chlamydial infection, as recommended by the Central Audit Group in Genito-urinary Medicine. This survey shows the necessity to disseminate proper guidelines for the management of uncomplicated C. trachomatis infection in the community. Sexual health clinics should make adequate provision to deal with additional workload resulting from the increased referrals of partners to the clinics when the opportunistic screening is widely provided by the GPs.

Screening for Chlamydia trachomatis infection in college women with a polymerase chain reaction assay.

This study sought to determine factors associated with chlamydial infection in a low-prevalence college health setting and to determine the testing characteristics of a polymerase chain reaction (PCR) assay for chlamydial infection (AMPLICOR chlamydia test; Roche Diagnostic Systems, Indianapolis) in this population. Young women (n = 1,149) at a university student health clinic underwent testing for cervical chlamydial infection by PCR assay and culture; the characteristics of women with and without chlamydial infection were compared. Chlamydial infection was diagnosed for 26 students (2.3%). The sensitivity and specificity of PCR assay and culture were 85% and 100% and 54% and 100%, respectively. Students with chlamydial infection were more likely to be 20 years of age or younger, have symptoms, report prior chlamydial infection or gonorrhea, report exposure to a sexually transmitted disease (STD), be black, or have cervical signs during examination; however, none of these were significant predictors for asymptomatic women. PCR assay detected significantly more cervical infections than did culture in this college student population. These data are consistent with recommendations for testing college women with symptoms, STD exposure, or age of younger than 25 years.

Urine as a diagnostic specimen for the detection of Chlamydia trachomatis in Malaysia by ligase chain reaction.

Noninvasive urine screening for Chlamydia trachomatis infections offers a valuable public health tool, which could be of vast importance in chlamydial control programs. The authors evaluated a new DNA amplification method, ligase chain reaction (LCR). The goal was to ascertain whether urine testing could be used as screening method to detect C. trachomatis infections in commercial sex workers, patients at sexually transmitted diseases clinic, and asymptomatic patients in Kuala Lumpur, Malaysia. First-void urine specimens from 300 men and 300 women were tested by LCR, as well as by a commercially available enzyme immunoassay. The LCR assay amplifies specific sequences within the chlamydial plasmid with ligand-labeled probes, and the resultant amplicons are detected by an automated immunoassay. Specimens with discrepant results were confirmed by another LCR of the specimen that targeted the gene for the major outer membrane protein (OMP1). There were 31 LCR-positive male urine and 37 LCR-positive female urine specimens. The resolved sensitivity and specificity for the LCR of the male urine specimens were 100% and 99.6%, respectively, whereas for female urine specimens, the sensitivity and specificity were 100% and 98.5%, respectively. After resolution of discrepant test results by OMP1 LCR, the prevalence was 10% for men and 11% for women. The urine enzyme immunoassay was not useful in diagnosing C. trachomatis infections in either men or women, as the resolved sensitivities were 10% and 15.2%, respectively. The specificities were 99.6% for men and 98.9% for women. Testing first-void urine specimens by LCR is a highly sensitive and specific method to diagnose C. trachomatis infections in men and women, providing health care workers and public health officials with a new molecular amplification assay that uses noninvasive urine specimens for population-based screening purposes.

Selective screening for Chlamydia trachomatis infection in a primary care population of women.

The authors used cell cultures to assess the prevalence of cervical infection caused by Chlamydia trachomatis in a population-based sample of nonpregnant women aged 15 to 34 years who attended two primary care clinics at Group Health Cooperative of Puget Sound, Seattle, Washington, between January 1, 1988, and June 30, 1989. C. trachomatis was isolated from 67 of 1,804 women (3.7%), including 13% of those who were less than 20 years of age. Seven patient characteristics were independently predictive of chlamydial infection by stepwise multivariate logistic regression analysis: being unmarried, examination showing cervical ectopy, black race, douching, nulliparity, age of 24 years or less, and intercourse with two or more partners within the preceding year. Testing all women who had a score of 5 or more (28% of women) on a weighted index based on risk factors would detect 77% of all infections with a positive predictive value of 9%. These results suggest that it should be feasible to develop a risk factor-based program to screen for cervical infection with C. trachomatis in populations where its prevalence is low.

Direct detection of Chlamydia trachomatis in urine specimens from symptomatic and asymptomatic men by using a rapid polymerase chain reaction assay

Screening for Chlamydia trachomatis infection in men has traditionally been limited to men who present with urethral symptoms, thereby limiting the detection of asymptomatic chlamydia infection in men. In order to effectively screen both symptomatic and asymptomatic men, we evaluated a newly developed polymerase chain reaction (PCR) assay, Amplicor C. trachomatis, from Roche Molecular Systems for the detection of C. trachomatis in urine specimens in comparison with urethral culture. A total of 530 male urine specimens were collected from 322 symptomatic and 208 asymptomatic men attending two sexually transmitted disease clinics in Baltimore, Md. The prevalence of C. trachomatis by culture was 9.8% (10.6% in symptomatic men and 8.2% in asymptomatic men). Compared with culture, the sensitivity of the PCR was 92.8%, the specificity was 94.7%, the positive predictive value was 68.4%, and the negative predictive value was 99.1%. Discrepant results between culture and PCR were further analyzed by direct fluorescent-antibody staining of elementary bodies in urine sediment and in culture transport vials and by major outer membrane protein PCR of transport media for specimens with negative culture. The revised sensitivity and specificity of PCR for urine were 95.0 and 99.8%, respectively, and the positive and negative predictive values were 98.7 and 99.1%, respectively. The sensitivity of culture compared with PCR and/or direct fluorescent-antibody staining was 68.4%. These results indicate that the PCR assay is a highly sensitive and specific assay for the detection of C. trachomatis in male urine specimens and provides a noninvasive technique for routine screening of chlamydia infection in both symptomatic and asymptomatic men.