Screening of urine specimens from men for Chlamydia trachomatis infection by a commercial PCR assay (AMPLICOR C. trachomatis Test; Roche Diagnostic Systems, Inc., Branchburg, N.J.) is a sensitive and specific noninvasive diagnostic assay. Since screening of women for C. trachomatis infection with the AMPLICOR C. trachomatis Test has been limited to use with endocervical swab specimens, we conducted an evaluation of the AMPLICOR C. trachomatis Test for the detection of C. trachomatis using female urine samples and compared the results with those obtained by in vitro culture and PCR of endocervical swab specimens. For 713 men we compared the performance of AMPLICOR C. trachomatis Test with urine specimens with that of culture of urethral specimens. For specimens that were PCR positive and culture negative, two additional tests were used to resolve the discrepancies: direct fluorescent-antibody assay (DFA) of sediment from a spun endocervical specimen culture vial and major outer membrane protein-based PCR of the sediment from the endocervical specimen culture vial. Of 525 urine specimens from females, 67 (12.8%) were PCR positive, and 41 (7.8%) endocervical specimens from the 525 women were culture positive. After resolution of the discrepancies, the resolved sensitivity of the urine PCR was 93.3%, whereas the sensitivity of endocervical swab specimen culture was 67.3%. Of 468 female endocervical swab specimens, 47 (10.0%) had a positive PCR result and 33 (7.0%) were culture positive. The resolved sensitivity of the endocervical swab specimen PCR was 86%. Of 415 matched female urine and endocervical swab specimens, there were 49 confirmed infections; 30 (61.2%) specimens were positive by culture of the endocervical swab specimen, 40 (81.6%) were positive by confirmed endocervical swab specimen PCR, 43 (87.8%) were positive by confirmed urine PCR, and all 49 (100%) were positive by either endocervical swab specimen PCR or urine PCR. For men, the resolved sensitivity of the urine PCR was 88%, and the sensitivity of culture was only 50.7%. These results indicate that urine PCR is highly sensitive for the detection of C. trachomatis in both women and men and provides a noninvasive technique for routine screening for chlamydial infection.
Objectives:We studied the eVect of small monetary incentives and non-monetary incentives of similar value on enrolment and participation in clinic based HIV/STD prevention counselling. We examined incident STDs to try to assess whether participants oVered money may be less motivated to change risky behaviours than those oVered other incentives. Methods: Patients from five US STD clinics were invited to enrol in a multisession risk reduction counselling intervention and, based on their enrolment date, were oVered either $15 for each additional session or non-monetary incentives worth $15. The two incentive groups were compared on participants' enrolment, completion of intervention sessions, and new STDs over the 24 months after enrolment. Results: Of 648 patients oVered money, 198 (31%) enrolled compared with 160 (23%) of 696 patients oVered other incentives (p=0.002). Enrollees in the two incentive groups had similar baseline characteristics, including condom use. Of the 198 participants oVered money, 109 (55%) completed all sessions compared with 59 (37%) of the participants oVered other incentives (p <0.0001). Comparing those oVered money with those oVered other incentives STD rates were similar after 6, 12, and 24 months. Conclusions: Small monetary incentives enhanced enrolment and participation compared with other incentives of similar value. Regardless of incentive oVered, participants had similar post-enrolment STD rates, suggesting that the type of incentive does not adversely aVect motivation to change behaviour. Money may be useful in encouraging high risk individuals to participate in and complete counselling or other public health interventions. (Sex Transm Inf 1998;74:253-255)
This is one study among a small number of studies examining the reproducibility of clinician-reported circumcision status by comparing multiple clinical examinations of the same patient. The magnitude of the misclassification discovered could bias results and indicates the need for greater accuracy in reporting circumcision status in future studies.
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