Diagnosis Of Chlamydia Trachomatis Urethral Infection In Symptomatic And Asymptomatic Men By Testing First-Void Urine In A Ligase Chain Reaction Assay

Chernesky, Max; Lee, Helen; Schachter, Julius; Burczak, John D.; Stamm, Walter E.; McCormack, William M.; Quinn, Thomas C.

doi:10.1093/infdis/170.5.1308

Cited by 185 publications

(134 citation statements)

References 14 publications

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“…With the use of matched specimens, we have shown that, for men, urethral swabs offer no yield advantage over FVU specimens because the organism load did not differ significantly between these two specimen types (821 and 1,200 EBs/ 100 l, respectively). Our results support those of previous studies suggesting that FVU is a more practical and acceptable specimen type for detection of C. trachomatis in men and is a better diagnostic specimen for screening of asymptomatic individuals (6,8). For women, the endocervical swab has been the standard sample for most tests approved by the U.S. Food and Drug Administration.…”

Section: Discussionsupporting

confidence: 89%

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Chlamydia trachomatis Load at Matched Anatomic Sites: Implications for Screening Strategies

et al. 2007

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Urethral and endocervical swabs and self-collected vaginal swabs (SCVSs) and urine specimens are all used as samples for diagnosis of urogenital infection with Chlamydia trachomatis. We have now determined chlamydial organism load in matched specimens from different anatomic sites and examined its relation to clinical signs and symptoms in men and women. Organism load was measured with assays based on the ligase chain reaction or real-time PCR analysis. The mean organism loads in 58 infected men were 1,200 and 821 elementary bodies (EBs) per 100 l of sample for first-void urine (FVU) and urethral swabs, respectively (P > 0.05). Organism load in FVU samples or urethral swabs was positively associated with symptoms (P < 0.01) and clinical signs (P < 0.01) in men. The mean organism loads in 73 infected women were 2,231, 773, 162, and 47 EBs/100 l for endocervical swabs, SCVSs, urethral swabs, and FVU samples, respectively (P < 0.001 for each comparison). Only the presence of multiple symptoms or clinical signs was associated with organism load in women. These results show that FVU is a suitable noninvasive sample type for men, given the fact that its chlamydial load did not differ significantly from that of urethral swabs. Given their higher organism load compared with FVU, SCVSs are the preferred noninvasive sample type for women.Urogenital infection with Chlamydia trachomatis is the most commonly reported bacterial sexually transmitted infection (STI) and continues to be a major public health problem worldwide (4, 35). Given that most chlamydial infections are asymptomatic in both men and women, they often remain undiagnosed and untreated and therefore provide a reservoir for the disease (33). Infection of the upper genital tract may lead to complications, such as epididymitis in men and pelvic inflammatory disease in women. The inflammation and subsequent tissue scarring associated with the latter can lead to more serious sequelae (4).Effective control of chlamydial infection within a population requires early diagnosis and prompt treatment of asymptomatic individuals (28). Targeted and regular screening is also recommended for people in high-risk groups or with a past history of genital chlamydial infection (14). The most common sites of infection in women are the cervix and urethra. Infected cells are shed from the endocervix into the vagina and are present in vaginal secretions. Infected epithelial cells from the urethra and the associated C. trachomatis elementary bodies (EBs) can also be detected in first-void urine (FVU) (3, 16). Potentially suitable clinical specimens for detection of chlamydial infection in women thus include urethral, vaginal, and endocervical swabs, self-inserted tampons, and FVU samples (3, 12). For screening programs, noninvasive specimens, such as vaginal swabs, tampons, and FVU, are preferable to invasive urethral and endocervical swabs because they overcome several barriers associated with the traditional diagnostic pathway (5, 11). Sensitivity of C. trachomatis detection with vag...

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Section: Discussionsupporting

confidence: 89%

“…Sensitivity of C. trachomatis detection with vaginal swabs has been shown to be similar to that with endocervical swabs or FVU samples (12,22,31). In men, C. trachomatis infects the urethral mucosa, which can be sampled effectively by collection of either urethral swabs or FVU, the latter being noninvasive (8)(9)(10).…”

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Chlamydia trachomatis Load at Matched Anatomic Sites: Implications for Screening Strategies

et al. 2007

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“…FVU specimens were collected in sterile containers and frozen at −20°C at each site until shipped to the regional virology and chlamydiology laboratory in Hamilton for testing by LCR as described previously. 5 Genotyping by restriction fragment length polymorphism (RFLP) of the outer membrane protein gene was performed at the microbiology laboratory, University of Sherbrooke, Quebec, on the specimens from first and subsequent visits of participants positive at any of the follow up visits, using previously described methods. 10 …”

Section: Laboratory Proceduresmentioning

confidence: 99%

“…4 Ligase chain reaction (LCR) testing of first void urine (FVU) to detect C trachomatis is an alternative to swab testing, especially in settings where most individuals are asymptomatic, or where patients are unlikely to agree to a pelvic examination or urethral swab. 5 Other nucleic acid amplification (NAA) tests such as polymerase chain reaction (PCR) and transcription mediated amplification (TMA) have demonstrated similar efficacy on FVU and some data are available on the role of NAA assays as tests of cure. [6][7][8] …”

mentioning

confidence: 99%

Correlation between culture testing of swabs and ligase chain reaction of first void urine from patients recently treated for Chlamydia trachomatis

Jang

Sellors²,

Howard³

et al. 2003

Sexually Transmitted Infections

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We assessed the correlation between ligase chain reaction (LCR) on first void urine (FVU) and cultures of urethral and cervical swabs to detect chlamydia during three posttreatment follow up visits for 10 men and 19 women with genital chlamydial infections who had been treated with azithromycin or doxcycline.T he most common sexually transmitted bacterial infection in North America is Chlamydia trachomatis. 1 Highest rates of infections occur among young adults aged 15-24, and rates are often higher in females than males. Infections are often asymptomatic, and if untreated, may lead to upper genital tract complications of proctitis and epididymitis in men, and pelvic inflammatory disease, endometritis, salpingitis, ectopic pregnancy, and tubal factor infertility in women. 2 Rates of recurrence or persistence of chlamydial infection in young women have been estimated to range from 4.1% to 13.4%. 3 Current treatment guidelines in Canada and the United States for C trachomatis infections recommend oral treatment with a 7 day course of doxycycline or a single dose of azithromycin. Studies have demonstrated comparable cure rates for both single and multidose therapy. 4 Ligase chain reaction (LCR) testing of first void urine (FVU) to detect C trachomatis is an alternative to swab testing, especially in settings where most individuals are asymptomatic, or where patients are unlikely to agree to a pelvic examination or urethral swab. 5 Other nucleic acid amplification (NAA) tests such as polymerase chain reaction (PCR) and transcription mediated amplification (TMA) have demonstrated similar efficacy on FVU and some data are available on the role of NAA assays as tests of cure. 6-8 METHODS Patient selectionTen men and 19 women, who were confirmed positive for C trachomatis by EIA or culture and were positive in FVU tested by LCR at baseline, were recruited from STD clinics which participated in a multicentre randomised controlled trial in Vancouver, British Columbia, Sherbrooke, Quebec, Laval, Quebec, and Regina, Saskatchewan. That trial compared the efficacy, safety, and tolerance of azithromycin (1 g single dose) and doxycycline (100 mg twice daily for 7 days). Men with symptoms (urethral discharge, dysuria or urethral irritation) and a urethral smear negative for Neisseria gonorrhoeae, showing >4 polymorphonuclear neutrophils (PMN) per high power field were eligible. Women with an endocervical smear showing >10 PMN per high power field or with a positive chlamydia enzyme immunoassay (EIA) or culture were also eligible. All subjects gave written informed consent, which was approved by the institutional review board at each participating institution.All 29 patients returned for at least two of the three follow up visits at 8, 28, and 42 days after treatment had begun. Clinical visitsAt the initial visit each patient underwent a physical examination and a medical history was taken. A clinical examination was performed, documenting urethral discharge, dysuria, and urethral irritation in men and purulent or mucopurulent di...

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“…We therefore questioned whether the commercially available and widely used LCx assay (Abbott Diagnostics) would be appropriate for routine screening of semen specimens. The LCx assay has been developed to assess C. trachomatis infection in urine, urethral or cervical specimens and has been shown to be highly sensitive and specific (Chernesky et al, 1994;Rumpianesi et al, 1996;Watson et al, 2002).…”

Section: Introductionmentioning

confidence: 99%

Assessment of Chlamydia trachomatis infection of semen specimens by ligase chain reaction

Pannekoek

Westenberg

Eijk

et al. 2003

Journal of Medical Microbiology

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Diagnostic potential of the Chlamydia trachomatis ligase chain reaction system (LCx) to assess the presence of C. trachomatis in urine and semen specimens was evaluated. Paired urine and semen specimens from 153 asymptomatic male partners of subfertile couples attending our Center for Reproductive Medicine were examined by LCx. As controls, 19 semen samples from four donors who were participating in the programme for artificial insemination were used. Of these, 12 samples had previously been shown to be C. trachomatis-positive by an in-house PCR. C. trachomatis was detected by LCx in seven of 153 (5 %) urine samples. None of the 153 semen samples tested positive by LCx. Also, none of the 12 C. trachomatis-containing control semen samples were positive by LCx. By in-house PCR, seven urine specimens and two of 153 (1 %) semen samples tested positive. The corresponding urine samples of these male partners were also C. trachomatis-positive, as well as the 12 C. trachomatis-containing samples from donors. In conclusion, LCx is not sensitive enough to assess the presence of C. trachomatis in semen specimens; therefore, this method is not recommended to routinely screen semen specimens from donors who participate in programmes for artificial insemination or male partners of subfertile couples for C. trachomatis.

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Diagnosis Of Chlamydia Trachomatis Urethral Infection In Symptomatic And Asymptomatic Men By Testing First-Void Urine In A Ligase Chain Reaction Assay

Cited by 185 publications

References 14 publications

Chlamydia trachomatis Load at Matched Anatomic Sites: Implications for Screening Strategies

Chlamydia trachomatis Load at Matched Anatomic Sites: Implications for Screening Strategies

Correlation between culture testing of swabs and ligase chain reaction of first void urine from patients recently treated for Chlamydia trachomatis

Assessment of Chlamydia trachomatis infection of semen specimens by ligase chain reaction

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