Leucocyte esterase dip-stick test as a point-of-care diagnostic for urogenital chlamydia in male patients: A multi-center evaluation in two STI outpatient clinics in Paramaribo and Amsterdam

Abstract

BackgroundPoint-of-care (POC) tests are an important strategy to address the epidemic of sexually transmitted infections (STIs). The leucocyte esterase test (LET) can be used as a POC test for chlamydia. The aim of this study was to determine the diagnostic accuracy of the LET to detect urogenital chlamydia among men at STI clinics in Paramaribo, Suriname and Amsterdam, the Netherlands.MethodsRecruitment of patients took place in 2008–2010 in Suriname and in 2009–2010 in the Netherlands. Urine of patients was examined with the LET. The reference test was a nucleic acid amplification test (NAAT).ResultsWe included 412 patients in Suriname and 645 in the Netherlands. Prevalence of chlamydia in Suriname and the Netherlands was respectively 22.8 and 13.6 %. The sensitivity of the LET was 92.6 % (95 % CI = 85.3–97.0) and 77.3 % (95 % CI = 67.1–85.5) respectively, the specificity was 38.1 % (95 % CI = 32.7–43.6 %) and 58.1 % (95 % CI = 53.9–62.3) respectively. The positive predictive value was 30.6 % (95 % CI = 27.3–36.4) and 22.6 % (95 % CI = 18.0–27.7) respectively and the negative predictive value was 94.5 % (95 % CI = 89.1–97.8) and 94.2 % (95 % CI = 91.1–96.4) respectively. The kappa was respectively 0.179 and 0.176.ConclusionsTo diagnose urogenital chlamydia in men the LET performs poorly. It has a high negative but low positive predictive value. If the LET result is negative, chlamydia is accurately excluded, yet a positive result has a low predictive value. Whether the advantages of direct management based on LET outweigh the disadvantages of overtreatment is a subject for further studies.

Prevalence and Genotype Distribution of <i>Chlamydia trachomatis</i> in Urine among Men Attending Sexually Transmitted Disease Clinics in Guangdong Province, China, in 2016

“…Collection of urine, however, is much more acceptable to patients and is considered the recommended sample type for men. Urine collection as a non-invasive sampling method has been used for CT screening in developed countries (13,14). Nonetheless, urine is seldom used for CT detection in China (15).…”

Urine Tests for Diagnosis of Infectious Diseases and Antibiotic-Resistant Pathogens

“…However, it shows low positive predictive value. Furthermore Chlamydia trachomatis, Mycoplasma genitalium, and Neisseria gonorrhea can be detected with PCR and real-time duplex PCR from urine samples [55][56][57][58]. Using urine as a specimen for diagnosis of Gonococcal infections by molecular tests has eased out uncomfortable sample collection by urethral swab and hence increased the number of patients volunteering to give specimen for this disease of public health importance.…”

Evaluation of the Predictive Value of Urine Leukocyte Esterase Test in Chlamydia trachomatis and Neisseria gonorrhoeae Infection Among Males Attending HIV/STI Clinics in Guangdong Province, China

“…The urine test is an indispensable preliminary examination performed during the diagnosis of many diseases ( 12 , 13 ). Leukocyte esterase detection during a routine urine examination is considered to be moderately sensitive and specific for detecting the presence of urinary tract infections ( 14 ), and the LET can also be used to screen for CT and NG infection ( 15 , 16 ).…”