Performance of urine leukocyte esterase in asymptomatic male youth: Another look with nucleic acid amplification testing as the gold standard for Chlamydia detection

Blake, Diane R.; Lemay, Celeste A.; Gaydos, Charlotte A.; Quinn, Thomas C.

doi:10.1016/j.jadohealth.2004.02.032

Cited by 21 publications

(16 citation statements)

References 33 publications

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“…In a similar study of mainly asymptomatic males with a C. trachomatis prevalence of 10.4 %, the sensitivity of the LE test for predicting a chlamydial infection was only 46 %, while the specificity was 91.6 % and only12 % of patients had a positive LE test [9]. Other studies have reported LE sensitivities of 48-67 % for predicting C. trachomatis infections in males and a single study in females [10][11][12][13]. Thus, the sensitivity of the LE test in our study is higher and the specificity lower than in most other studies.…”

Section: Discussionmentioning

confidence: 93%

Urine‐based testing forChlamydia trachomatisusing polymerase chain reaction, leucocyte esterase and urethral and cervical smears

Coble

Nordahl-Åkesson²,

Vinnerberg

et al. 2006

Scandinavian Journal of Clinical and Laboratory Investigation

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The performance of Roche polymerase chain reaction (PCR) Amplicor to detect Chlamydia trachomatis in first-voided urine specimens from 422 males and 456 females attending two clinics for sexually transmitted infections was evaluated in comparison with cultures of urethral and cervical specimens. At the same time, the ability of leucocyte esterase (LE) in first-voided urine and the presence of leucocytes in urethral and cervical smears to identify C. trachomatis-infected individuals based on PCR and culture was determined. The prevalence of C. trachomatis infection was 10.9% in men and 7.7% in women. Sensitivity, specificity, positive predictive value and negative predictive value of Amplicor was 93.5%, 99.7%, 97.7% and 99.2% in males and 91.4%, 99.5%, 94.1% and 99.3% in females. All Chlamydia-infected men were identified by means of a combination of urethritis (4 leucocytes in the urethral smear) and/or a positive LE test in urine, although the specificity was only 42.2%. In women, the combination of urethritis and/or cervicitis and/or a positive LE test identified 85.7% of Chlamydia-infected patients with a specificity of 38.2%. It is concluded that a combination of urethral and/or cervical smears and LE testing of urine can be used as a screening test to select patients, especially males, for specific C. trachomatis testing.

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Section: Discussionmentioning

confidence: 93%

Urine‐based testing forChlamydia trachomatisusing polymerase chain reaction, leucocyte esterase and urethral and cervical smears

Coble

Nordahl-Åkesson²,

Vinnerberg

et al. 2006

Scandinavian Journal of Clinical and Laboratory Investigation

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“…10 Mayaud et al 30 and Sellors et al 12 reported that the cost per case detected using LET dipstick to pre-screen urine specimens was relatively inexpensive compared with the strategy that would test every urine specimen with a diagnostic test. However, as Bowden observed, the social and economic costs of the sequelae of untreated STIs such as infertility are high with the hospital treatment of one case possibly outweighing those saved by screening with LET before definitive testing.…”

Section: Discussionmentioning

confidence: 99%

Using urinary leucocyte esterase tests as an indicator of infection with gonorrhoea or chlamydia in asymptomatic males in a primary health care setting

Rahman

Beever²,

Skov

et al. 2013

Int J STD AIDS

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To evaluate a leucocyte esterase test as a predictor of gonorrhoea or chlamydia in asymptomatic Aboriginal males at the Central Australian Aboriginal Congress Male Clinic (Ingkintja), first-void urine samples and clinical information were collected from consecutive asymptomatic males presenting to the Ingkintja in Alice Springs between March 2008 and December 2009. Urine was tested immediately with a leucocyte esterase test dipstick and then by polymerase chain reaction for gonorrhoea and chlamydia. Among the 292 specimens from asymptomatic males, 15.4% were positive for gonorrhoea or chlamydia. In this group, compared with polymerase chain reaction result for gonorrhoea or chlamydia, leucocyte esterase test alone and in combination with age ≤35 years showed sensitivities of 66.7% and 60%, specificities of 90.7% and 94.7%, positive predictive values of 56.6% and 67.5%, negative predictive values of 93.7% and 92.8% and the area under receiver operating characteristics curve values of 0.79 and 0.85, respectively. Leucocyte esterase tests can reasonably be used as a basis for immediate empirical treatment for gonorrhoea or chlamydia in asymptomatic central Australian Aboriginal men under 35 years of age.

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“…The discomfort caused by obtaining a urethral swab in males has precluded its widespread use in asymptomatic men. A dipstick test for leukocyte esterase performed on the first portion of a voided urine is a cost-effective and moderately sensitive screen (47-58 %) for detection of chlamydial infection in asymptomatic young males [60]. When feasible, urine NAAT provides a much more sensitive and equally noninvasive method of detecting Chlamydia.…”

Section: Diagnostic Specimensmentioning

confidence: 99%

“…Similar to other nonculture tests, NAATs do not require viable organisms. NAATs detect C. trachomatis in urine or in self-administered vaginal swab specimens with sensitivity comparable to clinician obtained urogenital swab specimens, which makes noninvasive testing for chlamydial infections possible on individual as well as pooled specimens from a single patient [60,64]. Multiple studies have determined that NAAT of self-obtained vaginal swabs are an acceptable, simple and sensitive diagnostic sample for the detection of C. trachomatis, as well as the sexually transmitted disease pathogens, N. gonorrhoea and Trichomonas vaginalis [65,66].…”

Section: Nonculture Tests For Ctrachomatismentioning

confidence: 99%

Recognition and Treatment of Chlamydial Infections from Birth to Adolescence

Darville

2012

Advances in Experimental Medicine and Biology

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The "silent epidemic" of Chlamydia trachomatis threatens to cause reproductive damage and infertility in many of the 50 million women who acquire it each year. Female reproductive tract infection has more recently been linked to stillbirth and premature delivery. Innate immune cells and mediators appear to be the primary players in pathogenesis, with neutrophils playing a prominent role in disease development. Although adaptive antibody and CD4 T cell responses appear primarily protective, these responses are inefficient. Infections are frequently chronic as a result, and when infection is diagnosed and treated with appropriate antibiotics, repeated infection is the rule. The lack of acute symptoms in many infected individuals contributes to the high prevalence of chlamydial infection. Although chronic sequelae are relatively rare in men, and many women sustain infection without developing pelvic inflammatory disease or chronic sequelae, the extremely high prevalence of chlamydial infection leads to significant morbidity and healthcare costs. A vaccine is urgently needed to prevent infection, but given the difficulties of inducing a CD4 T cell memory response that can home quickly to the genital tract, induction of sterilizing immunity may not be possible. A vaccine that prevents disease by lowering bacterial burden and dampening production of tissue-damaging responses may be possible. Until an efficacious vaccine is developed, screening and treatment programs appear to be the best method of disease prevention.

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Performance of urine leukocyte esterase in asymptomatic male youth: Another look with nucleic acid amplification testing as the gold standard for Chlamydia detection

Cited by 21 publications

References 33 publications

Urine‐based testing forChlamydia trachomatisusing polymerase chain reaction, leucocyte esterase and urethral and cervical smears

Urine‐based testing forChlamydia trachomatisusing polymerase chain reaction, leucocyte esterase and urethral and cervical smears

Using urinary leucocyte esterase tests as an indicator of infection with gonorrhoea or chlamydia in asymptomatic males in a primary health care setting

Recognition and Treatment of Chlamydial Infections from Birth to Adolescence

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