Point-of-care management of urogenital<i>Chlamydia trachomatis</i>via Gram-stained smear analysis in male high-risk patients. Diagnostic accuracy and cost-effectiveness before and after changing the screening indication at the STI Clinic in Amsterdam

Bartelsman, Menne; Rooijen, Martijn S. van; Alba, Sandra; Vaughan, Kelsey; Faber, William R.; Straetemans, Masja; Vries, Henry J. C. de

doi:10.1136/sextrans-2014-051941

Cited by 8 publications

(13 citation statements)

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“…Our previous study on the cost-effectiveness of microscopic examination of Gram stained urethral smears compared to NAAT at the STI outpatient clinic in Amsterdam showed a sensitivity of 83.8 % and specificity of 74.1 %, comparable with the sensitivity and specificity of the LET we found in the current study [37]. However, if available, microscopy is preferable above the LET because it can also detect Ng infections by finding Gram negative diplococci in a Gram stained smear.…”

Section: Discussionsupporting

confidence: 88%

“…A possible explanation can be that symptomatic patients had relatively more often infections like Neisseria gonorrhoeae (Ng), Mycoplasma genitalum (Mg) or Trichomonas Vaginalis (Tv) compared to asymptomatic patients which could have caused a relative higher proportion of ‘false positive’ results [34–36]. Also in a previous study we showed that light microscopic examination of Gram stained urethral smears is less specific to detect urogenital Ct infections when done in samples of symptomatic males only [37]. …”

Section: Discussionmentioning

confidence: 99%

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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

et al. 2016

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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.

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Section: Discussionsupporting

confidence: 88%

Section: Discussionmentioning

confidence: 99%

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

et al. 2016

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“…Bartelsman M et al reported the sensitivity of smear tests at 95.4% among symptomatic males but at 23.1% for symptomatic females, thus, the authors concluded and recommended the smear test only for high-risk males and those with visible signs and symptoms of an urogenital tract inflammation [28].…”

Section: Discussionmentioning

confidence: 99%

Detection of Common Bacterial Causes of STIs among STD Clinic Attendees by Gram Stain and Culture versus the Microarray Nucleic Acid Hybridization Method

Badrakh,

Aumakhan,

Oidov

et al. 2017

Cent. Asian j. Med. Sci.

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Objectives:The purpose of the study was to determine the prevalence and etiology of predominant sexually transmitted infections (STIs) occurring among the STD and Gynecology Clinic attendees and to compare sensitivity and specificity of conventional versus molecular diagnostic methods. Methods: A total of 1,441 individuals were recruited from the STD clinic at the National Center for Communicable Diseases and Gynecology Clinic at the National Center for Oncology between 2014 and 2015. Urogenital tract swab samples were collected and tested for N.gonorrhoeae, C.trachomatis, and T.vaginalis using conventional (Gram stain and culture) and molecular (Microarray Nucleic Acid Hybridization -MNAHM) diagnostic methods. The final infection status of participants was determined using the "either test positive" strategy. Results: Of the total 1,441 participants, 19.7% were N.gonorrhoeae infected, 12.5% were C.trachomatis infected, and 7.8% were T.vaginalis infected. For T. vaginalis, conventional methods and MNAHM had sensitivities of 17.9% and 98.2%, with specificities of 96.6% and 99.6%, respectively. For N.gonorrhoeae, conventional methods had sensitivity and specificity values of 33.3% and 99.1%, and MNAHM had values of 95.1% and 98.8%, respectively. Conclusion: The study found a high prevalence of N.gonorrhoeae and C.trachomatis among STD and Gynecology Clinic attendees. Conventional methods for detection of N.gonorrhoeae and T.vaginalis were significantly less sensitive than molecular diagnostic methods and didn't detect other STI pathogens.

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“…Combining this with portable point of care (POC) rapid test platforms gives potential to test for these infections in a variety of community settings, allowing people to receive results on the same day as testing. Using POC CT/NG tests in high prevalence settings may help reduce the burden of disease by making testing more convenient and providing results faster, thereby reducing the time to treatment [7,8]. However, data on the costs of providing community-based services are limited.…”

Section: Introductionmentioning

confidence: 99%

Near patient chlamydia and gonorrhoea screening and treatment in further education/technical colleges: a cost analysis of the ‘Test n Treat’ feasibility trial

Kerry-Barnard

Huntington

Fleming

et al. 2020

BMC Health Serv Res

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Background: Community-based screening may be one solution to increase testing and treatment of sexually transmitted infections in sexually active teenagers, but there are few data on the practicalities and cost of running such a service. We estimate the cost of running a 'Test n Treat' service providing rapid chlamydia (CT) and gonorrhoea (NG) testing and same day on-site CT treatment in technical colleges. Methods: Process data from a 2016/17 cluster randomised feasibility trial were used to estimate total costs and service uptake. Pathway mapping was used to model different uptake scenarios. Participants, from six London colleges, provided self-taken genitourinary samples in the nearest toilet. Included in the study were 509 sexually active students (mean 85/ college): median age 17.9 years, 49% male, 50% black ethnicity, with a baseline CT and NG prevalence of 6 and 0.5%, respectively. All participants received information about CT and NG infections at recruitment. When the Test n Treat team visited, participants were texted/emailed invitations to attend for confidential testing. Three colleges were randomly allocated the intervention, to host (non-incentivised) Test n Treat one and four months after baseline. All six colleges hosted follow-up Test n Treat seven months after baseline when students received a £10 incentive (to participate). Results: The mean non-incentivised daily uptake per college was 5 students (range 1 to 17), which cost £237 (range £1082 to £88) per student screened, and £4657 (range £21,281 to £1723) per CT infection detected, or £13,970 (range £63,842 to £5169) per NG infection detected. The mean incentivised daily uptake was 19 students which cost £91 per student screened, and £1408/CT infection or £7042/NG infection detected. If daily capacity for screening were achieved (49 students/day), costs including incentives would be £47 per person screened and £925/CT infection or £2774/NG infection detected.

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Point-of-care management of urogenitalChlamydia trachomatisvia Gram-stained smear analysis in male high-risk patients. Diagnostic accuracy and cost-effectiveness before and after changing the screening indication at the STI Clinic in Amsterdam

Cited by 8 publications

References 13 publications

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

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

Detection of Common Bacterial Causes of STIs among STD Clinic Attendees by Gram Stain and Culture versus the Microarray Nucleic Acid Hybridization Method

Near patient chlamydia and gonorrhoea screening and treatment in further education/technical colleges: a cost analysis of the ‘Test n Treat’ feasibility trial

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