Vulvovaginal-Swab or First-Catch Urine Specimen To Detect
            <i>Chlamydia trachomatis</i>
            in Women in a Community Setting?

Skidmore, Sue; Horner, Patrick J; Herring, A. J.; Sell, Joanne; Paul, Ian; Thomas, John I.; Caul, E.O.; Egger, Matthias; McCarthy, Anne; Sanford, Emma; Salisbury, Chris; Macleod, John; Sterne, Jonathan A C; Low, Nicola

doi:10.1128/jcm.01060-06

Cited by 39 publications

(22 citation statements)

References 31 publications

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“…The P value for comparison between urine and urethral specimens of men was 0.16 (paired t test), whereas those for comparisons between urine and urethra, urethra and vagina, and vagina and cervix for women were all Ͻ0.001 (analysis of variance). The low organism load for female FVU specimens, which was markedly less than that for male FVU specimens or for any other female specimen type, is consistent with evidence that amplified enzyme immunoassays and even some nucleic acid amplification-based tests, especially those without a concentration step during sample processing, struggle to achieve adequate sensitivity with female FVU specimens as the diagnostic specimen (27,29). The female urethra is only 3 to 4 cm in length, with its major distal portion being lined by stratified squamous epithelium (30).…”

Section: Fig 2 Organism Load In Matched Specimens From Men and Womementioning

confidence: 66%

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: Fig 2 Organism Load In Matched Specimens From Men and Womementioning

confidence: 66%

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

et al. 2007

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“…Many authors have advocated the use of self-collected vaginal swabs for the detection of Chlamydia and other STIs, as they are more acceptable, convenient and effective, and increase the rate of screening when compared with endocervical swabs collected by healthcare workers (Nelson et al, 2003;Skidmore et al, 2006;Tanaka et al, 1998;Thomas et al, 1998). In addition, unlike urine specimens, self-collected vaginal swabs do not require stringent transport requirements, may be transported at room temperature to the laboratory and do not require centrifugation or incubation processing steps.…”

Section: -34 (N536)mentioning

confidence: 99%

The prevalence of urogenital micro-organisms detected by a multiplex PCR–reverse line blot assay in women attending three sexual health clinics in Sydney, Australia

McKechnie

Hillman

Jones

et al. 2011

Journal of Medical Microbiology

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This study used a previously described multiplex PCR-based reverse line blot (mPCR/RLB) assay to assess the prevalence and distribution of 14 urogenital pathogens or putative pathogens, namely Neisseria gonorrhoeae, Chlamydia trachomatis, Mycoplasma genitalium, Mycoplasma hominis, Trichomonas vaginalis, Gardnerella vaginalis, Ureaplasma parvum, Ureaplasma urealyticum, Neisseria meningitidis, Streptococcus pneumoniae, Haemophilus influenzae, herpes simplex virus types 1 and 2, and human adenovirus. First-voided urine specimens and endocervical and self-collected vaginal swabs from each of 216 women attending three sexual health clinics in Sydney, Australia, were tested and the results were compared with those of reference methods for each organism. One hundred and sixty-eight women (77.7 %) had at least one and 105 (48.6 %) had more than one target organism, most commonly G. vaginalis and Ureaplasma spp. The prevalence of each of the four known sexually transmissible pathogens was ,5 %. Of the 216 women, 111 (51.4 %) reported at least one symptom consistent with genital or urethral infection, including discharge, pain or discomfort. Only G. vaginalis was detected more frequently in women with symptoms (P50.05). The specificity of the mPCR/RLB assay compared with that of the reference methods for each organism and for all specimen types was 100 %. The mean sensitivities of the mPCR/RLB assay compared with those of the reference methods for self-collected vaginal swabs, cervical swabs and first-voided urine specimens for all organisms were 99.3, 98.1 and 84.6 %, respectively; however, these differences were not significant. There were no differences in sensitivities between specimen types for C. trachomatis, N. gonorrhoeae, T. vaginalis and H. influenzae, although all were found infrequently. Overall, the mPCR/RLB platform was found to be an accurate testing platform in a sexual health clinic setting.

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“…155 Overall there were 146 (5.3%) Table 33). Inhibition was equally likely in swab and urine specimens tested by Cobas PCR, but was more common in urine specimens tested by BD SDA than with vulvovaginal swabs.…”

Section: Performance Of Vulvovaginal Swabs and First Catch Urine Specmentioning

confidence: 99%

Epidemiological, social, diagnostic and economic evaluation of population screening for genital chlamydial infection

Low

McCarthy²,

Macleod³

et al. 2007

Health Technol Assess

134

179

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Vulvovaginal-Swab or First-Catch Urine Specimen To Detect Chlamydia trachomatis in Women in a Community Setting?

Cited by 39 publications

References 31 publications

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

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

The prevalence of urogenital micro-organisms detected by a multiplex PCR–reverse line blot assay in women attending three sexual health clinics in Sydney, Australia

Epidemiological, social, diagnostic and economic evaluation of population screening for genital chlamydial infection

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