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Comparison of methods for detection of Chlamydia trachomatis and Neisseria gonorrhoeae using commercially available nucleic acid amplification tests and a liquid pap smear medium.
Journal of Clinical Microbiology 2003;41(4):1507-1511.
Koumans EH, Black CM, Markowitz LE, Unger ER, Pierce
A, Sawyer MK,
Papp JR.
Abstract
Annual screening for Chlamydia trachomatis infection is currently recommended
for sexually active women 15 to 25 years old and for women older than 25
if they have a new or multiple sex partners and have not used condoms during
the previous 3 months. Annual screening for cervical abnormalities using
the Pap smear has achieved a substantial reduction in morbidity and mortality
from cervical cancer. Screening for Neisseria gonorrhoeae infection has likely
contributed significantly to the reduction in the rates of gonococcal infection.
The introduction of liquid Pap smear methods using exfoliated cervical cells
presents an opportunity to screen for these three conditions using one specimen.
We evaluated the preservation of C. trachomatis and Neisseria gonorrhoeae
DNAs from ThinPrep liquid media (PreservCyt; Cytyc Corp., Boxborough, Mass.);
tested the feasibility of using a clinical specimen of this medium for the
detection of cytologic abnormalities, C. trachomatis, and N. gonorrhoeae;
evaluated the agreement between ligase chain reaction (LCR) performed on
PreservCyt and LCR performed on a cervical specimen; and compared the performance
of LCR performed on PreservCyt to those of LCR performed on a cervical specimen,
culture, PCR performed on a cervical specimen, on urine, and on a vaginal
specimen (a multiple-site infection status standard), and transcription-mediated
amplification (for C. trachomatis only) from 255 sexually active adolescent
women. The agreement between LCR performed on PreservCyt and LCR from a cervical
swab in LCx transport medium was high (for C. trachomatis, agreement = 0.97
and kappa = 0.92; for N. gonorrhoeae, agreement = 0.99 and kappa = 0.96).
Test performances were similar for LCR-urine, LCR-cervix, and LCR-ThinPrep,
with sensitivities from 93 to 99% for C. trachomatis and 81 to 83% for N.
gonorrhoeae and specificities from 95.5 to 99% for C. trachomatis and 99.1
to 99.6% for N. gonorrhoeae using a PCR-based multiple-site infection status
standard. This is the first study to examine the agreement between liquid
cytologic media and multiple nucleic acid amplification tests for the detection
of C. trachomatis and N. gonorrhoeae from patient samples. Cytologic fluid
shows promise for simultaneous screening for cytologic abnormalities and
sexually transmitted infections.