Surrogate methods to diagnose gonococcal and chlamydial cervicitis: comparison of leukocyte esterase dipstick, endocervical gram stain, and culture

Article Abstract:

Gonococcal and chlamydial infections, which cause cervicitis or inflammation of the cervix in women, are common and treatable sexually transmitted diseases. Left untreated, however, 10 percent to 20 percent of patients go on to develop pelvic inflammatory disease, which is associated with infertility, ectopic pregnancy (implantation of the fertilized egg outside the uterus), chronic pelvic pain, and chronic infection. Death, low birth weight, and infection may occur in infants born to women with cervical infections due to Neisseria gonorrhoeae or Chlamydia trachomatis. Cultures have traditionally been the standard for identification of gonococcal and chlamydial organisms, but laboratory culture takes time and money, and may not always be available. Endocervical gram staining (EGS) is another diagnostic technique, but it also requires equipment and training that may not be readily available in all areas. Leukocyte esterase dipsticks (LEDs) on the other hand are inexpensive, fast, and simple to use; a change of color on a dipstick indicates the presence of a specific organism. In the present study, EGS and LED techniques were compared with traditional specimen culture in the diagnosis of gonococcal and chlamydial cervicitis. Of the 478 women tested, 15.7 percent were found to have gonorrhea by culture, and 17.8 percent were found to have chlamydia. In an analysis of the sensitivity (ability to detect the presence of gonococcal or chlamydial organisms) and specificity (ability to distinguish between the presence and absence of infection) of these techniques, it was found that LED and EGS were similarly able to detect gonorrhea about 70 percent of the time. However, LED and EGS had a specificity of 44 percent, meaning that these techniques correctly identify the absence of infection in 44 percent of cases. Both tests are imperfect replacements for culture, but may be useful in specific settings. Therefore, where resources do not allow for standard culture techniques, LED and EGS may be used to diagnose gonorrhea or chlamydia infection with limited confidence. (Consumer Summary produced by Reliance Medical Information, Inc.)

Usage, Bacteriology, Bacterial cultures, Cervicitis, Gram's stain

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Laboratory to laboratory variation in Chlamydia trachomatis culture practices

Article Abstract:

Laboratories that publish results on the use of cell culture tests to identify Chlamydia trachomatis infection may use different techniques for handling and analyzing cell cultures. Researchers surveyed 25 North American laboratories and found that laboratories followed no standard technique for collecting, transporting, or analyzing cell cultures. Two labs took two to six hours to transport cultures without the benefit of refrigeration. Some labs used 10 times as much media to inoculate the cultures for analysis as other labs, which could change the culture's ability to show chlamydial infection. Discrepancies in cell culture sensitivity published in the scientific literature may be due to the way labs handle cell cultures rather than to the tests used on the cultures.

Methods, Human cell culture, Diagnosis, Laboratory, Laboratory diagnosis

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Urine-based screening of adolescents in detention to guide treatment for gonococcal and chlamydial infections: translating research into intervention

Article Abstract:

Analyzing urine samples with the ligase-chain reaction may be an effective way of testing teenagers in detention centers for sexually transmitted diseases. Traditional diagnostic tests that rely on genital swabs may not be accepted by such teenagers. Researchers used the ligase-chain reaction on urine samples of 263 teenagers in detention centers and found that 37 (14%) tested positive for chlamydia or gonorrhea although only one teen had symptoms. The incidence of chlamydia and gonorrhea was higher in girls than boys. Most of the teens were treated.

Testing, Teenagers, Youth, Urine

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