Comparison of IDEIA III and cell culture for the detection of Chlamydia trachomatis in endocervical specimens

Evaluation of vaginal tampons for collection of specimens for detection of Chlamydial infection

BACKGROUND AND OBJECTIVES

Previous studies have shown that self-inserted vaginal tampons can be used to obtain specimens for detection of Neisseria gonorrhoeae. There is a need to expand testing for infection with Chlamydia trachomatis to women who do not undergo regular gynecologic examinations.

GOAL

To compare self-inserted tampons with clinician-obtained endocervical swabs for collection of samples to be examined for chlamydial infection.

STUDY DESIGN

Women referred because of recently detected untreated chlamydial infection inserted a vaginal tampon. Two endocervical swabs were obtained after the tampon was removed. One swab was cultured for Chlamydia trachomatis. The other swab and the tampon were examined with the Testpack Chlamydia antigen detection test.

RESULTS

Sixty-nine women were studied. Chlamydial infection was detected by culture in 75.4%, by Testpack (swab) in 63.8%, and by Testpack (tampon) in 52.2%.

CONCLUSIONS

Tampon-obtained specimens evaluated in the Testpack Chlamydia test were relatively insensitive. More sensitive tests for the detection of Chlamydia trachomatis infection with self-obtained specimens should be evaluated.

Evaluation of two rapid tests for the diagnosis of Chlamydia trachomatis genital infections

The performance of two new enzyme immunoassays (EIA) for the detection of Chlamydia trachomatis in a practice setting was compared. A consecutive series of 207 female patients seen at an inner-city sexually transmitted disease clinic were tested by cell culture, the Kodak SureCell (SC) and Abbott TestPack Chlamydia (TP) EIAs. In addition 210 male patients, selected by physicians on the basis of the fact that multiple urethral samples could be obtained, were tested by cell culture and SC. The prevalence of infection was 19% in the females and 12.5% in males. The sensitivity, specificity, positive predictive value and negative predictive value for the SC and TP were 88%, 95%, 81%, 97% and 59%, 99%, 95%, 91%, respectively, in the female population. The sensitivity of the SC was significantly greater than that of the TP (p less than or equal to 0.002). The performance values of the SC in men (in the same order) were 64%, 96%, 71% and 95%, respectively. The SC in male patients and the TP in female patients had low sensitivity. The sensitivity of the SC in female patients was significantly higher than that of the TP. However, the SC yielded more false positive results. To determine the utility of these tests in a practice setting further studies are required.

Evaluation of a DNA probe of plasmid origin for the detection of Chlamydia trachomatis in cultures and clinical specimens

This study evaluates five cryptic plasmid-derived DNA probes in a 4-h slot-blot hybridization assay for the detection of Chlamydia trachomatis in cultures and clinical specimens. The probes, consisting of either the entire cloned 7.5 kbp cryptic plasmid pSE8 or one of four Hin dIII/Eco RI fragments measuring 710, 1055, 710, and 500 bp, respectively, were labelled with Photoprobe biotin. The probe was detected using a streptavidin-alkaline phosphatase conjugate followed by addition of BCIP and NBT. The sensitivity of the assay, using 25 ng of probe DNA, ranged from 50 pg (with the entire plasmid as probe) to 5 ng (with the 500 bp fragment as probe). A total of 103 reference strains of Chlamydia trachomatis and other bacteria were tested for reactivity with the probes. All 18 reference strains of C. trachomatis hybridized with the probes. None of the DNA from the heterologous organisms tested was found to hybridize with any of the probes. A total of 174 samples taken from patients visiting the STD clinic at the University Hospital, University of Seville were used in the study. The overall sensitivity of the assay, using the 710 bp biotinylated probe was 94.5% compared to culture while the specificity was 97.5%. Positive and negative predictive values were 96.5% and 97.5%, respectively. It appears that the plasmid-derived probes used in this study could serve as useful tools for the rapid and specific detection of Chlamydia trachomatis in cell cultures and clinical specimens.

Preliminary evaluation of "Clearview Chlamydia" for the rapid detection of chlamydial antigen in cervical secretions

Clearview Chlamydia (Unipath) is a rapid monoclonal antibody based latex immunodiffusion test for detecting chlamydial antigen in endocervical specimens. The assay does not require specialised equipment or extensive training and takes less than 30 minutes from sample to results. The clinical performance of Clearview Chlamydia was evaluated with 478 paired endocervical swabs from patients attending a genitourinary medicine clinic. In the first part of the study, 221 non-randomised specimens were tested by cell culture (1st swab) and Clearview (2nd swab) whereas in the second part of the study 257 randomised swabs were examined by Clearview, cell culture and immunofluorescence. The overall prevalence of chlamydial infection was 8.8% and the sensitivity, specificity, positive and negative predictive values for Clearview were 85.7%, 99.1%, 90% and 98.6%. The test requires further evaluation to establish its role in the management and control of chlamydial infection.

Comparison of three new nonculture tests in the diagnosis of Chlamydia genital infections

This study compares three new rapid nonculture tests to cell culture with passage for the diagnosis of Chlamydia genital infections in sexually active adolescent and young adult females. Two hundred consecutive patients having a pelvic examination had cervical samples taken for the following: Papanicolaou smear, gonorrhea culture, Chlamydia cell culture, direct fluorescent antibody (DFA; Difco), isotopic DNA probe (Gen-Probe), and enzyme immunoassay (EIA; IDEIA III, Novo BioLabs). After resolution of discrepant results, 25 of the specimens were judged to be positive. The DFA identified 17 of the 25, with 3 false-positive results; the DNA probe identified 20 of the 25, with no false positive results; and the EIA identified 22 of the 25, with one false-positive result. The sensitivities, specificities, and positive and negative predictive values, respectively, were DFA, 68%, 98.2%, 85%, 95.5%; DNA probe, 80%, 100%, 100%, 97.2%; and EIA, 88%, 99.4%, 95.6%, 98.3%. These new rapid nonculture tests are comparable and relatively reliable, with trends favoring the EIA and the DNA probe. Further studies with larger samples are needed to determine their clinical utility.