Recommendations for the Laboratory-Based Detection of Chlamydia trachomatis and Neisseria gonorrhoeae - 2014


This report updates CDC's 2002 recommendations regarding screening tests to detect Chlamydia trachomatis and Neisseria gonorrhoeae infections (CDC. Screening tests to detect Chlamydia trachomatis and Neisseria gonorrhoeae infections-2002. MMWR 2002;51[No. RR-15]) and provides new recommendations regarding optimal specimen types, the use of tests to detect rectal and oropharyngeal C. trachomatis and N. gonorrhoeae infections, and circumstances when supplemental testing is indicated. The recommendations in this report are intended for use by clinical laboratory directors, laboratory staff, clinicians, and disease control personnel who must choose among the multiple available tests, establish standard operating procedures for collecting and processing specimens, interpret test results for laboratory reporting, and counsel and treat patients. The performance of nucleic acid amplification tests (NAATs) with respect to overall sensitivity, specificity, and ease of specimen transport is better than that of any of the other tests available for the diagnosis of chlamydial and gonococcal infections. Laboratories should use NAATs to detect chlamydia and gonorrhea except in cases of child sexual assault involving boys and rectal and oropharyngeal infections in prepubescent girls and when evaluating a potential gonorrhea treatment failure, in which case culture and susceptibility testing might be required. NAATs that have been cleared by the Food and Drug Administration (FDA) for the detection of C. trachomatis and N. gonorrhoeae infections are recommended as screening or diagnostic tests because they have been evaluated in patients with and without symptoms. Maintaining the capability to culture for both N. gonorrhoeae and C. trachomatis in laboratories throughout the country is important because data are insufficient to recommend nonculture tests in cases of sexual assault in prepubescent boys and extragenital anatomic site exposure in prepubescent girls. N. gonorrhoeae culture is required to evaluate suspected cases of gonorrhea treatment failure and to monitor developing resistance to current treatment regimens. Chlamydia culture also should be maintained in some laboratories to monitor future changes in antibiotic susceptibility and to support surveillance and research activities such as detection of lymphogranuloma venereum or rare infections caused by variant or mutated C. trachomatis.

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    • "The method is based on binding of antibodies to an epitope (a specific trisaccharide component (aKdo-(2-8)-aKdo-(2-4)-aKdo) of cell wall lipopolysaccharide (LPS) for C. trachomatis, a surface protein antigen for M. hominis, or a surface protein antigen for U. urealyticum); currently, DFA tests are the only tests cleared by the Food and Drug Administration for the detection of ocular C. trachomatis infections [15]. Moreover, the DFA is of relatively low cost, easy, rapid, and suitable for routine use. "
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    ABSTRACT: Aim. To determine the frequency of detection of conjunctival C. trachomatis (CT), M. hominis (MH), and U. urealyticum (UU) infections in young adults with dry eye disease (DED), since these infections may potentially produce the chronic subclinical inflammation characteristic of DED. Materials and Methods. The study included subjects of 25–45 years of age, divided into the DED ( n = 114 ) and nondry eye control ( n = 98 ) groups, with the diagnosis based on self-reported complaints, biomicroscopy, the Schirmer I test, and break-up time. All patients had conjunctival scrapings taken to detect CT, MH, and UU with direct fluorescent-antibody assay kits. Results. At least one of the three microorganisms was found in 87.7% of the DED patients versus 8.2% of the controls. Of all the DED patients, 63.2%, 50.8%, and 42.1% were found to be infected with CT, MH, and UU, respectively. Multiple pathogens were identified in 65% of the DED patients found to be infected. CT infection was detected in 6.1% of the controls. Conclusion. C. trachomatis, M. hominis, and U. urealyticum were detected with high frequency in the conjunctiva of young adults with DED and may be an important risk factor for DED in them.
    Full-text · Article · May 2014 · Journal of Ophthalmology
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    • "Chlamydia serology can support LGV diagnosis in the appropriate clinical context, but the diagnostic utility of serological methods other than complement fixation and microimmunofluorescence procedures has not been well established yet [22,23]. In this study, we found a significant elevation of anti-Chlamydia IgG by an immunoenzimatic assay in LGV-positive patients, suggesting a potential role of IgG testing for LGV diagnosis. "
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    ABSTRACT: We evaluated LGV prevalence and predictors in a high risk population attending a STI Outpatients Clinic in the North of Italy. A total of 108 patients (99 MSM and 9 women), with a history of unsafe anal sexual intercourses, were enrolled. Anorectal swabs and urine samples were tested for Chlamydia trachomatis (CT) DNA detection by Versant CT/GC DNA 1.0 Assay (Siemens Healthcare Diagnostics Terrytown, USA). RFLP analysis was used for CT molecular typing. L2 CT genotype was identified in 13/108 (12%) rectal swabs. All LGV cases were from MSM, declaring high-risk sexual behaviour and complaining anorectal symptoms. Patients first attending the STI Outpatient Clinic received a significant earlier LGV diagnosis than those first seeking care from general practitioners or gastroenterologists (P = 0.0046).LGV prevalence and characteristics found in our population are in agreement with international reports. Statistical analysis showed that LGV positive patients were older (P = 0.0008) and presented more STIs (P = 0.0023) than LGV negative ones, in particular due to syphilis (P < 0.001), HIV (P < 0.001) and HBV (P = 0.001).Multivariate logistic regression analysis revealed that HIV and syphilis infections are strong risk factors for LGV presence (respectively, P = 0.001 and P = 0.010). Even if our results do not provide sufficient evidence to recommend routine screening of anorectal swabs in high-risk population, they strongly suggest to perform CT NAAT tests and genotyping on rectal specimens in presence of ulcerative proctitis in HIV and/or syphilis-positive MSM. In this context, CT DNA detection by Versant CT/GC DNA 1.0 Assay, followed by RFLP analysis for molecular typing demonstrated to be an excellent diagnostic algorithm for LGV identification.
    Full-text · Article · Apr 2014 · BMC Research Notes
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    ABSTRACT: Worldwide, Chlamydia trachomatis infections rank among the most common sexually transmitted infections (STI), and cause notable reproductive morbidity in women. Although advances in highly accurate and non-invasive diagnostic testing have allowed for better estimation of the burden of disease-especially the asymptomatic state-we still lack a true point-of-care test, and many infections go undetected and untreated. Moreover, limited resources and effort for managing sexual partners of those in whom infection is actually identified comprise a major challenge to control. Here, we review the current state of understanding of this common infection, and efforts to control it.
    Full-text · Article · Jan 2014 · F1000 Prime Reports
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