Evaluation of ligase chain reaction for use with urine for identification of Neisseria gonorrhoeae in females attending a sexually transmitted disease clinic

Abstract

The high sensitivity of nucleic acid amplification tests such as ligase chain reaction (LCR) has the potential to simplify specimen collection for the microbiologic diagnosis of gonorrhea. We screened first-void urine specimens from 283 women attending a Birmingham, Ala., sexually transmitted disease (STD) clinic by using LCR and compared the results to those of cervical and urethral cultures for gonorrhea diagnosis. Fifty-three (18.7%) women had positive cervical cultures for gonorrhea, and 41 of the 53 (77%) also had positive urethral cultures. One additional patient had only a positive urethral culture (the cervical gonorrhea culture was negative). LCR testing of urine specimens for gonorrhea yielded positive results for 51 of 54 (94.4%) women with positive cervical or urethral cultures. Of 229 women with both urethral and cervical cultures negative for gonorrhea, 2 (0.8%) had positive urine LCR results as well. To resolve the discrepancies between urine LCR and culture results, LCR tests of simultaneously collected urethral and cervical swab specimens and LCR tests of the same urine specimens using different nucleotide primers were conducted. After evaluation of five discrepant results, the sensitivity, specificity, positive predictive value, and negative predictive value of LCR for the detection of gonorrhea in urine specimens were 94.6%, 100%, 100%, and 98.7%, respectively. We conclude that urine LCR testing for Neisseria gonorrhoeae is a practical alternative to culture for the detection of gonorrhea in women. Urine testing for STD diagnosis has the potential to simplify and expand the opportunities for STD screening and surveillance of women.

What Sexually Transmitted Disease Screening Method Does the Adolescent Prefer?

“…1 All major health policy organizations recommend annual chlamydial screening for sexually active adolescent females. [2][3][4] The nucleic acid amplification technique applied to urine samples provides a sensitive noninvasive method to screen adolescents for Chlamydia trachomatis and Neisseria gonorrhoeae [5][6] and are more cost-effective compared with pelvic examinations. 7 Recently, self-collected vaginal swab tests have been successfully implemented as another method of obtaining sexually transmitted disease (STD) specimens from adolescent and adult women, [8][9][10] although this technique awaits approval by the Food and Drug Administration (Rockville, Md).…”

Detection of Neisseria gonorrhoeae and Chlamydia trachomatis in genitourinary specimens from men and women by a coamplification PCR assay

“…Recent studies have demonstrated that molecular amplification assays such as PCR and ligase chain reaction (LCR) have high sensitivity and specificity for detection of either gonorrhea or chlamydia in a variety of sample types including urethral and endocervical swabs and urine (2,7,11,16,17,19,21,22). However, they require separate processing and ampli-fication techniques for each pathogen.…”

Detection of Chlamydia trachomatis and Neisseria gonorrhoeae by ligase chain reaction-based assays with clinical specimens from various sites: implications for diagnostic testing and screening

“…Besides endocervical specimens, female urine can be also be used for the detection of C. trachomatis by PCR-or LCR-based assays (1,2,4,13,16,18,19,21,23). An LCR-based assay for the detection of Neisseria gonorrhoeae in female urine specimens has also been described (6,24). The use of these highly sensitive tests has prompted the adoption of an expanded "gold standard" to compare the assay results obtained with specimens collected from different sites of infection (15,18).…”