Pooled 3-Anatomic-Site Testing for Chlamydia trachomatis and Neisseria gonorrhoeae: A Systematic Review and Meta-Analysis

Abstract

Background: Pooled testing for Chlamydia trachomatis (CT) and Neisseria gonorrhoeae (NG) may be a cost-saving solution to increase screening by simplifying testing procedures and reducing resource burdens. We conducted a systematic review and meta-analysis to examine the performance of pooled 3-anatomic-site testing (pharyngeal, rectal, and urogenital sites) for CT and NG in comparison with single-anatomic-site testing. Methods:We conducted a systematic literature search in PubMed, Embase, and Web of Science to identify original evaluation studies of the performance of pooled testing for CT and NG infections and identified 14 studies for inclusion. Each study was systematically evaluated for bias. We conducted bivariate fixed-effects and random-effects meta-analyses using a full Bayesian method of the positive percent agreement and negative percent agreement. Results:The combined positive percent agreement for CT was 93.11% (95% confidence interval [CI], 91.51%-94.55%), and the negative percent agreement was 99.44% (95% CI, 99.18%-99.65%). For NG, the combined positive percent agreement was 93.80% (95% CI, 90.26%-96.61%), and the negative percent agreement was 99.73% (95% CI, 99.30%-99.97%). Conclusions:We found that pooled 3-anatomic-site tests performed similarly to single-anatomic-site tests for the detection of CT and NG. The pooled 3-anatomic-site tests have the added potential benefit of reduced cost and resource requirement, which could lead to improved testing access and screening uptake.

Pooling Rectal, Pharyngeal, and Urine Samples to Detect Neisseria gonorrhoeae, Chlamydia trachomatis, and Mycoplasma genitalium Using Multiplex Polymerase Chain Reaction Is as Effective as Single-Site Testing for Men Who Have Sex With Men

“…Overall, there have been 8 studies assessing pooling of genital and extragenital samples in MSM [ 11–19 ] and a recent meta-analysis of these studies and others involving women [ 20 ]. In this meta-analysis of these 8 studies, the positive percentage agreement of pooled testing with single-site testing was >93% using fixed-effects and random-effects models, and the negative percentage agreement was >99% for both infection types.…”

“…If rectal and pharyngeal samples are taken along with urogenital samples, the diagnostic cost could be unaffordable for most publicly funded sexual health services [ 10 ]. Over the last 3 years, a limited number of studies have aimed to evaluate the performance of pooled versus single-site testing to detect CT and NG using assays such as the Aptima Combo 2 Assay (Hologic Inc, San Diego, California), Xpert CT/NG (Cepheid, Sunnyvale, California), and Abbott RealTime CT/NG (Abbott, Chicago, Illinois) [ 11–19 ], showing a positive percentage agreement varying from 82.4% to 98.3% for NG and from 77.8% to 96.0% for CT [ 20 ].…”

Prevalence of five curable sexually transmitted infections and associated risk factors among tertiary student men who have sex with men in Nairobi, Kenya: a respondent-driven sampling survey†

“…Though more expensive than culturing of bacterial microorganisms, NAATs are currently the gold standard for detecting asymptomatic extra-genital bacterial STIs given their high sensitivity and speci city (15). Pooling samples from different anatomical sites from an individual and testing them together can be used to lower the cost of NAATs ( 16) and has been shown to perform as well as single-anatomic site testing for CT and NG among MSM in various settings (17)(18)(19)(20)(21)(22).…”