Screening for Chlamydia trachomatis and Neisseria gonorrhoeae Infections in Men Who Have Sex With Men: Diagnostic Accuracy of Nucleic Acid Amplification Test on Pooled Urine, Anorectal, and Pharyngeal Specimens

Abstract

Neisseria gonorrhoeae and Chlamydia trachomatis screening was performed in a cohort of 100 men who have sex with men. A nucleic acid amplification test on a pooled sample of first-pass urine, pharyngeal, and anorectal specimens was compared with results on nonpooled samples. Despite an excellent agreement (Cohen κ, 0.932), pooling specimens reduced test sensitivity to 89.5%.

Pooling Pharyngeal, Anorectal, and Urogenital Samples for Screening Asymptomatic Men Who Have Sex with Men for Chlamydia trachomatis and Neisseria gonorrhoeae

“…It is possible that our lower numbers were due to our having an asymptomatic cohort while Speers et al had a mixed cohort. De Baetselier et al showed no significant sensitivity loss with pooling (25), and Thielemans et al reported the sensitivity of pooling as 89.5% using a NAAT; however, that study had a small sample size of positive participants (n ϭ 19), and it is difficult to make a comparison, as the authors did not report individual sensitivities for C. trachomatis and N. gonorrhoeae (23).…”

“…To our knowledge, there have been four studies assessing pooling of genital and extragenital samples in MSM (22)(23)(24)(25). Sultan et al conducted the largest study of pooling to date in MSM in the United Kingdom using self-collected samples and the AC2 assay (22).…”

“…Several large pooling studies have been done over the last 2 decades (18)(19)(20)(21)(22); however, most focused on pooling urine samples from multiple individuals for largescale C. trachomatis and N. gonorrhoeae screening in resource-limited settings and settings with low prevalence of C. trachomatis or N. gonorrhoeae. Few pooling studies have included both urogenital and extragenital samples (22)(23)(24)(25), and there is still no clear consensus on whether pooling has sufficient sensitivity to be used as a detection tool in at-risk populations, including MSM. A 2018 study in the United Kingdom demonstrated that although cost-effectiveness is a major driver for services to implement pooled-sample testing, the majority of clinicians regard the existing evidence as insufficient to make a decision (26).…”

To Pool or Not to Pool Samples for Sexually Transmitted Infections Detection in Men Who Have Sex With Men? An Evaluation of a New Pooling Method Using the GeneXpert Instrument in West Africa

“…Hence, pooling of the three collected samples per individual offers potential cost-savings in CT/NG detection in MSM presenting for PrEP [21]. Several pooling methods are described, including two using the GeneXpert instrument for STI detection [21][22][23][24][25]. To our knowledge, none of these pooling methods have been implemented in LMIC.…”

The Performance of Pooled 3 Anatomic Site Testing for Chlamydia trachomatis and Neisseria gonorrhoeae Among Men Who Have Sex With Men and Transgender Women

“…Three anatomic site pooled testing has been evaluated in some prior studies using various NAAT assays [16][17][18][19][20][21][22][23][24][25][26] ; however, there is no consensus on whether pooled testing has sufficient validity for clinical implementation. The objective of our study was to assess the performance of routine pooled 3-anatomic site testing (1 test vs 3 tests per person) for CT and NG using the Xpert CT/NG assay (Cepheid, Sunnyvale, CA).…”