Using urinary leucocyte esterase tests as an indicator of infection with gonorrhoea or chlamydia in asymptomatic males in a primary health care setting

Abstract

To evaluate a leucocyte esterase test as a predictor of gonorrhoea or chlamydia in asymptomatic Aboriginal males at the Central Australian Aboriginal Congress Male Clinic (Ingkintja), first-void urine samples and clinical information were collected from consecutive asymptomatic males presenting to the Ingkintja in Alice Springs between March 2008 and December 2009. Urine was tested immediately with a leucocyte esterase test dipstick and then by polymerase chain reaction for gonorrhoea and chlamydia. Among the 292 specimens from asymptomatic males, 15.4% were positive for gonorrhoea or chlamydia. In this group, compared with polymerase chain reaction result for gonorrhoea or chlamydia, leucocyte esterase test alone and in combination with age ≤35 years showed sensitivities of 66.7% and 60%, specificities of 90.7% and 94.7%, positive predictive values of 56.6% and 67.5%, negative predictive values of 93.7% and 92.8% and the area under receiver operating characteristics curve values of 0.79 and 0.85, respectively. Leucocyte esterase tests can reasonably be used as a basis for immediate empirical treatment for gonorrhoea or chlamydia in asymptomatic central Australian Aboriginal men under 35 years of age.

Evaluation of the Predictive Value of Urine Leukocyte Esterase Test in Chlamydia trachomatis and Neisseria gonorrhoeae Infection Among Males Attending HIV/STI Clinics in Guangdong Province, China

“…Although LET showed moderate sensitivities of 46.4% and 68.4% for CT and NG, respectively, it had high specificity values of 92.0% and 91.8% and NPVs of 96.1% and 98.7%. This finding is in agreement with the results reported for the Central Australian Aboriginal population, which reported sensitivities of 60.0% and 66.7% and specificities of 94.7% and 90.7% compared with NAAT results for CT and NG detection, respectively ( 18 ). CT and NG can be accurately excluded if the LET result is negative.…”

“…Previous studies reported LET sensitivity ranging from 45 to 100% for the detection of urogenital CT infections in men, with specificity ranging from 78% to 96% ( 16 , 17 ). Compared with the NAAT results for NG and CT detection, LET alone showed sensitivities of 66.7% and 60% and specificities of 90.7% and 94.7%, respectively, among Central Australian Aboriginal individuals ( 18 ). The variety of outcomes can be explained by differences in settings, patient groups, experimental test thresholds, and reference tests.…”

Sterile Pyuria

“…9,10 In asymptomatic men, urine tests to detect leukocyte esterase have a sensitivity of 66.7% for the diagnosis of gonorrhea and 60.0% for the diagnosis of chlamydia. Commercially available nucleic acid hybridization tests provide rapid detection of N. gonorrhoeae and Chlamydia trachomatis.…”

Descriptive Evaluation of Male Emergency Department Patients in the United States With Gonorrhea and Chlamydia

“…Thus, ED patients continue to be overtreated with antibiotics for both N gonorrhoeae and C trachomatis [7,10]. Men infected with N gonorrhoeae and C trachomatis can have inflammatory changes in the urine including higher levels of urine leukocyte esterase [11][12][13][14][15]. Most research involving N gonorrhoeae and C trachomatis in men come from ambulatory care centers or STI clinics with fewer epidemiologic investigations occurring in the ED patients.…”