The 130th Annual Meeting of APHA

Abstract #44319

Susan M. Rogers, PhD¹, Jonathan Zenilman, MD², Charles F. Turner, PhD¹, Alia A. Al-Tayyib, BA¹, and Elizabeth Eggleston, PhD¹. (1) Health and Behavior Measurement Program, Research Triangle Institute, 1615 M Street, NW, Washington, DC 20036, 202-728-2494, smr@rti.org, (2) Baltimore City Health Department and Johns Hopkins University, Ross 1165-720 Rutland Ave, Baltimore, MD 21205

STD clinics routinely evaluate patients for gonorrhea (GC) by clinical examination and urethral or endocervical culture¹. Nucleic acid amplification tests (NAAT), including ligase chain reaction (LCR), are highly sensitive (>90%) for detection of GC infections^2-3. Unlike culture, NAAT can be used with non-invasive urine specimens and do not require detection of a viable organism. Between July 2000 and December 2001, 983 men and women ages 15-39 who presenting to an urban STD clinic were screened for GC using urine-based LCR and completed a detailed behavioral audio-CASI questionnaire. Urethral and endocervical swabs for gonorrhea culture were obtained during the routine clinical exam. Among the first 399 cases (all analyses will be completed by Summer, 2002), prevalence of GC as determined by LCR was 21.8%, but only 15.8% by culture (culture sensitivity=0.72). The sensitivity of culture varied by gender, presence/absence of symptoms, and age, ranging from 0.29 among asymptomatic patients to 0.89 patients with symptoms. Including LCR screening increased the detection of GC among young females (ages 15-24) two-fold (from 11% to 22%), and five-fold among asymptomatic females (from 2.7 to 13.5%). Five patients tested positive by culture, but were negative by LCR; all were symptomatic. In this high-risk population of STD clinic attendees, prevalence of GC was high. LCR detected 40% more GC infection (21.8%) than traditional culture (15.8%). While culture is a relatively inexpensive diagnostic technique in clinical settings, NAAT screening enhances detection of asymptomatic and female infections. The epidemiological significance of asymptomatic GC infections detected by NAAT, yet undetectable by culturing techniques, is unknown.

Learning Objectives:

• To compare the performance of nucleic acid amplification tests and culture for the identification of gonococcal infection among STD clinic patients, and to identify individual characteristics and behaviors associated with discordant test results.

Keywords: Health Behavior, STD

Presenting author's disclosure statement:
I do not have any significant financial interest/arrangement or affiliation with any organization/institution whose products or services are being discussed in this session.