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Farfour E, Kitous C, Zucman D, Touche P, Panel K, Fourn E, Vasse M. Comparison of the Alinity M STI with the GeneXpert CT/NG for the detection of sexually transmitted microorganisms. Diagn Microbiol Infect Dis 2024; 108:116179. [PMID: 38198980 DOI: 10.1016/j.diagmicrobio.2024.116179] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/21/2023] [Revised: 12/31/2023] [Accepted: 01/03/2024] [Indexed: 01/12/2024]
Abstract
We assess the performances of the Alinity M STI assay (Abbott Molecular) in comparison to the Xpert CT/NG assay (Cepheid). We first retrospectively used a collection of 70 frozen samples of which 33, 31, and 6 were positives for Chlamydia trachomatis (CT), Neisseria gonorrhoea (NG), and both micro-organisms respectively. The Alinity M STI and the Xpert CT/NG results were in accordance for all. The mean difference in cycle threshold values between the Xpert CT/NG and the Alinity M STI were -1.6 and 0.0 for CT and NG respectively. Then 214 fresh samples collected from 121 patients were prospectively tested with both instruments. Anal swabs, throat swabs, vaginal swabs, and urines accounted each for about 25%. Seven (3.2%) samples of which 5 anal swabs, provided inconclusive results with the Alinity M STI. In conclusion, the Alinity M STI is an accurate device for the microbiological diagnosis of NG and CT infections.
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Affiliation(s)
- Eric Farfour
- Service de biologie Clinique, hôpital Foch, Suresnes, France.
| | - Cyril Kitous
- Service de biologie Clinique, hôpital Foch, Suresnes, France
| | - David Zucman
- Réseau Ville-Hôpital, Service de médecine interne, Hôpital Foch, Suresnes, France
| | - Pauline Touche
- Délégation à la recherche clinique et à l'innovation, Hôpital Foch, Suresnes, France
| | - Kewin Panel
- Délégation à la recherche clinique et à l'innovation, Hôpital Foch, Suresnes, France
| | - Erwan Fourn
- Réseau Ville-Hôpital, Service de médecine interne, Hôpital Foch, Suresnes, France
| | - Marc Vasse
- Service de biologie Clinique, hôpital Foch, Suresnes, France; Université Paris-Saclay, INSERM Hémostase inflammation thrombose HITH U1176, 94276 Le Kremlin-Bicêtre, France
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2
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Ramsden S, Ovens K, Griffiths J, Muir P, Steele-Nicholson A, Horner PJ. Environmental contamination by Chlamydia trachomatis and Neisseria gonorrhoeae: is it time to change our infection control practices? Results of a regional study. Sex Transm Infect 2023; 99:35-40. [PMID: 35584899 DOI: 10.1136/sextrans-2021-055360] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/23/2021] [Accepted: 02/23/2022] [Indexed: 01/20/2023] Open
Abstract
OBJECTIVES Nucleic acid amplification tests (NAATs) are highly sensitive for the detection of Chlamydia trachomatis (CT) and Neisseria gonorrhoeae (NG) DNA/ribosomal RNA (rRNA). Previous studies have demonstrated contamination of surfaces in sexual health clinics (SHCs) with CT/NG. False positive results can occur if patient samples are contaminated by environmental DNA/rRNA. This can have a dramatic impact on patients' lives and relationships. Previous attempts to reduce contamination, through staff training alone, have been unsuccessful. We aimed to investigate environmental contamination levels in SHCs and to assess a two-armed intervention aimed at reducing surface contamination. METHODS Questionnaires were sent to 10 SHCs. Six clinics, with differing characteristics, were selected to participate in sample collection. Each clinic followed standardised instructions to sample surfaces using a CT/NG NAAT swab. Clinics were invited to introduce the two-armed intervention. The first arm was cleaning with a chlorine-based cleaning solution once daily. The second arm involved introducing clinic-specific changes to reduce contamination. RESULTS 7/10 (70%) clinics completed the questionnaire. Overall, 88/263 (33%) swabs were positive for CT/NG. Clinics 1, 3 and 4 had high levels of contamination, with 28/64 (44%), 17/33 (52%) and 30/52 (58%) swabs testing positive, respectively. Clinics 2 and 6 had lower levels of contamination, with 7/46 (15%) and 6/35 (17%), respectively. 0/33 (0%) of swabs were positive at clinic 5 and this was the only clinic already using a chlorine-based solution to clean all surfaces and delivering twice-yearly clinic-specific infection control training. Following both intervention arms at clinic 1, 2/50 (4%, p<0.0001) swabs tested positive for CT/NG. Clinic 4 introduced each arm separately. After the first intervention, 13/52 (25%, p=0.003) swabs tested positive and following the second arm 4/50 (8%, p<0.0001) swabs were positive. CONCLUSIONS Environmental contamination is a concern in SHCs. We recommend that all SHCs monitor contamination levels and, if necessary, consider using chlorine-based cleaning products and introduce clinic-specific changes to address environmental contamination.
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Affiliation(s)
- Sophie Ramsden
- Unity Sexual Health, University Hospitals Bristol NHS Trust, Bristol, UK
| | - Katie Ovens
- Sexual Health in Plymouth (SHiP), University Hospitals Plymouth NHS Trust, Plymouth, UK
| | - James Griffiths
- Clinical Microbiology, Royal Cornwall Hospitals NHS Trust, Truro, UK
| | - Peter Muir
- Public Health Laboratory Bristol, National Infection Service, Public Health England, Bristol, UK
| | | | - Paddy J Horner
- Unity Sexual Health, University Hospitals Bristol NHS Trust, Bristol, UK.,Population Health Sciences, University of Bristol, Bristol, UK.,National Institute for Health Research Health Protection Research Unit (NIHR HPRU) in Behavioural Science and Evaluation, Bristol, UK
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Wilson JD, Wallace HE, Loftus-Keeling M, Ward H, Davies B, Vargas-Palacios A, Hulme C, Wilcox MH. Swab-yourself Trial With Economic Monitoring and Testing for Infections Collectively (SYSTEMATIC): Part 1. A Diagnostic Accuracy and Cost-effectiveness Study Comparing Clinician-taken vs Self-taken Rectal and Pharyngeal Samples for the Diagnosis of Gonorrhea and Chlamydia. Clin Infect Dis 2021; 73:e3172-e3180. [PMID: 32877521 DOI: 10.1093/cid/ciaa1266] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/27/2020] [Indexed: 11/14/2022] Open
Abstract
BACKGROUND Urogenital testing misses extragenital Neisseria gonorrhoeae (NG) and Chlamydia trachomatis (CT). Extragenital self-sampling is frequently undertaken despite no robust randomized, controlled trial evidence of efficacy. We compared clinician-taken rectal and pharyngeal samples with self-taken samples for diagnostic accuracy and cost in men who have sex with men (MSM) and in females. METHODS This was a prospective convenience sample from a UK sexual health clinic. We randomized the order of clinician- and self-taken samples from the pharynx and rectum, plus first catch urine (MSM) and vulvovaginal swabs (females), for NG/CT detection. RESULTS Of 1793 participants (1284 females, 509 MSM), 116 had NG detected (75 urogenital, 83 rectum, 72 pharynx); 9.4% infected females and 67.3% MSM were urogenital-negative. A total of 276 had CT detected (217 urogenital, 249 rectum, 63 pharynx); 13.1% infected females and 71.8% MSM were urogenital-negative. Sexual history did not identify those with rectal infections. There was no difference in diagnostic accuracy between clinician- and self-taken samples from the rectum or pharynx. Clinicians took swabs more quickly than participants, so costs were lower. However, in asymptomatic people, nonqualified clinicians would oversee self-swabbing making these costs lower. CONCLUSIONS There was no difference in the diagnostic accuracy of clinician-taken compared with self-taken extragenital samples. Sexual history did not identify those with rectal infections, so individuals should have extragenital clinician- or self-taken samples. Clinician-taken swabs cost less than self-taken swabs; however, in asymptomatic people or those who perform home testing, the costs would be lower than for clinician-taken swabs. CLINICAL TRIALS REGISTRATION NCT02371109.
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Affiliation(s)
- Janet D Wilson
- Leeds Sexual Health, Leeds Teaching Hospitals National Health Service Trust, Leeds, United Kingdom
| | - Harriet E Wallace
- Leeds Sexual Health, Leeds Teaching Hospitals National Health Service Trust, Leeds, United Kingdom
| | - Michelle Loftus-Keeling
- Leeds Sexual Health, Leeds Teaching Hospitals National Health Service Trust, Leeds, United Kingdom
| | - Helen Ward
- Department of Infectious Disease Epidemiology, Imperial College, London, United Kingdom
| | - Bethan Davies
- Department of Epidemiology and Biostatistics, Imperial College, London, United Kingdom
| | | | - Claire Hulme
- Academic Unit of Health Economics, University of Leeds, Leeds, United Kingdom
| | - Mark H Wilcox
- Department of Clinical Microbiology, Leeds Teaching Hospitals National Health Service Trust, Leeds, United Kingdom
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Wilson JD, Wallace HE, Loftus-Keeling M, Ward H, Davies B, Vargas-Palacios A, Hulme C, Wilcox MH. Swab-Yourself Trial With Economic Monitoring and Testing for Infections Collectively (SYSTEMATIC): Part 2. A Diagnostic Accuracy and Cost-effectiveness Study Comparing Rectal, Pharyngeal, and Urogenital Samples Analyzed Individually, Versus as a Pooled Specimen, for the Diagnosis of Gonorrhea and Chlamydia. Clin Infect Dis 2021; 73:e3183-e3193. [PMID: 33044490 DOI: 10.1093/cid/ciaa1546] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/27/2020] [Indexed: 11/12/2022] Open
Abstract
BACKGROUND Sexual history does not accurately identify those with extragenital Neisseria gonorrhoeae (NG) and Chlamydia trachomatis (CT), so universal extragenital sampling is recommended. Nucleic acid amplification tests (NAATs) are expensive. If urogenital, plus rectal and pharyngeal, samples are analyzed, the diagnostic cost is trebled. Pooling samples into 1 NAAT container would cost the same as urogenital samples alone. We compared clinician triple samples analyzed individually with self-taken pooled samples for diagnostic accuracy, and cost, in men who have sex with men (MSM) and females. METHODS This was a prospective, convenience sample in United Kingdom sexual health clinic. Randomized order of clinician and self-samples from pharynx, rectum, plus first-catch urine (FCU) in MSM and vulvovaginal swabs (VVS) in females, for NG and CT detection. RESULTS Of 1793 participants (1284 females, 509 MSM), 116 had NG detected (75 urogenital, 83 rectum, 72 pharynx); 276 had CT detected (217 urogenital, 249 rectum, 63 pharynx). There was no difference in sensitivities between clinician triple samples and self-pooled specimens for NG (99.1% and 98.3%), but clinician samples analyzed individually identified 3% more chlamydia infections than pooled (99.3% and 96.0%; P = .027). However, pooled specimens identified more infections than VVS/FCU alone. Pooled specimens missed 2 NG and 11 CT infections, whereas VVS/FCU missed 41 NG and 58 CT infections. Self-taken pooled specimens were the most cost-effective. CONCLUSIONS FCU/VVS testing alone missed many infections. Self-taken pooled samples were as sensitive as clinician triple samples for identifying NG, but clinician samples analyzed individually identified 3% more CT infections than pooled. The extragenital sampling was achievable at no additional diagnostic cost to the FCU/VVS. CLINICAL TRIALS REGISTRATION NCT02371109.
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Affiliation(s)
- Janet D Wilson
- Leeds Sexual Health, Leeds Teaching Hospitals National Health Services Trust, Leeds, United Kingdom
| | - Harriet E Wallace
- Leeds Sexual Health, Leeds Teaching Hospitals National Health Services Trust, Leeds, United Kingdom
| | - Michelle Loftus-Keeling
- Leeds Sexual Health, Leeds Teaching Hospitals National Health Services Trust, Leeds, United Kingdom
| | - Helen Ward
- Department of Infectious Disease Epidemiology, Imperial College London, London, United Kingdom
| | - Bethan Davies
- Department of Epidemiology and Biostatistics, Imperial College London, London, United Kingdom
| | | | - Claire Hulme
- Academic Unit of Health Economics, University of Leeds, Leeds, United Kingdom
| | - Mark H Wilcox
- Department of Clinical Microbiology, Leeds Teaching Hospitals National Health Services Trust, Leeds, United Kingdom
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Environmental Contamination by Chlamydia trachomatis RNA Can Cause False-Positive Test Results in Clinical Samples. Sex Transm Dis 2021; 48:e88-e90. [PMID: 33093289 DOI: 10.1097/olq.0000000000001323] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/01/2023]
Abstract
ABSTRACT An investigation of unexpected positive test results for Chlamydia trachomatis at a women's health clinic in Sweden revealed that samples were contaminated by RNA in the clinic. The risk for RNA contamination at a clinic has been postulated previously. We are, however, not aware that this has actually been demonstrated in practice.
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Herrmann B, Malm K. Comparison between Abbott m2000 RealTime and Alinity m STI systems for detection of Chlamydia trachomatis, Neisseria gonorrhoeae, and Mycoplasma genitalium. Eur J Clin Microbiol Infect Dis 2021; 40:2217-2220. [PMID: 33723736 PMCID: PMC8449771 DOI: 10.1007/s10096-020-04135-9] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/16/2020] [Accepted: 12/16/2020] [Indexed: 11/29/2022]
Abstract
The new Abbott Alinity m STI Assay was compared with Abbott m2000 RealTime PCR. For Chlamydia trachomatis, 26 (7.5%) of 347 samples were positive in the Alinity assay and 24 (6.9%) in the m2000 assay. Corresponding figures for Neisseria gonorrhoeae were 23 (6.6%) and 17 (4.9%). For Mycoplasma genitalium, 22 (7.9%) of 279 samples were positive in the Alinity assay and 18 (6.5%) in the m2000 assay, for which DNA extraction was performed on an m2000sp instrument combined with in-house real-time PCR. The Alinity assay has at least the same sensitivity as the m2000 assay. The specificity was evaluated by discrepancy analysis.
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Affiliation(s)
- Björn Herrmann
- Department of Clinical Microbiology, Uppsala University Hospital, SE-751 85, Uppsala, Sweden. .,Section of Clinical Bacteriology, Department of Medical Sciences, Uppsala University, Uppsala, Sweden.
| | - Karin Malm
- Department of Clinical Microbiology, Uppsala University Hospital, SE-751 85, Uppsala, Sweden
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Genital and Extragenital Gonorrhea and Chlamydia in Children and Adolescents Evaluated for Sexual Abuse. Pediatr Emerg Care 2018; 34:761-766. [PMID: 28072668 DOI: 10.1097/pec.0000000000001014] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
OBJECTIVE The aim of this study was to describe the use of a nucleic acid amplification test in detecting genital and extragenital Neisseria gonorrhoeae (NG) and Chlamydia trachomatis (CT) in children and adolescents assessed for sexual abuse/assault. METHODS The charts of children aged 0 to 17 years, consecutively evaluated for sexual victimization, in emergency department and outpatient settings were reviewed. Data extracted included age, sex, type of sexual contact, anogenital findings, previous sexual contact, toxicology results, and sites tested for NG and CT. RESULTS Of the 1319 patients who were tested, 579 were tested at more than 1 site, and 120 had at least 1 infected site. Chlamydia trachomatis was identified in 104 patients, and NG was found in 33. In bivariate analysis, a positive test was associated with female sex, age older than 11 years, previous sexual contact, acute or healed genital injury, drug/alcohol intoxication, and examination within 72 hours of sexual contact. Fifty-one patients had positive anal tests, and 24 had positive oral tests. More than 75% of patients with positive extragenital tests had additional positive tests or anogenital injury. Most with a positive anal (59%) or oral (77%) test did not report that the assailant's genitals came into contact with that site. CONCLUSIONS Positive tests for NG and CT in patients evaluated for sexual victimization may represent infection from sexual contact, contiguous spread of infection, or the presence of infected assailant secretions. Relying on patient reports of symptoms, or types of sexual contact, to determine need for testing may miss NG and CT infections in patients evaluated for sexual victimization.
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8
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Giffard PM, Su JY, Andersson P, Holt DC. Primary health clinic toilet/bathroom surface swab sampling can indicate community profile of sexually transmitted infections. PeerJ 2017; 5:e3487. [PMID: 28652937 PMCID: PMC5483037 DOI: 10.7717/peerj.3487] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/22/2017] [Accepted: 06/01/2017] [Indexed: 11/20/2022] Open
Abstract
BACKGROUND The microbiome of built environment surfaces is impacted by the presence of humans. In this study, we tested the hypothesis that analysis of surface swabs from clinic toilet/bathroom yields results correlated with sexually transmitted infection (STI) notifications from corresponding human populations. We extended a previously reported study in which surfaces in toilet/bathroom facilities in primary health clinics in the Australian Northern Territory (NT) were swabbed then tested for nucleic acid from the STI agents Chlamydia trachomatis, Neisseria gonorrhoeae and Trichomonas vaginalis. This was in the context of assessing the potential for such nucleic acid to contaminate specimens collected in such facilities. STIs are notifiable in the NT, thus allowing comparison of swab and notification data. METHODS An assumption in the design was that while absolute built environment loads of STI nucleic acids will be a function of patient traffic density and facility cleaning protocols, the relative loads of STI nucleic acids from different species will be largely unaffected by these processes. Another assumption was that the proportion of swabs testing positive for STIs provides a measure of surface contamination. Accordingly, "STI profiles" were calculated. These were the proportions that each of the three STIs of interest contributed to the summed STI positive swabs or notifications. Three comparisons were performed, using swab data from clinics in remote Indigenous communities, clinics in small-medium towns, and a single urban sexual health clinic. These data were compared with time and place-matched STI notifications. RESULTS There were significant correlations between swab and notifications data for the both the remote Indigenous and regional data. For the remote Indigenous clinics the p values ranged from 0.041 to 0.0089, depending on data transformation and p value inference method. Further, the swab data appeared to strongly indicate known higher relative prevalence of gonorrhoeae in central Australia than in northern Australia. Similarly, the regional clinics yielded p values from 0.0088-0.0022. In contrast, swab and notifications data from the sexual health clinic were not correlated. DISCUSSION Strong correlations between swab and notifications were observed. However, there was evidence for limitations of this approach. Despite the correlation observed with the regional clinics data, one clinic yielded zero positive swabs for C. trachomatis, although this STI constituted 25.1% of the corresponding notifications. This could be ascribed to stochastic effects. The lack of correlation observed for sexual health clinic data was also likely due to stochastic effects. It was concluded that toilet/bathroom surface swab sampling has considerable potential for public health surveillance. The approach may be applicable in situations other than primary health clinics, and for targets other than STIs.
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Affiliation(s)
- Philip M Giffard
- Division of Global and Tropical Health, Menzies School of Health Research, Charles Darwin University, Darwin, Northern Territory, Australia.,School of Psychological and Clinical Sciences, Charles Darwin University, Darwin, Northern Territory, Australia
| | - Jiunn-Yih Su
- Division of Child Health, Menzies School of Health Research, Charles Darwin University, Darwin, Northern Territory, Australia.,Centre for Disease Control, Northern Territory Department of Health, Darwin, Northern Territory, Australia
| | - Patiyan Andersson
- Division of Global and Tropical Health, Menzies School of Health Research, Charles Darwin University, Darwin, Northern Territory, Australia
| | - Deborah C Holt
- Division of Global and Tropical Health, Menzies School of Health Research, Charles Darwin University, Darwin, Northern Territory, Australia
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Giffard PM, Lilliebridge RA, Wilson J, Murray G, Phillips S, Tabrizi SN, Garland SM, Martin L, Singh G, Tong SYC, Holt DC, Andersson P. Contaminated fingers: a potential cause of Chlamydia trachomatis-positive urine specimens. Sex Transm Infect 2017; 94:32-36. [PMID: 28600332 PMCID: PMC5800334 DOI: 10.1136/sextrans-2016-053081] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/02/2017] [Revised: 04/21/2017] [Accepted: 04/29/2017] [Indexed: 11/24/2022] Open
Abstract
Objectives The detection of an STI agent in a urogenital tract (UGT) specimen from a young child is regarded as being indicative of sexual abuse. However, the probabilities of contamination events that could conceivably lead to STI positive specimens in the absence of sexual contact are unclear. The objective was to estimate the potential for fingers that have come in contact with Chlamydia trachomatis-positive urine to detectably contaminate C. trachomatis-negative urine. Methods The study design was based on self-experimentation. Dilutions of C. trachomatis elementary bodies (EBs) were prepared. A participant contacted an EB dilution then a urine surrogate specimen. The experiment was performed by three participants using three C. trachomatis isolates, of genotype E, F and B. Two surrogate urine contact methods were used to mimic contamination of a carer assisting with a child’s urine collection. All EB dilutions and urine surrogate specimens were subjected to C. trachomatis assay and quantification in a real-time PCR-based diagnostic system. Results The amplimer crossing point (Cq) for EB dilutions was 10.0±1.6 less than for corresponding finger contacted urine specimens, which corresponds to ~10 µL of EB suspension transferred. This was largely independent of participant identity, C. trachomatis strain or EB dilution. Hand decontamination led to large reductions in EBs transferred, but transfer remained consistently detectable. Recent Cq data from C. trachomatis-positive clinical urine specimens were collated, and 20% clearly contained sufficient C. trachomatis to detectably contaminate another specimen by finger-mediated transfer, as in this experiment. Conclusions This study directly demonstrated the potential for urine contaminated fingers to convert a C. trachomatis-negative urine specimen to C. trachomatis positive as a result of contact. Accordingly, procedures for urine specimen collection, particularly from children, need to be designed to prevent contamination.
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Affiliation(s)
- Philip M Giffard
- Global and Tropical Health Division, Menzies School of Health Research, Charles Darwin University, Darwin, Northern Territory, Australia.,School of Psychological and Clinical Sciences, Charles Darwin University, Darwin, Northern Territory, Australia
| | - Rachael A Lilliebridge
- Global and Tropical Health Division, Menzies School of Health Research, Charles Darwin University, Darwin, Northern Territory, Australia
| | - Judith Wilson
- Global and Tropical Health Division, Menzies School of Health Research, Charles Darwin University, Darwin, Northern Territory, Australia
| | - Gerald Murray
- Murdoch Childrens Research Institute, Melbourne, Victoria, Australia.,Department of Microbiology and Infectious Diseases, The Royal Women's Hospital, Melbourne, Victoria, Australia
| | - Samuel Phillips
- Murdoch Childrens Research Institute, Melbourne, Victoria, Australia.,Department of Microbiology and Infectious Diseases, The Royal Women's Hospital, Melbourne, Victoria, Australia
| | - Sepehr N Tabrizi
- Murdoch Childrens Research Institute, Melbourne, Victoria, Australia.,Department of Microbiology and Infectious Diseases, The Royal Women's Hospital, Melbourne, Victoria, Australia.,Department of Obstetrics and Gynaecology, University of Melbourne, Melbourne, Victoria, Australia.,Department of Microbiology, Royal Children's Hospital, Melbourne, Victoria, Australia
| | - Suzanne M Garland
- Murdoch Childrens Research Institute, Melbourne, Victoria, Australia.,Department of Microbiology and Infectious Diseases, The Royal Women's Hospital, Melbourne, Victoria, Australia.,Department of Obstetrics and Gynaecology, University of Melbourne, Melbourne, Victoria, Australia.,Department of Microbiology, Royal Children's Hospital, Melbourne, Victoria, Australia
| | - Louise Martin
- Royal Darwin Hospital, Top End Health Service, Northern Territory Government, Darwin, Northern Territory, Australia
| | - Gurmeet Singh
- Royal Darwin Hospital, Top End Health Service, Northern Territory Government, Darwin, Northern Territory, Australia.,Sexual Assault Referral Centre, Northern Territory Government, Northern Territory, Australia.,Northern Territory Medical Program, Flinders University, Darwin, Northern Territory, Australia.,Child Health Division, Menzies School of Health Research, Charles Darwin University, Darwin, Northern Territory, Australia
| | - Steven Y C Tong
- Global and Tropical Health Division, Menzies School of Health Research, Charles Darwin University, Darwin, Northern Territory, Australia.,Victorian Infectious Disease Service, The Royal Melbourne Hospital, and The University of Melbourne, at the Peter Doherty Institute for Infection and Immunity, Melbourne, Victoria, Australia
| | - Deborah C Holt
- Global and Tropical Health Division, Menzies School of Health Research, Charles Darwin University, Darwin, Northern Territory, Australia.,School of Psychological and Clinical Sciences, Charles Darwin University, Darwin, Northern Territory, Australia
| | - Patiyan Andersson
- Global and Tropical Health Division, Menzies School of Health Research, Charles Darwin University, Darwin, Northern Territory, Australia
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10
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Bazan JA, Reese PC, Esber A, Lahey S, Ervin M, Davis JA, Fields K, Turner AN. High prevalence of rectal gonorrhea and Chlamydia infection in women attending a sexually transmitted disease clinic. J Womens Health (Larchmt) 2015; 24:182-9. [PMID: 25692800 PMCID: PMC4363910 DOI: 10.1089/jwh.2014.4948] [Citation(s) in RCA: 28] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
BACKGROUND Testing women for urogenital Neisseria gonorrhoeae (GC) and Chlamydia trachomatis (CT) is common in sexually transmitted disease (STD) clinics. However, women may not be routinely tested for rectal GC/CT. This may lead to missed infections in women reporting anal intercourse (AI). METHODS This was a retrospective review of all women who underwent rectal GC/CT testing from August 2012 to June 2013 at an STD clinic in Columbus, Ohio. All women who reported AI in the last year had a rectal swab collected for GC/CT nucleic acid amplification testing (n=331). Using log-binomial regression models, we computed unadjusted and adjusted associations for demographic and behavioral factors associated with rectal GC/CT infection. RESULTS Participants (n=331) were 47% African-American, with median age of 29 years. Prevalence of rectal GC was 6%, rectal CT was 13%, and either rectal infection was 19%. Prevalence of urogenital GC and CT was 7% and 13% respectively. Among women with rectal GC, 14% tested negative for urogenital GC. Similarly, 14% of women with rectal CT tested negative for urogenital CT. In unadjusted analyses, there was increased rectal GC prevalence among women reporting sex in the last year with an injection drug user, with a person exchanging sex for drugs or money, with anonymous partners, and while intoxicated/high on alcohol or illicit drugs. After multivariable adjustment, no significant associations persisted, but a trend of increased rectal GC prevalence was observed for women <26 years of age (p=0.06) and those reporting sex while intoxicated/high on alcohol or drugs (p=0.05). For rectal CT, only age <26 years was associated with prevalent infection in unadjusted models; this association strengthened after multivariable adjustment (prevalence ratio: 6.03; 95% confidence interval: 2.29-15.90). CONCLUSION Nearly one in five women who reported AI in the last year had rectal GC or CT infection. Urogenital testing alone would have missed 14% of rectal infections. Standardized guidelines would increase rectal GC/CT testing in women and help detect missed infections.
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Affiliation(s)
- Jose A. Bazan
- Colleges of Medicine, The Ohio State University, Columbus, Ohio
- Sexual Health Clinic, Columbus Public Health, Columbus, Ohio
| | | | - Allahna Esber
- Public Health, The Ohio State University, Columbus, Ohio
| | - Samantha Lahey
- Colleges of Medicine, The Ohio State University, Columbus, Ohio
| | - Melissa Ervin
- Sexual Health Clinic, Columbus Public Health, Columbus, Ohio
| | - John A. Davis
- Colleges of Medicine, The Ohio State University, Columbus, Ohio
| | - Karen Fields
- Sexual Health Clinic, Columbus Public Health, Columbus, Ohio
| | - Abigail Norris Turner
- Colleges of Medicine, The Ohio State University, Columbus, Ohio
- Public Health, The Ohio State University, Columbus, Ohio
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11
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Andersson P, Tong SYC, Lilliebridge RA, Brenner NC, Martin LM, Spencer E, Delima J, Singh G, McCann F, Hudson C, Johns T, Giffard PM. Multisite Direct Determination of the Potential for Environmental Contamination of Urine Samples Used for Diagnosis of Sexually Transmitted Infections. J Pediatric Infect Dis Soc 2014; 3:189-96. [PMID: 25349693 PMCID: PMC4208730 DOI: 10.1093/jpids/pit085] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/16/2013] [Accepted: 11/09/2013] [Indexed: 11/29/2022]
Abstract
BACKGROUND The detection of a sexually transmitted infection (STI) agent in a urine specimen from a young child is regarded as an indicator of sexual contact. False positives may conceivably arise from the transfer of environmental contaminants in clinic toilet or bathroom facilities into urine specimens. METHODS The potential for contamination of urine specimens with environmental STI nucleic acid was tested empirically in the male and female toilets or bathrooms at 10 Northern Territory (Australia) clinics, on 7 separate occasions at each. At each of the 140 experiments, environmental contamination with Chlamydia trachomatis, Neisseria gonorrhoeae, and Trichomonas vaginalis nucleic acid contamination was determined by swabbing 10 locations, and urine collection was simulated 5 times, using a (1) synthetic urine surrogate and (2) a standardized finger contamination procedure. RESULTS The most contaminated toilets and bathrooms were in remote Indigenous communities. No contamination was found in the Northern Territory Government Sexual Assault Referral Centre clinics, and intermediate levels of contamination were found in sexual health clinics and in clinics in regional urban centres. The frequency of surrogate urine sample contamination was low but non-zero. For example, 4 of 558 of the urine surrogate specimens from remote clinics were STI positive. CONCLUSIONS This is by far the largest study addressing the potential environmental contamination of urine samples with STI agents. Positive STI tests arising from environmental contamination of urine specimens cannot be ruled out. The results emphasize that urine specimens from young children taken for STI testing should be obtained by trained staff in clean environments, and duplicate specimens should be obtained if possible.
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Affiliation(s)
- Patiyan Andersson
- Division of Global and Tropical Health, Menzies School of Health Research, Charles Darwin University, Tiwi, Northern Territory, Australia
| | - Steven Y. C. Tong
- Division of Global and Tropical Health, Menzies School of Health Research, Charles Darwin University, Tiwi, Northern Territory, Australia
| | - Rachael A. Lilliebridge
- Division of Global and Tropical Health, Menzies School of Health Research, Charles Darwin University, Tiwi, Northern Territory, Australia
| | - Nicole C. Brenner
- Division of Global and Tropical Health, Menzies School of Health Research, Charles Darwin University, Tiwi, Northern Territory, Australia
| | | | | | - Jennifer Delima
- Northern Territory Government Sexual Assault Referral Centre (Alice Springs), Australia
| | - Gurmeet Singh
- Royal Darwin Hospital, Tiwi, Australia,Division of Child Health, Menzies School of Health Research, Charles Darwin University, Tiwi, Australia
| | - Frances McCann
- Northern Territory Government Sexual Assault Referral Centre (Darwin), Casuarina Health Service Centre, Casuarina Northern Territory, Australia
| | - Carolyn Hudson
- Northern Territory Government Sexual Assault Referral Centre (Alice Springs), Australia
| | - Tracy Johns
- Northern Territory Government Sexual Assault Referral Centre (Darwin), Casuarina Health Service Centre, Casuarina Northern Territory, Australia
| | - Philip M. Giffard
- Division of Global and Tropical Health, Menzies School of Health Research, Charles Darwin University, Tiwi, Northern Territory, Australia
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Dimech W, Lim MSC, Van Gemert C, Guy R, Boyle D, Donovan B, Hellard M. Analysis of laboratory testing results collected in an enhanced chlamydia surveillance system in Australia, 2008-2010. BMC Infect Dis 2014; 14:325. [PMID: 24920016 PMCID: PMC4061452 DOI: 10.1186/1471-2334-14-325] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/11/2013] [Accepted: 06/06/2014] [Indexed: 11/29/2022] Open
Abstract
BACKGROUND Chlamydial infection is the most common notifiable disease in Australia, Europe and the US. Australian notifications of chlamydia rose four-fold from 20,274 cases in 2002 to 80,846 cases in 2011; the majority of cases were among young people aged less than 29 years. Along with test positivity rates, an understanding of the number of tests performed and the demographics of individuals being tested are key epidemiological indicators. The ACCESS Laboratory Network was established in 2008 to address this issue. METHODS The ACCESS Laboratory Network collected chlamydia testing data from 15 laboratories around Australia over a three-year period using data extraction software. All chlamydia testing data from participating laboratories were extracted from the laboratory information system; patient identifiers converted to a unique, non-reversible code and de-identified data sent to a single database. Analysis of data by anatomical site included all specimens, but in age and sex specific analysis, only one testing episode was counted. RESULTS From 2008 to 2010 a total of 628,295 chlamydia tests were referred to the 15 laboratories. Of the 592,626 individual episodes presenting for testing, 70% were from female and 30% from male patients. In female patients, chlamydia positivity rate was 6.4% overall; the highest rate in 14 year olds (14.3%). In male patients, the chlamydia positivity rate was 9.4% overall; the highest in 19 year olds (16.5%). The most common sample type was urine (57%). In 3.2% of testing episodes, multiple anatomical sites were sampled. Urethral swabs gave the highest positivity rate for all anatomical sites in both female (7.7%) and male patients (14%), followed by urine (7.6% and 9.4%, respectively) and eye (6.3% and 7.9%, respectively). CONCLUSIONS The ACCESS Laboratory Network data are unique in both number and scope and are representative of chlamydia testing in both general practice and high-risk clinics. The findings from these data highlight much lower levels of testing in young people aged 20 years or less; in particular female patients aged less than 16 years, despite being the group with the highest positivity rate. Strategies are needed to increase the uptake of testing in this high-risk group.
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Affiliation(s)
- Wayne Dimech
- NRL, 4th Floor Healy Building, 41 Victoria Parade, Fitzroy 3065, Australia
| | - Megan SC Lim
- Burnet Institute, Centre for Population Health, 85 Commercial Road, Melbourne, Victoria 3004, Australia
- Monash University, School of Population Health and Preventive Medicine, 99 Commercial Rd, Melbourne 3004, Australia
| | - Caroline Van Gemert
- Burnet Institute, Centre for Population Health, 85 Commercial Road, Melbourne, Victoria 3004, Australia
- Monash University, School of Population Health and Preventive Medicine, 99 Commercial Rd, Melbourne 3004, Australia
| | - Rebecca Guy
- The Kirby Institute, Sexual Health Program, University of New South Wales, Sydney, NSW 2052, Australia
| | - Douglas Boyle
- GRHANITE Health Informatics Unit, Rural Health Academic Centre, Melbourne Medical School, University of Melbourne, 49 Graham Street, Shepparton, Victoria 3630, Australia
| | - Basil Donovan
- The Kirby Institute, Sexual Health Program, University of New South Wales, Sydney, NSW 2052, Australia
- Sydney Sexual Health Centre, Sydney Hospital, Sydney, NSW 2000, Australia
| | - Margaret Hellard
- Burnet Institute, Centre for Population Health, 85 Commercial Road, Melbourne, Victoria 3004, Australia
- Monash University, School of Population Health and Preventive Medicine, 99 Commercial Rd, Melbourne 3004, Australia
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13
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Carmine L, Castillo M, Fisher M. Testing and treatment for sexually transmitted infections in adolescents--what's new? J Pediatr Adolesc Gynecol 2014; 27:50-60. [PMID: 24119658 DOI: 10.1016/j.jpag.2013.06.005] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/04/2012] [Revised: 06/03/2013] [Accepted: 06/04/2013] [Indexed: 11/28/2022]
Abstract
BACKGROUND Significant changes are taking place in the diagnosis and management of sexually transmitted infections (STI) in adolescents and young adults. FINDINGS In this review article, we provide an update of STIs in adolescents and young adults including: (1) Adolescent risk; (2) Screening guidelines; (3) Clinical manifestations; (4) Diagnostic testing; (5) Treatment; and (6) Prevention; with an emphasis on "what's new" in the field. CONCLUSIONS/SIGNIFICANCE While the impacts of STI epidemiology and health care access are leading to new recommendations for screening and prevention, changes in technology and drug resistance are promoting new methods of STI testing and ongoing revisions of STI treatment recommendations.
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Affiliation(s)
- Linda Carmine
- Division of Adolescent Medicine, Steven and Alexandra Cohen Children's Medical Center of New York, North Shore-Long Island Jewish Health System, New Hyde Park, NY; Hofstra North Shore-LIJ School of Medicine at Hofstra University, Hempstead, NY.
| | - Marigold Castillo
- Division of Adolescent Medicine, Steven and Alexandra Cohen Children's Medical Center of New York, North Shore-Long Island Jewish Health System, New Hyde Park, NY; Hofstra North Shore-LIJ School of Medicine at Hofstra University, Hempstead, NY
| | - Martin Fisher
- Division of Adolescent Medicine, Steven and Alexandra Cohen Children's Medical Center of New York, North Shore-Long Island Jewish Health System, New Hyde Park, NY; Hofstra North Shore-LIJ School of Medicine at Hofstra University, Hempstead, NY
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14
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False-positive PCR results linked to administration of seasonal influenza vaccine. J Med Microbiol 2012; 61:332-338. [DOI: 10.1099/jmm.0.036178-0] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022] Open
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15
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Evaluation of Self-Collected Versus Clinician-Collected Swabs for the Detection of Chlamydia trachomatis and Neisseria gonorrhoeae Pharyngeal Infection Among Men Who Have Sex With Men. Sex Transm Dis 2011; 38:1036-9. [DOI: 10.1097/olq.0b013e318227713e] [Citation(s) in RCA: 40] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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Sethupathi M, Blackwell A, Davies H. Rectal Chlamydia trachomatis infection in women. Is it overlooked? Int J STD AIDS 2009; 21:93-5. [PMID: 19917639 DOI: 10.1258/ijsa.2008.008406] [Citation(s) in RCA: 28] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
Abstract
Screening for rectal chlamydia was not routinely offered in our department until we had a local outbreak of lymphogranuloma venereum (LGV) in men who have sex with men (MSM) in 2004/2005. We later decided to extend the screening to high-risk women (women who had receptive anal sex, contacts of gonorrhoea, women, with anorectal symptoms, women who had been sexually assaulted). A retrospective study of 152 women from whom 160 rectal chlamydia swabs were taken was carried out. Twenty (12.5%) swabs were positive, 19 of which were also positive at the cervix. All were non-LGV serovars. The groups at greatest risk were high-risk women aged less than 20 years and women with proven gonococcal infection where the prevalence was 22.6% and 30%, respectively. We conclude that rectal chlamydial infection in women may be common and further studies are needed to elucidate its importance.
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Affiliation(s)
- M Sethupathi
- Department of Genitourinary Medicine, Singleton Hospital, Sketty Lane, Swansea SA28QA, UK.
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