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Three Part Question

In [women] is [N. gonorrhoeae and C. trachomatis PCR on urine samples more sensitive than that of cervical samples] in [detecting gonococcal and chlamydial infection]?

Clinical Scenario

An asymptomatic 25 year old female requesting for a screening gonorrhea and chlamydia test at a primary care clinic. The patient is actively menstruating and a speculum exam cannot be performed at the time of evaluation.

Search Strategy

Pubmed 1990-2005
Limit to English Language and Human
(gonorrhea[Text Word] OR gonorrhoea[Text Word] OR "gonorrhea"[MeSH Terms]) AND ("chlamydia"[MeSH Terms] OR ("chlamydia infections"[TIAB] NOT Medline[SB]) OR "chlamydia infections"[MeSH Terms] OR chlamydia[Text Word]) AND ("nucleic acids"[TIAB] NOT Medline[SB]) OR "nucleic acids"[MeSH Terms] OR nucleic acid[Text Word]) AND amplification[All Fields])

Search Outcome

52 articles were identified. Only one study was a meta-analysis that assessed the sensitivity and specificity of nucleic acid amplification tests for C. trachomatis and N. gonorrhoeae of urine and cervical samples in women.

Relevant Paper(s)

Author, date and country	Patient group	Study type (level of evidence)	Outcomes	Key results	Study Weaknesses
Cook et al. Jun 2005 USA	C. trachomatis: 14 studies n = 11,327	Meta-analysis	Urine sample PCR	Sensitivity 83.3% (95% CI, 77.7% to 88.9%)
			Cervical sample PCR	Sensitivity 85.5% (95% CI, 80.3% to 90.6%)

Clinical Bottom Line

Urine PCR for N. gonorrhoeae in women has a much lower sensitivity than traditional cervical sampling. Urine PCR should not be used for routine gonorrhea screening if the patient is agreeable to a speculum exam. Urine PCR for C. trachomatis in women is equal in sensitivity to that of cervical samples and is an adequate screening tool for chlamydia.

References

1. Cook RL, Hutchison SL, Ostergaard L, Braithwaite RS, Ness RB Systematic Review: Noninvasive testing for Chlamydia trachomatis and Neisseria gonorrhoeae Annals of Internal Medicine 142(11):914-925, June 2005.