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. 1998 Feb;74(1):66–70. doi: 10.1136/sti.74.1.66

Pooling of urine specimens for PCR testing: a cost saving strategy for Chlamydia trachomatis control programmes

R W Peeling, B Toye, P Jessamine, I Gemmill
PMCID: PMC1758079  PMID: 9634309

Abstract

OBJECTIVES: To evaluate pooling of first catch urine (FCU) specimens as a cost effective strategy for chlamydia testing. METHODS: Mock specimens were pooled with and without dilution to determine optimal pool size and ease of work flow. The performance of the Amplicor Chlamydia trachomatis PCR assay on pooled specimens was compared with individual testing using 370 FCU specimens from asymptomatic men presenting to an STD clinic. Cost savings associated with pooling were estimated. RESULTS: Using mock specimens, the sensitivity and specificity of the Amplicor PCR assay were not affected by pool sizes of two and five, but at a pool size of 10 decreased sensitivity due to inhibition was observed in one of five mock pools when the pooling method which involved no dilution was used. Archived FCU specimens from a study of 370 asymptomatic men were combined consecutively into 74 pools of five and tested by PCR. Of the 18 pools that contained positive specimens, 17 were PCR positive. Compared with testing FCU specimens individually, pooling resulted in a sensitivity of 95%, specificity of 100%, and a cost savings of 57% based on reduced number of tests required. CONCLUSION: Depending on the prevalence of infection, pooling of FCU specimens for PCR testing may result in cost savings compared with testing specimens individually. Further evaluations to validate this strategy using fresh FCU specimens are needed. 




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Selected References

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  1. Bauwens J. E., Clark A. M., Loeffelholz M. J., Herman S. A., Stamm W. E. Diagnosis of Chlamydia trachomatis urethritis in men by polymerase chain reaction assay of first-catch urine. J Clin Microbiol. 1993 Nov;31(11):3013–3016. doi: 10.1128/jcm.31.11.3013-3016.1993. [DOI] [PMC free article] [PubMed] [Google Scholar]
  2. Buimer M., van Doornum G. J., Ching S., Peerbooms P. G., Plier P. K., Ram D., Lee H. H. Detection of Chlamydia trachomatis and Neisseria gonorrhoeae by ligase chain reaction-based assays with clinical specimens from various sites: implications for diagnostic testing and screening. J Clin Microbiol. 1996 Oct;34(10):2395–2400. doi: 10.1128/jcm.34.10.2395-2400.1996. [DOI] [PMC free article] [PubMed] [Google Scholar]
  3. Chernesky M. A., Jang D., Lee H., Burczak J. D., Hu H., Sellors J., Tomazic-Allen S. J., Mahony J. B. Diagnosis of Chlamydia trachomatis infections in men and women by testing first-void urine by ligase chain reaction. J Clin Microbiol. 1994 Nov;32(11):2682–2685. doi: 10.1128/jcm.32.11.2682-2685.1994. [DOI] [PMC free article] [PubMed] [Google Scholar]
  4. Chernesky M. A., Lee H., Schachter J., Burczak J. D., Stamm W. E., McCormack W. M., Quinn T. C. Diagnosis of Chlamydia trachomatis urethral infection in symptomatic and asymptomatic men by testing first-void urine in a ligase chain reaction assay. J Infect Dis. 1994 Nov;170(5):1308–1311. doi: 10.1093/infdis/170.5.1308. [DOI] [PubMed] [Google Scholar]
  5. Deguchi T., Yasuda M., Uno M., Tada K., Iwata H., Komeda H., Maeda S., Latila V., Saito I., Kawada Y. Comparison among performances of a ligase chain reaction-based assay and two enzyme immunoassays in detecting Chlamydia trachomatis in urine specimens from men with nongonococcal urethritis. J Clin Microbiol. 1996 Jul;34(7):1708–1710. doi: 10.1128/jcm.34.7.1708-1710.1996. [DOI] [PMC free article] [PubMed] [Google Scholar]
  6. Grosskurth H., Mosha F., Todd J., Mwijarubi E., Klokke A., Senkoro K., Mayaud P., Changalucha J., Nicoll A., ka-Gina G. Impact of improved treatment of sexually transmitted diseases on HIV infection in rural Tanzania: randomised controlled trial. Lancet. 1995 Aug 26;346(8974):530–536. doi: 10.1016/s0140-6736(95)91380-7. [DOI] [PubMed] [Google Scholar]
  7. Jaschek G., Gaydos C. A., Welsh L. E., Quinn T. C. Direct detection of Chlamydia trachomatis in urine specimens from symptomatic and asymptomatic men by using a rapid polymerase chain reaction assay. J Clin Microbiol. 1993 May;31(5):1209–1212. doi: 10.1128/jcm.31.5.1209-1212.1993. [DOI] [PMC free article] [PubMed] [Google Scholar]
  8. Lin J. S., Jones W. E., Yan L., Wirthwein K. A., Flaherty E. E., Haivanis R. M., Rice P. A. Underdiagnosis of Chlamydia trachomatis infection. Diagnostic limitations in patients with low-level infection. Sex Transm Dis. 1992 Sep-Oct;19(5):259–265. doi: 10.1097/00007435-199209000-00004. [DOI] [PubMed] [Google Scholar]
  9. Pasternack R., Vuorinen P., Kuukankorpi A., Pitkäjärvi T., Miettinen A. Detection of Chlamydia trachomatis infections in women by Amplicor PCR: comparison of diagnostic performance with urine and cervical specimens. J Clin Microbiol. 1996 Apr;34(4):995–998. doi: 10.1128/jcm.34.4.995-998.1996. [DOI] [PMC free article] [PubMed] [Google Scholar]
  10. Peeling R. W., Brunham R. C. Molecular techniques for the laboratory identification of Chlamydia trachomatis. J Int Fed Clin Chem. 1994 Jun;6(3):78–82. [PubMed] [Google Scholar]
  11. Plummer F. A., Simonsen J. N., Cameron D. W., Ndinya-Achola J. O., Kreiss J. K., Gakinya M. N., Waiyaki P., Cheang M., Piot P., Ronald A. R. Cofactors in male-female sexual transmission of human immunodeficiency virus type 1. J Infect Dis. 1991 Feb;163(2):233–239. doi: 10.1093/infdis/163.2.233. [DOI] [PubMed] [Google Scholar]
  12. Quinn T. C., Welsh L., Lentz A., Crotchfelt K., Zenilman J., Newhall J., Gaydos C. Diagnosis by AMPLICOR PCR of Chlamydia trachomatis infection in urine samples from women and men attending sexually transmitted disease clinics. J Clin Microbiol. 1996 Jun;34(6):1401–1406. doi: 10.1128/jcm.34.6.1401-1406.1996. [DOI] [PMC free article] [PubMed] [Google Scholar]
  13. Raboud J. M., Sherlock C., Schechter M. T., Lepine D. G., O'Shaughnessy M. V. Combining pooling and alternative algorithms in seroprevalence studies. J Clin Microbiol. 1993 Sep;31(9):2298–2302. doi: 10.1128/jcm.31.9.2298-2302.1993. [DOI] [PMC free article] [PubMed] [Google Scholar]
  14. Schachter J., Stamm W. E., Quinn T. C., Andrews W. W., Burczak J. D., Lee H. H. Ligase chain reaction to detect Chlamydia trachomatis infection of the cervix. J Clin Microbiol. 1994 Oct;32(10):2540–2543. doi: 10.1128/jcm.32.10.2540-2543.1994. [DOI] [PMC free article] [PubMed] [Google Scholar]
  15. Scholes D., Stergachis A., Heidrich F. E., Andrilla H., Holmes K. K., Stamm W. E. Prevention of pelvic inflammatory disease by screening for cervical chlamydial infection. N Engl J Med. 1996 May 23;334(21):1362–1366. doi: 10.1056/NEJM199605233342103. [DOI] [PubMed] [Google Scholar]
  16. Talbot H., Romanowski B. Factors affecting urine EIA sensitivity in the detection of Chlamydia trachomatis in men. Genitourin Med. 1994 Apr;70(2):101–104. doi: 10.1136/sti.70.2.101. [DOI] [PMC free article] [PubMed] [Google Scholar]
  17. Toye B., Peeling R. W., Jessamine P., Claman P., Gemmill I. Diagnosis of Chlamydia trachomatis infections in asymptomatic men and women by PCR assay. J Clin Microbiol. 1996 Jun;34(6):1396–1400. doi: 10.1128/jcm.34.6.1396-1400.1996. [DOI] [PMC free article] [PubMed] [Google Scholar]
  18. Verkooyen R. P., Luijendijk A., Huisman W. M., Goessens W. H., Kluytmans J. A., van Rijsoort-Vos J. H., Verbrugh H. A. Detection of PCR inhibitors in cervical specimens by using the AMPLICOR Chlamydia trachomatis assay. J Clin Microbiol. 1996 Dec;34(12):3072–3074. doi: 10.1128/jcm.34.12.3072-3074.1996. [DOI] [PMC free article] [PubMed] [Google Scholar]
  19. Washington A. E., Johnson R. E., Sanders L. L., Jr Chlamydia trachomatis infections in the United States. What are they costing us? JAMA. 1987 Apr 17;257(15):2070–2072. [PubMed] [Google Scholar]
  20. Wiesenfeld H. C., Uhrin M., Dixon B. W., Sweet R. L. Diagnosis of male Chlamydia trachomatis urethritis by polymerase chain reaction. Sex Transm Dis. 1994 Sep-Oct;21(5):268–271. doi: 10.1097/00007435-199409000-00004. [DOI] [PubMed] [Google Scholar]
  21. de Barbeyrac B., Pellet I., Dutilh B., Bébéar C., Dumon B., Géniaux M., Bébéar C. Evaluation of the Amplicor Chlamydia trachomatis test versus culture in genital samples in various prevalence populations. Genitourin Med. 1994 Jun;70(3):162–166. doi: 10.1136/sti.70.3.162. [DOI] [PMC free article] [PubMed] [Google Scholar]
  22. van Doornum G. J., Buimer M., Prins M., Henquet C. J., Coutinho R. A., Plier P. K., Tomazic-Allen S., Hu H., Lee H. Detection of Chlamydia trachomatis infection in urine samples from men and women by ligase chain reaction. J Clin Microbiol. 1995 Aug;33(8):2042–2047. doi: 10.1128/jcm.33.8.2042-2047.1995. [DOI] [PMC free article] [PubMed] [Google Scholar]

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