Abstract
We evaluated the use of the leukocyte esterase test (LET) on first-catch urine specimens from women as a screening test to predict infection with Chlamydia trachomatis. For diagnosis, we used Abbott's ligase chain reaction (LCR) on urine specimens and isolation by tissue culture (TC) on cervical brushes. Of 4,053 women attending sexually transmitted disease and family planning clinics, 4.3% (n = 174) were positive by TC and 5.9% (n = 239) were positive by LCR. When LET was compared to TC, the sensitivity, specificity, positive predictive value, and negative predictive value were 54.0, 67.0, 6.8, and 97.0%, respectively. The corresponding performance of LET versus LCR was 53.1, 67.3, 10.1, and 95.8%. Almost half of the laboratory-confirmed chlamydial infections were negative by LET. The low specificity probably reflects multiple causes of pyuria in women and results in a low positive predictive value. LET is neither sensitive nor specific as a predictor of chlamydial infection and cannot be recommended for use as a screening test for C. trachomatis with first-catch urine samples from females from low- or moderate-prevalence populations.
Full Text
The Full Text of this article is available as a PDF (174.2 KB).
Selected References
These references are in PubMed. This may not be the complete list of references from this article.
- Adger H., Shafer M. A., Sweet R. L., Schachter J. Screening for Chlamydia trachomatis and Neisseria gonorrhoeae in adolescent males: value of first-catch urine examination. Lancet. 1984 Oct 27;2(8409):944–945. doi: 10.1016/s0140-6736(84)91164-4. [DOI] [PubMed] [Google Scholar]
- Bassiri M., Hu H. Y., Domeika M. A., Burczak J., Svensson L. O., Lee H. H., Mårdh P. A. Detection of Chlamydia trachomatis in urine specimens from women by ligase chain reaction. J Clin Microbiol. 1995 Apr;33(4):898–900. doi: 10.1128/jcm.33.4.898-900.1995. [DOI] [PMC free article] [PubMed] [Google Scholar]
- Cates W., Jr, Wasserheit J. N. Genital chlamydial infections: epidemiology and reproductive sequelae. Am J Obstet Gynecol. 1991 Jun;164(6 Pt 2):1771–1781. doi: 10.1016/0002-9378(91)90559-a. [DOI] [PubMed] [Google Scholar]
- 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]
- 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]
- Chow J. M., Yonekura M. L., Richwald G. A., Greenland S., Sweet R. L., Schachter J. The association between Chlamydia trachomatis and ectopic pregnancy. A matched-pair, case-control study. JAMA. 1990 Jun 20;263(23):3164–3167. [PubMed] [Google Scholar]
- Lee H. H., Chernesky M. A., Schachter J., Burczak J. D., Andrews W. W., Muldoon S., Leckie G., Stamm W. E. Diagnosis of Chlamydia trachomatis genitourinary infection in women by ligase chain reaction assay of urine. Lancet. 1995 Jan 28;345(8944):213–216. doi: 10.1016/s0140-6736(95)90221-x. [DOI] [PubMed] [Google Scholar]
- McNagny S. E., Parker R. M., Zenilman J. M., Lewis J. S. Urinary leukocyte esterase test: a screening method for the detection of asymptomatic chlamydial and gonococcal infections in men. J Infect Dis. 1992 Mar;165(3):573–576. doi: 10.1093/infdis/165.3.573. [DOI] [PubMed] [Google Scholar]
- Moncada J., Schachter J., Shafer M. A., Williams E., Gourlay L., Lavin B., Bolan G. Detection of Chlamydia trachomatis in first catch urine samples from symptomatic and asymptomatic males. Sex Transm Dis. 1994 Jan-Feb;21(1):8–12. doi: 10.1097/00007435-199401000-00003. [DOI] [PubMed] [Google Scholar]
- Patrick D. M., Rekart M. L., Knowles L. Unsatisfactory performance of the leukocyte esterase test of first voided urine for rapid diagnosis of urethritis. Genitourin Med. 1994 Jun;70(3):187–190. doi: 10.1136/sti.70.3.187. [DOI] [PMC free article] [PubMed] [Google Scholar]
- Ripa K. T., Mårdh P. A. Cultivation of Chlamydia trachomatis in cycloheximide-treated mccoy cells. J Clin Microbiol. 1977 Oct;6(4):328–331. doi: 10.1128/jcm.6.4.328-331.1977. [DOI] [PMC free article] [PubMed] [Google Scholar]
- Schachter J. Immunodiagnosis of sexually transmitted disease. Yale J Biol Med. 1985 Sep-Oct;58(5):443–452. [PMC free article] [PubMed] [Google Scholar]
- Schachter J., Moncada J., Whidden R., Shaw H., Bolan G., Burczak J. D., Lee H. H. Noninvasive tests for diagnosis of Chlamydia trachomatis infection: application of ligase chain reaction to first-catch urine specimens of women. J Infect Dis. 1995 Nov;172(5):1411–1414. doi: 10.1093/infdis/172.5.1411. [DOI] [PubMed] [Google Scholar]
- 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]
- Shafer M. A., Schachter J., Moncada J., Keogh J., Pantell R., Gourlay L., Eyre S., Boyer C. B. Evaluation of urine-based screening strategies to detect Chlamydia trachomatis among sexually active asymptomatic young males. JAMA. 1993 Nov 3;270(17):2065–2070. [PubMed] [Google Scholar]
- Shafer M. A., Schachter J., Moscicki A. B., Weiss A., Shalwitz J., Vaughan E., Millstein S. G. Urinary leukocyte esterase screening test for asymptomatic chlamydial and gonococcal infections in males. JAMA. 1989 Nov 10;262(18):2562–2566. [PubMed] [Google Scholar]