The accuracy and efficacy of screening tests for Chlamydia trachomatis: a systematic review

Emma Honey, Alexander Allan Templeton, J. Paavonen, A. Stary, B. S. Pederson, I. Russell, P. A. Mardh

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158 Citations (Scopus)

Abstract

Screening women for lower genital tract infection with Chlamydia trachomatis is important in the prevention of pelvic inflammatory disease, ectopic pregnancy and infertility. This systematic review aims to state clearly which of the available diagnostic tests for the detection of C trachomatis would be most effective in terms of clinical effectiveness. The review included all studies published from 1990 onward that evaluated diagnostic tests in asymptomatic, young, sexually active populations. Medline and Embase were searched electronically and key journals were hand-searched. Further studies were identified through the Internet and contact with experts in the field. All studies were reviewed by two reviewers and were scored by Irwig's assessment criteria. Additional quality assessment criteria included a documented sexual history and recording of previous chlamydial infection. The reviews were subjected to meta-analysis and meta-regression. The 30 studies that were included examined three types of DNA-based test-ligase chain reaction (LCR), PCR and gene probe-as well as enzyme immuno-assay (EIA). The results showed that while specificities were high, sensitivities varied widely across the tests and were also dependent on the specimen tested. Pooled sensitivities for LCR, PCR, gene probe and EIA on urine were 96.5%, 85.6%, 92% and 38%, respectively, while on cervical swabs the corresponding sensitivities of PCR, gene probe and EIA were 88.6%, 84% and 65%. Meta-analysis demonstrated that DNA amplification techniques performed best for both urine and swabs in low prevalence populations. We conclude that nucleic acid amplification tests used on non-invasive samples such as urine are more effective at detecting asymptomatic chlamydial infection than conventional tests, but there are few data to relate a positive result with clinical outcome.

Original languageEnglish
Pages (from-to)1021-1031
Number of pages10
JournalJournal of Medical Microbiology
Volume51
Issue number12
Publication statusPublished - 2002

Keywords

  • LIGASE CHAIN-REACTION
  • SEXUALLY-TRANSMITTED DISEASE
  • LOW-PREVALENCE POPULATION
  • TRANSCRIPTION-MEDIATED AMPLIFICATION
  • FIRST-VOID URINE
  • DIRECT FLUORESCENT-ANTIBODY
  • ASYMPTOMATIC YOUNG-WOMEN
  • LEUKOCYTE ESTERASE TEST
  • AMPLICOR PCR TEST
  • PACE 2 ASSAY

Cite this

Honey, E., Templeton, A. A., Paavonen, J., Stary, A., Pederson, B. S., Russell, I., & Mardh, P. A. (2002). The accuracy and efficacy of screening tests for Chlamydia trachomatis: a systematic review. Journal of Medical Microbiology, 51(12), 1021-1031.