Sadof M D, Woods E R, Emans S J
Division of Adolescent/Young Adult Medicine, Children's Hospital, Boston, MA 02115.
JAMA. 1987 Oct 9;258(14):1932-4.
Although sexually active female adolescents are often routinely screened for sexually transmitted diseases, indications for culturing adolescent males for sexually transmitted urethral infections are controversial. A study of 54 sexually active males (14 to 22 years old) was undertaken to assess the reliability of using dipstick leukocyte esterase activity in first-catch urine specimens to detect urethritis caused by Neisseria gonorrhoeae and Chlamydia trachomatis. Eighteen males had sexually transmitted diseases: N gonorrhoeae (nine patients), C trachomatis (eight patients), and N gonorrhoeae and C trachomatis (one patient). First-catch urine specimens with a 1+ (mild) or 2+ (moderate) reaction on dipstick testing had a leukocyte (WBC) count of 10 WBCs per high-power field or greater on microscopic analysis, with an 83% sensitivity, 100% specificity, a 100% positive predictive value, and a 92% negative predictive value for the presence of N gonorrhoeae, C trachomatis, or both. Clinical criteria for screening (urethral discharge, dysuria, or exposure to a sexually transmitted infection) plus a dipstick-positive first-catch urine specimen had a 94% sensitivity, 89% specificity, an 81% positive predictive value, and a 97% negative predictive value.
尽管通常会对性活跃的女性青少年进行常规性传播疾病筛查，但对青少年男性进行性传播尿道感染培养的指征仍存在争议。一项针对54名性活跃男性（14至22岁）的研究旨在评估使用首次晨尿标本中的试纸条白细胞酯酶活性来检测由淋病奈瑟菌和沙眼衣原体引起的尿道炎的可靠性。18名男性患有性传播疾病：淋病奈瑟菌感染（9例）、沙眼衣原体感染（8例）以及淋病奈瑟菌和沙眼衣原体混合感染（1例）。在试纸条检测中呈1+（轻度）或2+（中度）反应的首次晨尿标本，显微镜分析时白细胞（WBC）计数为每高倍视野10个白细胞或更多，对于淋病奈瑟菌、沙眼衣原体或两者皆有的存在，其敏感性为83%，特异性为100%，阳性预测值为100%，阴性预测值为92%。筛查的临床标准（尿道分泌物、排尿困难或接触性传播感染）加上试纸条检测呈阳性的首次晨尿标本，敏感性为94%，特异性为89%，阳性预测值为81%，阴性预测值为97%。
