University of Alabama at Birmingham, Department of Medicine, Division of Infectious Diseases, Heersink School of Medicine, Birmingham, Alabama
University of North Texas Health Science Center School of Public Health, Fort Worth, Texas.
Ann Fam Med. 2023 Mar-Apr;21(2):172-179. doi: 10.1370/afm.2942.
(CT) and (NG) are the 2 most frequently reported notifiable sexually transmitted infections (STIs) in the United States, and (TV), although not a notifiable disease, is the most common curable non-viral STI worldwide. Women bear a disproportionate burden of these infections and testing is necessary to identify infections. Although vaginal swabs are the recommended sample type, the specimen most often used among women is urine. The objective of this meta-analysis was to assess the diagnostic sensitivity of commercially available assays for vaginal swabs vs urine specimens from women.
A systematic search of multiple databases from 1995 through 2021 identified studies that (1) evaluated commercially available assays, (2) presented data for women, (3) included data obtained from the same assay on both a urine specimen and a vaginal swab from the same patient, (4) used a reference standard, and (5) were published in English. We calculated pooled estimates for sensitivity and the corresponding 95% CIs for each pathogen as well as odds ratios for any difference in performance.
We identified 28 eligible articles with 30 comparisons for CT, 16 comparisons for NG, and 9 comparisons for TV. Pooled sensitivity estimates for vaginal swabs and urine, respectively, were 94.1% and 86.9% for CT, 96.5% and 90.7% for NG, and 98.0% and 95.1% for TV (all values <.001).
Evidence from this analysis supports the Centers for Disease Control and Prevention's recommendation that vaginal swabs are the optimal sample type for women being tested for chlamydia, gonorrhea, and/or trichomoniasis.
（CT）和（NG）是美国报告最多的两种性传播感染（STI），（TV）虽然不是一种应报告的疾病，但它是全球最常见的可治愈的非病毒性 STI。女性承受着这些感染的不成比例的负担，检测是识别感染的必要手段。尽管阴道拭子是推荐的样本类型，但女性最常使用的标本是尿液。本荟萃分析的目的是评估市售检测方法对女性阴道拭子和尿液标本的诊断敏感性。
从 1995 年到 2021 年，通过对多个数据库进行系统搜索，确定了符合以下标准的研究：（1）评估市售检测方法，（2）报告了女性的数据，（3）包括了从同一患者的尿液标本和阴道拭子获得的相同检测数据，（4）使用了参考标准，（5）以英文发表。我们计算了每种病原体的敏感性汇总估计值及其相应的 95%置信区间（CI），以及任何性能差异的比值比。
我们确定了 28 篇符合条件的文章，其中包括 30 项关于 CT 的比较、16 项关于 NG 的比较和 9 项关于 TV 的比较。阴道拭子和尿液的敏感性汇总估计值分别为 94.1%和 86.9%用于 CT、96.5%和 90.7%用于 NG 以及 98.0%和 95.1%用于 TV（所有 值<0.001）。
本分析的证据支持疾病控制与预防中心的建议，即阴道拭子是对女性进行衣原体、淋病和/或滴虫病检测的最佳样本类型。
