Wong Arthur, Lima Nicole, Applegate Tanya L, Guy Rebecca, Huston Wilhelmina M, Hocking Jane S, Boettiger David
Sydney Sexual Health Centre, Sydney, Australia.
The Kirby Institute, Sydney, Australia.
Clin Infect Dis. 2024 Aug 5. doi: 10.1093/cid/ciae401.
Modern assays for the detection of Chlamydia trachomatis (CT) rely on nucleic acid amplification testing (NAAT) of DNA or ribosomal RNA. However, it is also known that both viable ("living") & non-viable ("dead") CT can be detected by NAAT. Multiple laboratory techniques to measure CT viability have emerged.
We searched PubMed, EMBASE, Scopus and Dimensions as well as conference abstracts for entries between January 2000 to May 2023. We included any studies that measured CT viability among NAAT-positive samples. Viability assays include enhanced cell culture, direct fluorescent antibody (DFA), messenger RNA (mRNA) detection via digital droplet PCR (ddPCR), viability PCR (V-PCR) & real-time PCR measuring RNA-to-DNA ratio (RDR) (e.g. InSignia®). A meta-analysis was performed on the proportions of non-viable CT by anatomical site.
We screened 31,342 records and included 16 studies in the analysis. The pooled proportions of non-viable CT by site were: 33% (95%CI 19-47%) in rectal swabs (eight studies), 17% (95%CI 7-27%) in cervical swabs (six studies), 15% (95%CI 6-25%) in vaginal swabs (six studies) and 11% (95%CI 9-17%) in urine/urethral swabs (two studies).
All included studies found that a proportion of NAAT-detected CT is non-viable. The findings have far-reaching implications for screening programs and studies evaluating new STI tests and antimicrobial regimens.
现代沙眼衣原体（CT）检测方法依赖于DNA或核糖体RNA的核酸扩增检测（NAAT）。然而，已知活的（“存活的”）和非活的（“死亡的”）CT均可通过NAAT检测到。多种测量CT活力的实验室技术已经出现。
我们检索了PubMed、EMBASE、Scopus和Dimensions以及会议摘要，查找2000年1月至2023年5月期间的条目。我们纳入了任何在NAAT阳性样本中测量CT活力的研究。活力检测包括增强细胞培养、直接荧光抗体（DFA）、通过数字液滴PCR（ddPCR）检测信使RNA（mRNA）、活力PCR（V-PCR）以及测量RNA与DNA比率（RDR）的实时PCR（例如InSignia®）。对不同解剖部位非活CT的比例进行了荟萃分析。
我们筛选了31342条记录，纳入16项研究进行分析。不同部位非活CT的合并比例分别为：直肠拭子中33%（95%CI 19 - 47%）（八项研究），宫颈拭子中17%（95%CI 7 - 27%）（六项研究），阴道拭子中15%（95%CI 6 - 25%）（六项研究），尿液/尿道拭子中11%（95%CI 9 - 17%）（两项研究）。
所有纳入研究均发现，NAAT检测到的CT中有一部分是无活力的。这些发现对筛查项目以及评估新的性传播感染检测和抗菌治疗方案的研究具有深远影响。
