Jaschek G, Gaydos C A, Welsh L E, Quinn T C
Department of Medicine, Johns Hopkins University School of Medicine, Baltimore, Maryland 21205-2196.
J Clin Microbiol. 1993 May;31(5):1209-12. doi: 10.1128/jcm.31.5.1209-1212.1993.
Screening for Chlamydia trachomatis infection in men has traditionally been limited to men who present with urethral symptoms, thereby limiting the detection of asymptomatic chlamydia infection in men. In order to effectively screen both symptomatic and asymptomatic men, we evaluated a newly developed polymerase chain reaction (PCR) assay, Amplicor C. trachomatis, from Roche Molecular Systems for the detection of C. trachomatis in urine specimens in comparison with urethral culture. A total of 530 male urine specimens were collected from 322 symptomatic and 208 asymptomatic men attending two sexually transmitted disease clinics in Baltimore, Md. The prevalence of C. trachomatis by culture was 9.8% (10.6% in symptomatic men and 8.2% in asymptomatic men). Compared with culture, the sensitivity of the PCR was 92.8%, the specificity was 94.7%, the positive predictive value was 68.4%, and the negative predictive value was 99.1%. Discrepant results between culture and PCR were further analyzed by direct fluorescent-antibody staining of elementary bodies in urine sediment and in culture transport vials and by major outer membrane protein PCR of transport media for specimens with negative culture. The revised sensitivity and specificity of PCR for urine were 95.0 and 99.8%, respectively, and the positive and negative predictive values were 98.7 and 99.1%, respectively. The sensitivity of culture compared with PCR and/or direct fluorescent-antibody staining was 68.4%. These results indicate that the PCR assay is a highly sensitive and specific assay for the detection of C. trachomatis in male urine specimens and provides a noninvasive technique for routine screening of chlamydia infection in both symptomatic and asymptomatic men.
传统上，对男性沙眼衣原体感染的筛查仅限于有尿道症状的男性，从而限制了对男性无症状沙眼衣原体感染的检测。为了有效筛查有症状和无症状的男性，我们评估了罗氏分子系统公司新开发的一种聚合酶链反应（PCR）检测方法——Amplicor沙眼衣原体检测法，用于检测尿液标本中的沙眼衣原体，并与尿道培养法进行比较。我们从马里兰州巴尔的摩市两家性传播疾病诊所的322名有症状男性和208名无症状男性中总共收集了530份男性尿液标本。通过培养法检测出的沙眼衣原体患病率为9.8%（有症状男性中为10.6%，无症状男性中为8.2%）。与培养法相比，PCR的灵敏度为92.8%，特异性为94.7%，阳性预测值为68.4%，阴性预测值为99.1%。对于培养结果与PCR结果不一致的情况，我们通过对尿沉渣和培养物转运瓶中的原体进行直接荧光抗体染色，以及对培养阴性标本的转运培养基进行主要外膜蛋白PCR，进一步进行分析。修订后，尿液PCR检测的灵敏度和特异性分别为95.0%和99.8%，阳性和阴性预测值分别为98.7%和99.1%。与PCR和/或直接荧光抗体染色相比，培养法的灵敏度为68.4%。这些结果表明，PCR检测法是一种检测男性尿液标本中沙眼衣原体的高灵敏度和高特异性检测方法，为有症状和无症状男性沙眼衣原体感染的常规筛查提供了一种非侵入性技术。
