Escolar Documentos
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Cultura Documentos
Richard Buller Ph.D. Clinical Laboratories Department of Pediatrics Washington University School of Medicine
(No Disclosures)
EIA
Exist only for C. trachomatis Laboratory tests vs. point-of-care tests
Trichomonas vaginalis
Wet mount Culture
Confirming Positive Results of NAATs for C. trachomatis: All NAATs are not Created Equal
CDC recommends confirming positive screening results when PPV are <90% Tested a variety of specimens from ~2700 men and women using BD and AC2 assays AC2 significantly more sensitive than BD Using BD to confirm AC2 would result in incorrectly reporting 15% of confirmable positive results as negative
Schachter et al. JCM 2005
Vaginal Swabs Detect More Chlamydial Infections Than Do First Catch Urine Specimens Collected FCU, 2 Cx swabs, and patient collected vaginal (PCV) swab from 1464 women attending STD, family planning and OB/Gyn clinics FCU and 1 Cx swab tested by AC2 and FCU and 2nd Cx swab by BDProbe Tec PCV tested by AC2
Schachter and Chernesky APHL Poster 2005
Vaginal Swabs.....(Cont.)
AC2 more sensitive than BD
Detected 20% more positives with Cx swab Detected 19% more positive with FCU
Testing of PCV with AC2 identified as many positive women as did testing of Cx swabs and more positives than did FCU VS should be considered specimen of choice for screening of women for chlamydia
Schachter and Chernesky APHL Poster 2005
Swabs
2006
Use of Flocked Swabs and a Universal Transport Medium to Enhance Molecular Detection of C. trachomatis and N. gonorrhoeae
Prepared mock specimens in Copan Universal Transport Medium (UTM) Placed kit swab (KS) or Copan flocked swab (FS) into UTM and then tested by 3 assays Found FS enhanced the analytical sensitivity of each assay for both C. trachomatis and N. gonorrhoeae
Chernesky et al. JCM 2006
Use of the leukocyte esterase test (LET) to select for NAAT testing for C. trachomatis and N. gonorrhoeae
Real-Time PCR
PCR product is detected during amplification Rapid Cycling Times Quantitation capability
26 (34%) Type II
23 (88%) genital; 3 (12%) oral
Tests provide information on presence or absence of HSV antibody, but are not diagnostic of clinical ulcer etiology Allow clinicians to counsel seropositive patients about transmission risk
HerpSelect Immunoblot
Trichomonas vaginalis
Wet mount examination picks up only two-thirds of all infections Culture with Diamonds medium is more sensitive, but also more expensive and cumbersome in clinical settings Bedside test for trichomonas culture is now available
Trichomonas vaginalis
In-Pouch test kit
small pouch with modified Diamonds medium bedside inoculation of pouch incubation at 37o C read daily for 5 days - look for motile trichomonads
Trichomonas vaginalis
In-Pouch increases yield by 30-50% in females May be performed on males
urethral swab specimens centrifuged first-catch urine samples
Inexpensive: $2-3 per test kit (but requires substantial staff time in incubating and reading specimens)
Trichomonas Vaginalis
Xenostrip-Tv
Qualitative immunochromatographic assay Company claims:
Sensitivity compared to culture of 99-100% Specificity compared to culture of >98%
Xenostrip-Tv
Results
Sensitivity Specificity Xenostrip tv Wet Mount 78.5% 72.4% 98.6% 100%
Conclusions
Xenostrip performed as well or better than wet mount Sensitivity did not differ between symptomatic and asymptomatic women Xenostrip is rapid does not require specialized training or equipment
Summary
New STD testing methods continue to appear on the commercial marketplace Clinical utility of newer tests depends on independent validation in real-world clinical settings Continuing research is required to fully clarify the role of emerging STD products
Summary
NAATs offer significant increases in sensitivity with acceptable specificity Some NAATs appear to be significantly more sensitive than others Patient-collected vaginal swabs may be the specimen of choice for screening women for chlamydial infections using the Gen-Probe Aptima Combo 2 assay
Summary
NAATs tests are not perfect and physicians should be aware of test limitations
False positives False negatives Specimen requirements Effect on test performance of prevalence
Serological tests can now accurately discriminate between prior infection with Herpes simples virus types 1 and 2 Convenient inexpensive new tests exist for Trichomonas vaginalis