Chlamydia genital diagnose: NAAT or Point-Of-Care Tecniques?
ESC Congress Library. Obiol Saiz M. May 10, 2018; 208124; ESC157
Dr. Maria Antonia Obiol Saiz
Dr. Maria Antonia Obiol Saiz
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Introduction: NAAT is the gold standard to Chlamydia diagnose but the World Health Organization (WHO) has promoted the development of diagnostic methods (point-of-care techniques (POCT)) to facilitate initial treatment. In recent years, POCT have been questioned regarding their low sensitivity and specificity. Objective: To evaluate the positive predictive value of the Quick Vue point-of-care techniques, and to evaluate the clinical profile of diagnosed women by using three different approaches.   Methods: Three groups were assessed: In the first group, only POCT 'Quick Vue' was used in a total of 141 patients with a suspected Chlamydia infection. In a second group of a convenience sample of 90 patients with a POCT positive result, a molecular biology technique DxCT/ NG/MG auto-assay, which is an in vitro nucleic acid amplification test (NAAT), was also tested (as gold standard). True positive (TP) cases and Positive Predictive Value (PPV) of the Quick Vue technique were assessed. In a third group, NAATs Seegene STI-7, a multiplex real-time PCR assay, was the only technique used for chlamydia diagnose. Data on age, contraceptive method, and request motive were also collected. Results: The PPV of the Quick Vue technique in our sample of patients was 17.7%.  The clinical profiles are: The first group of diagnosed women with only POCT are on average 32.6 years old, condom users, and tested before setting an intrauterine device. The second group of diagnosed women, with both POCT and NAAT positive results, were on average 31.0 years old, condom users who presented altered bleeding pattern. The third group of diagnosed women, with only NAAT, were on average 26.6 years old and combined contraceptive users who presented altered bleeding pattern. Other characteristics of this group were: 28% presented previous induced abortions; 27% of them had children; 11% presented previous sexually transmitted diseases; 16% were previous drug consumers; average age of first intercourses of 16.9 years old; average of 7.9 sexual partners during life; average of 2.8 sexual partners during the last two years; average of 1.2 sexual partners in the last two months; 16.6% reported gender violence; and 84% of them declared azithromycin consumption. Conclusions: :  Chlamydia infection in lower genital tract is usually oligo-symptomatic. Untreated chlamydial infection can cause chronic pelvic pain, ectopic pregnancy, and sterility. Thus, diagnostic techniques of high sensitivity and specificity are needed. These criteria are not met by POCT, so we must consider the NAAT as the technique of choice in the diagnosis of Chlamydia.
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