Nucleic acid amplification tests in the diagnosis of chlamydial and gonococcal infections of the oropharynx and rectum in men who have sex with men
Nucleic acid amplification tests in the diagnosis of chlamydial and gonococcal infections of the oropharynx and rectum in men who have sex with men
复制标题
DOI：
10.1097/olq.0b013e31817bdd7e
复制
发表时间：
2008-07-01
影响因子：
3.1
通讯作者：
Klausner, Jeffrey D.
中科院分区：
文献类型：
--
作者：
Schachter, Julius;Moncada, Jeanne;Klausner, Jeffrey D.
背景：美国食品和药物管理局批准了几种核酸扩增检测 (NAAT)，用于检测泌尿生殖道沙眼衣原体 (CT) 和淋病奈瑟菌 (GC) 感染，但尚未对男男性行为者 (MSM) 中相对常见的口咽或直肠 CT 和 GC 感染进行充分评估。 方法：从就诊的 MSM 的口咽和直肠采集多份拭子。市性病门诊。标本通过标准培养物和以下 NAAT 进行测试：Roche 的 Amplicor (PCR)、Becton Dickinson 的 ProbeTec (SDA) 和 Gen-Probe 的 APTIMA Combo 2 (AC2)，用于检测 CT 和 GC。 NAAT 使用备用引物对结果不一致的样本进行了验证性测试。结果：总共招募了 1110 名 MSM。根据 205 MSM 的初步结果，PCR 对口咽拭子的 GC 特异性为 78.9%。因此，我们在研究的其余部分停止了 PCR 检测。对于口咽部 GC（检测到 89 例感染），培养的敏感性为 41%，SDA 的敏感性为 72%，AC2 的敏感性为 84%。对于直肠 GC（检测到 88 例感染），培养的敏感性为 43%，SDA 的敏感性为 78%，AC2 的敏感性为 93%。对于口咽 CT（检测到 9 例感染），培养的敏感性为 44%，SDA 的敏感性为 67%，AC2 的敏感性为 100%。对于直肠 CT（检测到 68 例感染），培养的敏感性为 27%，SDA 的敏感性为 63%，AC2 的敏感性为 93%。对于生物体和解剖部位，SDA 和 AC2 的特异性均 >= 99.4%。 结论：在检测口咽和直肠 CT 或 GC 方面，AC2 和 SDA 远远优于培养物，AC2 检测到的感染数量是培养物的两倍。需要对更大的咽部样本进行进一步分析，但显然 NAAT 可以提高我们在 MSM 中使用 CT 或 GC 诊断直肠和口咽感染的能力。
Background: Several nucleic acid amplification tests (NAATs) are US Food and Drug Administration-cleared for detecting urogenital Chlamydia trachomatis (CT) and Neisseria gonorrhoeae (GC) infection, but they have not been adequately evaluated for the relatively common oropharyngeal or rectal CT and GC infections in men, who have sex with men (MSM).Methods: Multiple swabs were collected from the oropharynx and rectum of MSM attending a city sexually transmitted disease clinic. The specimens were tested by standard culture and the following NAATs: Roche's Amplicor (PCR), Becton Dickinson's ProbeTec (SDA), and Gen-Probe's APTIMA Combo 2 (AC2) for the detection of CT and GC. Confirmatory testing of specimens with discrepant results was done by NAATs using alternate primers.Results: A total of 1110 MSM were enrolled. Based on initial findings on 205 MSM, PCR had a 78.9% GC specificity with oropharyngeal swabs. Thus, we discontinued PCR testing for the rest of the study. For oropharyngeal GC (89 infections detected), sensitivities were 41% for culture, 72% for SDA, and 84% for AC2. For rectal GC (88 infections detected), sensitivities were 43% for culture, 78% for SDA and 93% for AC2. For oropharyngeal CT (9 infections detected), sensitivities were 44% for culture, 67% for SDA, and 100% for AC2. For rectal CT (68 infections detected), sensitivities were 27% for culture, 63% for SDA, and 93% for AC2. Specificities of SDA and AC2 were >= 99.4% for both organisms and anatomical sites.Conclusions: AC2 and SDA were far superior to culture for the detection of CT or GC from the oropharynx and rectum with AC2 detecting twice as many infections as culture. Further analyses with larger pharyngeal samples are needed, but clearly NAATs can improve our ability to diagnose rectal and oropharyngeal infection with CT or GC in MSM.