The Potential Misuse of DNA Probe for the Detection of Neisseria gonorrhoeae and Chlamydía trachomatis When Used for Test of Cure

Content Provider	Semantic Scholar
Copyright Year	1997
Abstract	he use of cell culture systems for the detection of Calamydia tracaomatis is the gold standard. However, the sensitivity of a single endocervical specimen may be only 70-90. e-Unfortunately, cell culture is labor intensive and requires 48 hours for completion. These problems fostered the development of simplified rapid diagnostic tests which bypassed the issue of organism viability. The first detection systems were based on either immunodetection of solubilized chlamydia antigens (enzyme immunoassay) or direct visualiza-tion using chlamydia-specific fluorescin-conjugated monoclonal antibodies (direct fluorescent antibody test). The relative sensitivity and poorer positive predictive values of these methods led ulti:mately to their relative abandonment in favor of tests based on DNA/rRNA hybridization. The ability of the DNA probe to detect both Neisseria gonorroeae and C. tracomatis in a single test has made nucleic acid probe testing an attractive alternative. The long-term cost of false-negative gonococcal cultures outweighed the cost differential between properly handled specific cultures for N. gonorroeae and 6: tracomatis and a DNA probe (Table 1). With the recent introduction of single-dose therapy for both N. gonorroeae and C. tracomatis, routine test of cure during the immediate post-therapy period is not recommended by the Centers for Disease Control. The CDC recommends that test of cure for N. gonorroeae or C. tracomatis be performed 7-14 days after completion of therapy if symptoms persist. While this strategy is probably valid for men, its applicability to asymptomatic women is not well documented. In the absence of symptomology, why should one do a test of cure? If a macrolide other than azithromycin has been utilized , the probability of poor compliance is significant. When compliance is questioned, a test of cure is advocated. Seventy percent of treatment failures with erythromycin appear to be related to compliance problems. Published cure rates with macro-lides, such as erythromycin, are not totally comparable to those observed with doxycycline. A test of cure may be warranted three weeks after completion of treatment with these antibiotics. With non-cultured tests, residual chlamydial antigen and nucleic acids, in the absence of viable organisms, may result in a positive test. Such a positive result can be misinterpreted as a treatment failure. False-positive tests due to antigen persistence can occur up to three weeks after doxycycline therapy. A second situation which appears to warrant a test of cure is that of an individual who is at high risk for reinfection. High-risk women should be rescreened one …
Starting Page	395
Ending Page	396
Page Count	2
File Format	PDF HTM / HTML
PubMed reference number	18476195
Volume Number	5
Journal	Infectious diseases in obstetrics and gynecology
Alternate Webpage(s)	http://ftp.ncbi.nlm.nih.gov/pub/pmc/1e/b8/IDOG-05-395.PMC2364591.pdf
Language	English
Access Restriction	Open
Subject Keyword	Azithromycin Cell Culture Techniques Cell Nucleus Chlamydia DNA Probes Direct Fluorescent Antibody Test Doxycycline Endocervix Enzyme Immunoassay Erythromycin Fluorescent Antibody Technique Gonorrhea Immunoenzyme Procedure Immunostimulating conjugate (antigen) Macrolides Monoclonal Antibodies Neisseria gonorrhoeae Nucleic Acid Hybridization Nucleic Acids
Content Type	Text
Resource Type	Article