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Urine-Based Screening for Chlamydia trachomatis in Men Attending Sexually Transmitted Disease Clinics

MARRAZZO, JEANNE M. MD, MPH*; WHITTINGTON, WILLIAM L. H. AB*;†; CELUM, CONNIE L. MD, MPH*; HANDSFIELD, H. HUNTER MD*;†; CLARK, AGNES BS*; CLES, LINDA BS, BFA*; KREKELER, BARBARA MHA; STAMM, WALTER E. MD*

Sexually Transmitted Diseases: April 2001 - Volume 28 - Issue 4 - p 219-225
Articles

Background Nucleic acid-amplified tests for Chlamydia trachomatis are accurate but costly. Screening strategies for asymptomatic men are needed.

Goal To assess C trachomatis screening strategies for asymptomatic males.

Study Design Men attending a sexually transmitted disease clinic were tested for C trachomatis with ligase chain reaction and culture, and for urethral inflammation with urine leukocyte esterase and urethral Gram stain.

Results C trachomatis prevalence was 5.5% among 1,625 asymptomatic men. Ligase chain reaction increased detection by 49% among men without urethral inflammation. An age of younger than 25 years and urethral inflammation were associated with positive ligase chain reaction results. The negative predictive value of urine leukocyte esterase was highest among older men, but urethral Gram stain was equally sensitive in predicting infection regardless of age. An age of younger than 30 years or urethral inflammation identified the highest proportion of infections (92%) and reduced the percentage of men screened by 43%.

Conclusions Urine ligase chain reaction increased C trachomatis detection, particularly among men without urethral inflammation. Testing all asymptomatic men younger than 30 years is optimal, whereas negative urine leukocyte esterase or urethral Gram stain results in men 30 years or older support no testing.

From the *Department of Medicine, University of Washington School of Medicine, and the † Department of Public Health—Seattle & King County, Seattle, Washington

The authors thank Tim Tyree for assistance in data management.

The study was approved by the Human Subjects Review Committee of the University of Washington.

Reprint requests: Jeanne M. Marrazzo, MD, MPH, Harborview Medical Center, 325 Ninth Avenue, Box 359931, Seattle, WA 98104. E-mail: jmm2@u.washington.edu

Received for publication May 18, 2000, revised August 8, 2000, and accepted August 15, 2000.

Urine-based ligase chain reaction screening increased chlamydia detection, particularly among asymptomatic men without urethral inflammation. Testing asymptomatic male sexually transmitted disease clinic clients younger than 30 years may be optimal; however, negative urine leukocyte esterase results do not support such testing in men 30 years or older.

© Copyright 2001 American Sexually Transmitted Diseases Association