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Journal of Clinical Microbiology, November 2001, p. 3927-3937, Vol. 39, No. 11
0095-1137/01/$04.00+0   DOI: 10.1128/JCM.39.11.3927-3937.2001
Copyright © 2001, American Society for Microbiology. All rights reserved.

Relative Accuracy of Nucleic Acid Amplification Tests and Culture in Detecting Chlamydia in Asymptomatic Men

Hong Cheng,1,* Maurizio Macaluso,1 Sten H. Vermund,1 and Edward W. Hook III2

Department of Epidemiology and International Health1 and Department of Medicine,2 University of Alabama at Birmingham, Birmingham, Alabama 35294

Received 5 February 2001/Returned for modification 7 July 2001/Accepted 19 August 2001

Published estimates of the sensitivity and specificity of PCR and ligase chain reaction (LCR) for detecting Chlamydia trachomatis are potentially biased because of study design limitations (confirmation of test results was limited to subjects who were PCR or LCR positive but culture negative). Relative measures of test accuracy are less prone to bias in incomplete study designs. We estimated the relative sensitivity (RSN) and relative false-positive rate (RFP) for PCR and LCR versus cell culture among 1,138 asymptomatic men and evaluated the potential bias of RSN and RFP estimates. PCR and LCR testing in urine were compared to culture of urethral specimens. Discordant results (PCR or LCR positive, but culture negative) were confirmed by using a sequence including the other DNA amplification test, direct fluorescent antibody testing, and a DNA amplification test to detect chlamydial major outer membrane protein. The RSN estimates for PCR and LCR were 1.45 (95% confidence interval [CI] = 1.3 to 1.7) and 1.49 (95% CI = 1.3 to 1.7), respectively, indicating that both methods are more sensitive than culture. Very few false-positive results were found, indicating that the specificity levels of PCR, LCR, and culture are high. The potential bias in RSN and RFP estimates were <5 and <20%, respectively. The estimation of bias is based on the most likely and probably conservative parameter settings. If the sensitivity of culture is between 60 and 65%, then the true sensitivity of PCR and LCR is between 90 and 97%. Our findings indicate that PCR and LCR are significantly more sensitive than culture, while the three tests have similar specificities.


* Corresponding author. Mailing address: Department of Epidemiology and International Health, School of Public Health, University of Alabama at Birmingham, 1530 3rd Ave., S, Birmingham, AL 35294. Phone: (205) 975-8679. Fax: (205) 975-7058. E-mail: hcheng{at}ms.soph.uab.edu.


Journal of Clinical Microbiology, November 2001, p. 3927-3937, Vol. 39, No. 11
0095-1137/01/$04.00+0   DOI: 10.1128/JCM.39.11.3927-3937.2001
Copyright © 2001, American Society for Microbiology. All rights reserved.



This article has been cited by other articles:

  • Jespersen, D. J., Flatten, K. S., Jones, M. F., Smith, T. F. (2005). Prospective Comparison of Cell Cultures and Nucleic Acid Amplification Tests for Laboratory Diagnosis of Chlamydia trachomatis Infections. J. Clin. Microbiol. 43: 5324-5326 [Abstract] [Full Text]