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Journal of Clinical Microbiology, November 2001, p. 3927-3937, Vol. 39, No. 11
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.
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
*
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.
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