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Journal of Clinical Microbiology, October 2002, p. 3757-3763, Vol. 40, No. 10
0095-1137/02/$04.00+0     DOI: 10.1128/JCM.40.10.3757-3763.2002
Copyright © 2002, American Society for Microbiology. All Rights Reserved.

Head-to-Head Multicenter Comparison of DNA Probe and Nucleic Acid Amplification Tests for Chlamydia trachomatis Infection in Women Performed with an Improved Reference Standard

Carolyn M. Black,1* Jeanne Marrazzo,2 Robert E. Johnson,3 Edward W. Hook III,4 Robert B. Jones,5 Timothy A. Green,1 Julius Schachter,6 Walter E. Stamm,2 Gail Bolan,7 Michael E. St. Louis,3 and David H. Martin8

National Center for Infectious Diseases,1 National Center for HIV, STD, and TB Prevention, Centers for Disease ControlPrevention (CDC), Atlanta, Georgia,3 Department of Medicine, University of Washington, Seattle, Washington,2 Department of Medicine, University of Alabama at Birmingham, Birmingham, Alabama,4 School of Medicine, Indiana University, Indianapolis, Indiana,5 Department of Laboratory Medicine, University of California,6 San Francisco Department of Public Health, San Francisco, California,7 School of Medicine, Louisiana State University Health Sciences Center, New Orleans, Louisiana8

Received 20 February 2002/ Accepted 15 May 2002

Few evaluations of tests for Chlamydia trachomatis have compared nucleic acid amplification tests (NAATs) with diagnostic tests other than those by culture. In a five-city study of 3,551 women, we compared the results of commercial ligase chain reaction (LCR) and PCR tests performed on cervical swabs and urine with the results of PACE 2 tests performed on cervical swabs, using independent reference standards that included both cervical swabs and urethral swab-urine specimens. Using cervical culture as a standard, the sensitivities of PACE 2, LCR, and PCR tests with cervical specimens were 78.1, 96.9, and 89.9%, respectively, and the specificities were 99.3, 97.5, and 98.2%, respectively. Using either cervical swab or urine LCR-positive tests as the standard decreased sensitivities to 60.8% for PACE 2 and to 75.8 and 74.9% for PCR with cervical swabs and urine, respectively. Specificities increased to 99.7% for PACE 2 and to 99.7 and 99.4% for PCR with cervical swabs and urine, respectively. Sensitivities with a cervical swab-urine PCR standard were 61.9% for PACE 2 and 85.5 and 80.8% for LCR with cervical swabs and urine, respectively. Specificities were 99.6% for PACE 2 and 99.0 and 98.9% for LCR with cervical swabs and urine, respectively. Cervical swab versus urine differences were significant only for PCR specificities (P = 0.034). Overall, LCR sensitivity exceeded that of PCR, and sensitivities obtained with cervical swabs exceeded those obtained with urine specimens by small amounts. These data have substantiated, using a large multicenter sample and a patient standard, that LCR and PCR tests performed on endocervical swabs and urine are superior to PACE 2 tests for screening C. trachomatis infections in women. In our study, NAATs improved the detection of infected women by 17 to 38% compared to PACE 2.

* Corresponding author. Mailing address: National Center for Infectious Diseases, Mailstop C17, Centers for Disease Control and Prevention, 1600 Clifton Rd. NE, Atlanta, GA 30333. Fax: (404) 639-3199. E-mail: cblack{at}cdc.gov.

Journal of Clinical Microbiology, October 2002, p. 3757-3763, Vol. 40, No. 10
0095-1137/02/$04.00+0     DOI: 10.1128/JCM.40.10.3757-3763.2002
Copyright © 2002, American Society for Microbiology. All Rights Reserved.



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