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Prevalence of Chlamydia trachomatis Infection among Low- and High-Risk Filipino Women and Performance of Chlamydia Rapid Tests in Resource-Limited Settings

Francis Saison,¹ Lourdes Mahilum-Tapay,^2, Claude-Edouard E. Michel,² Nigel D. Buttress,^2, Elpidio Cesar B. Nadala Jr.,^2, Jose Paolo V. Magbanua,² Emma M. Harding-Esch,³ M. Odeta Villaruel,⁴ Lorna Canong,¹ Rey L. Celis,¹ and Helen H. Lee^2*

Department of Obstetrics and Gynecology, Western Visayas Medical Center, Iloilo City, Philippines,¹ Diagnostics Development Unit, Department of Haematology, University of Cambridge, Cambridge CB2 2PT, United Kingdom,² Department of Infectious and Tropical Diseases, London School of Hygiene and Tropical Medicine, London WC1E 7HT, United Kingdom,³ Social Hygiene Clinic, Tanza, Iloilo City, Philippines⁴

Received 5 July 2007/ Returned for modification 24 August 2007/ Accepted 3 October 2007

The prevalence of urogenital Chlamydia trachomatis infection was determined with a PCR-based test of women from low- and high-risk populations in Iloilo City, Philippines, between August 2002 and March 2006. Two rapid tests for C. trachomatis, Clearview Chlamydia MF and the Chlamydia Rapid Test (CRT), were also evaluated in these resource-limited settings. Specimens were obtained from female sex workers (FSWs; n = 1,484) attending a social hygiene clinic (SHC) and from women (n = 838) attending an obstetrics-gynecology (OB-GYN) clinic. The sensitivity, specificity, positive predictive value (PPV), and negative predictive value (NPV) of the rapid tests were determined, with PCR as the gold standard. The PCR positivity rate for SHC participants (72% asymptomatic) ranged from 17.9 to 32.0% during the study period. Compared with those of PCR, the sensitivities and specificities of the Clearview test were 53.5 and 99.1%, respectively, with endocervical swab specimens (CS; n = 822) from the FSWs and 31.1 and 95.2%, respectively, with vaginal swab specimens (VS; n = 333) from these women. The sensitivity, specificity, PPV, and NPV of the CRT with VS from the FSWs were 71.0, 99.0, 97.1, and 87.9%, respectively. At the OB-GYN site, the PCR positivity rate with VS was 6.3%. The sensitivity, specificity, PPV, and NPV of the CRT with these specimens were 86.8, 99.6, 93.9, and 99.1%, respectively. The performance of the Clearview test at the SHC was thus markedly lower with VS than with CS, whereas the CRT performed well with VS from both populations.

Published ahead of print on 17 October 2007.

Present address: Diagnostics for the Real World (Europe) Ltd., Cambridge Science Park, Cambridge, United Kingdom.