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Canadian Journal of Infectious Diseases
Volume 9, Issue 5, Pages 281-286
Original Article

Noninvasive Screening for Genital Chlamydial Infections in Asymptomatic Men: Strategies and Costs Using a Urine PCR Assay

Rosanna W Peeling,1 Baldwin Toye,2,4 Peter Jessamine,3,4 and Ian Gemmill5

1Laboratory Centre for Disease Control, Winnipeg, Manitoba, Canada
2Ottawa General Hospital, Ottawa, Ontario, Canada
3Ottawa Civic Hospital, Ottawa, Ontario, Canada
4University of Ottawa, Ottawa, Ontario, Canada
5Ottawa-Carleton Health Department, Ottawa, Ontario, Canada

Received 9 October 1997; Accepted 13 December 1997

Copyright © 1998 Hindawi Publishing Corporation. This is an open access article distributed under the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.


OBJECTIVE: To evaluate cost saving strategies to screen for genital chlamydial infection in men using polymerase chain reaction (PCR) technology.

METHODS: Men with no urethral symptoms presenting to a sexually transmitted disease (STD) clinic were recruited. Study participants underwent a questionnaire interview. Urethral swabs were taken to perform a smear for polymorphonuclear leucocytes (PMN) and for the detection of Chlamydia trachomatis by culture and PCR. First-catch urine was collected for a leukocyte esterase test (LET) and PCR.

RESULTS: C trachomatis infection was detected in 36 of 463 (7.8%) men. LET and PMN were positive in 10 (28%) and 12 (33%) infected men, respectively. Risk factors for chlamydial infection were younger than age 25 years, LET-positive, PMN-positive and STD contact (P<0.001). The direct cost of genital chlamydial infection in men in Canada has been previously estimated at $381/case. Based on a sensitivity of 90% for urine PCR, the estimated direct cost of testing all participants to detect 32 cases was $453/case. Using risk factors recommended in the Canadian STD Guidelines (age younger than 25 years, new partner, STD contact or unprotected sex), the same number of cases would have been detected by testing only 384 men at $376/case. Using age younger than 25 years or STD contact as the screening criterion, 78% of those infected would have been detected at $259/case, and no new cases would have been detected by adding LET-positive or PMN-positive as risk factors.

CONCLUSION: Targeted screening for chlamydial infection using urine PCR assay and risk factors recommended in the Canadian guidelines could substantially reduce the cost of screening at a STD clinic setting. LET and PMN smear did not appear to be useful indicators of chlamydial infection in this population.