Diagnosis of Chlamydia trachomatis infections in a sexually transmitted disease clinic: evaluation of a urine sample tested by enzyme immunoassay and polymerase chain reaction in comparison with a cervical and/or a urethral swab tested by culture and polymerase chain reaction

Objective To evaluate the value of a urine sample for diagnosing Chlamydia trachomatis infection in an STD clinic in a prospective study of samples collected from 410 consecutive STD patients (167 female and 243 male). Methods Urine samples were tested by enzyme immunoassay (EIA) and polymerase chain reaction (PCR) in comparison with cervical and/or urethral swabs tested by PCR and cell culture. A questionnaire was completed for a total of 320 patients concerning symptoms, and determining whether they were controls, contacts or were being tested subsequent to legal abortion. Results The overall prevalence of C. trachomatis infection was 11.5%. At least 40% of patients were asymptomatic. Of the C. trachomatis-positive patients, 85% were diagnosed by testing urine, compared to 91% by testing swabs. For urine tests, the sensitivities of PCR were 66.7% and 71.9% for female and male patients, respectively, and the sensitivities of EIA were 40.0% and 62.5%, or 46.7% and 71.9%, for female and male patients, respectively, by including a 30% gray zone below the cut-off value. For swabs, the sensitivities of PCR were 93.3% and 87.5% for female and male patients, respectively, and equal to the sensitivities of culture. In total, 3.3% of controls and 35% of contacts were found to be C. trachomatis positive. Conclusion The use of urine samples for the diagnosis of C. trachomatis infections was effective, but urine samples should be additional to conventional swab(s) instead of replacing. Partner notification and a confirmation of cure is recommended.