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Decision Analysis: Point-of-care Chlamydia Testing vs. Laboratory-based Methods

City of Milwaukee Health Department, Milwaukee, Wisconsin, and the Medical College of Wisconsin Department of Family and Community Medicine, Milwaukee, Wisconsin

Roberta A. McDonald, BS

Wisconsin State Laboratory of Hygiene, Madison, Wisconsin

John R. Pfister, MS

Wisconsin State Laboratory of Hygiene, Madison, Wisconsin

M. Stephen Gradus, PhD

City of Milwaukee Health Department, Milwaukee, Wisconsin

Gerald V. Sedmak, PhD

City of Milwaukee Health Department, Milwaukee, Wisconsin

Ajaib Singh, PhD

City of Milwaukee Health Department, Milwaukee, Wisconsin

REPRINT REQUESTS: Geoffrey R. Swain, MD, MPH, City of Milwaukee Health Department, 841 N. Broadway, Room 315, Milwaukee, WI 53202, Telephone: 414-286-8172, Email: gswain{at}milwaukee.gov

OBJECTIVE

To evaluate and compare the performance of several different methods available for detection of Chlamydia trachomatis (Ct) infection, and to explore possible testing and treatment strategies incorporating point-of-care testing versus laboratory-based tests.

DESIGN

Prospective trial and decision analysis.

SETTING

Large, urban, publicly funded sexually transmitted disease clinic.

PARTICIPANTS

1,384 female patients.

METHODS

Each subject was tested for Ct infection by direct fluorescent antibody (DFA, Sanofi/Kallestad, Chaska, MN), optical immunoassay (OIA, Thermo Electron, Point of Care and Rapid Diagnostics, Louisville CO), McCoy cell culture (in-house method), and polymerase chain reaction (microwell PCR, microwell assay, Roche, Branchburg NJ).

RESULTS

Performing a rapid in-clinic test on women who did not meet empiric treatment criteria would have increased the overall proportion of infected persons receiving same-day treatment from 48.6% to 79.1% using DFA or 78.4% using OIA.

CONCLUSIONS

Use of empiric treatment criteria and same-day point-of-care testing for patients not meeting the empiric treatment threshold appears to be an appropriate, useful, and cost-effective strategy for increasing same-day treatment of Ct infections in this population.

Key Words: Chlamydia infections • Sexually transmitted diseases • Clinical laboratory techniques • Point-of-care systems

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				G L Dean Near-patient testing will not improve the control of sexually transmitted infections Sex Transm Inf, December 1, 2006; 82(6): 509 - 512. [Full Text] [PDF]