Nucleic-acid amplification testing of urine vs. patient complaint-driven evaluation

Area of Science:

• Infectious Diseases
• Public Health
• Clinical Diagnostics

Background:

• Conventional methods for diagnosing sexually transmitted diseases (STDs) in Emergency Departments (EDs) often rely on patient-reported symptoms, potentially leading to underdiagnosis.
• Nucleic-acid amplification testing (NAAT) offers a sensitive and specific diagnostic approach for common STDs.

Purpose of the Study:

• To compare the diagnostic yield of urine-based NAAT with the conventional complaint-driven approach for identifying Chlamydia trachomatis (CT), Neisseria gonorrhoeae (NG), and Trichomonas vaginalis (TV) in an urban ED population.
• To evaluate the effectiveness of NAAT in increasing STD detection rates among ED attendees.

Main Methods:

• A pilot study enrolled 614 adult ED patients.
• Urine samples were collected for NAAT after questionnaire completion and before physician examination.
• Complete physical examinations were performed on 348 (56.6%) patients, with women more likely to receive them.

Main Results:

• 153 (24.9%) patients tested positive for at least one STD.
• A history of STD and a recent new sexual partner were predictive of positive STD tests.
• NAAT of urine samples from patients not receiving a complete physical examination increased the diagnostic yield by 33% (51/153).

Conclusions:

• Urine NAAT is a valuable tool for increasing the detection of CT, NG, and TV in the ED setting.
• NAAT offers a significant diagnostic advantage over traditional methods, especially when complete physical examinations are not performed.
• Implementing NAAT in EDs can improve STD identification and potentially reduce transmission.