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New Recommendations for Lab-Based Sexually Transmitted Disease Diagnosis

April 10, 2014

New Recommendations for Lab-Based Sexually Transmitted Disease Diagnosis

  1. Abigail Zuger, MD

Nucleic acid amplification tests are preferred for diagnosing gonorrhea and chlamydia in both genital and extragenital infections.

  1. Abigail Zuger, MD

Sponsoring Organization: Centers for Disease Control and Prevention

Target Audience: Primary care providers, clinical laboratory directors and staff, disease control personnel

Background and Objective

The CDC has updated its 2002 recommendations for the laboratory confirmation of Chlamydia trachomatis and Neisseria gonorrhoeae infections.

Key Points

Although much of the report pertains primarily to clinical laboratory practices, some changes are important for clinicians to note, including these:

  • Nucleic acid amplification tests (NAATs) are now the preferred means of diagnosing chlamydia and gonorrhea because of the sensitivity of the tests and ease of specimen collection. Genital infections are best evaluated with vaginal swabs from women and first-catch urine from men.

  • Although NAATs have not yet been approved by the FDA for detecting rectal or pharyngeal infections, they are preferred for these sites as well, with details of test validation deferred to individual clinical laboratories. Clinicians should note that nongonococcal Neisseria in the pharynx might cause false-positive results.

  • Present generation NAAT tests are sensitive and specific enough that routine reconfirmation is unnecessary for both positive and negative results. If a false-positive result for pharyngeal gonorrhea is suspected, an alternate test should be performed.

  • Routine testing for cure with NAATs immediately after treatment should be avoided, because NAATs cannot discriminate between viable and nonviable bacteria and might remain positive for weeks after treatment.

  • Because of increasing antibiotic resistance among Neisseria gonorrhoeae, all patients with gonorrhea who have clinical or NAAT evidence of treatment failure should be reevaluated with swabs sent for culture and sensitivity testing.

  • NAATs have not been validated fully for diagnosis in some pediatric situations, including sexual assault in boys and nongenital exposure in girls. In these situations, cultures still are preferred for diagnosis.

  • Disclosures for Abigail Zuger, MD at time of publication Editorial boards Journal Watch AIDS Clinical Care; Clinical Infectious Diseases Other New York Times medical writer

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