Direct urine polymerase chain reaction for chlamydia and gonorrhoea: a simple means of bringing high-throughput rapid testing to remote settings?
Frashta Rahimi A B , Namraj Goire A B , Rebecca Guy C , John M. Kaldor C , James Ward D , Michael D. Nissen A B E , Theo P. Sloots A B E and David M. Whiley A B FA Queensland Paediatric Infectious Diseases Laboratory, Queensland Children’s Medical Research Institute, Children’s Health Service District, Brisbane, Qld 4029, Australia.
B Clinical Medical Virology Centre, Sir Albert Sakzewski Virus Research Centre, University of Queensland, Brisbane, Qld 4029, Australia.
C Kirby Institute, University of New South Wales, Sydney, NSW 2052, Australia.
D Baker IDI Heart and Diabetes Institute, Central Australia, Alice Springs, NT 0871, Australia.
E Microbiology Division, Pathology Queensland Central, Royal Brisbane and Women’s Hospital Campus, Brisbane, Qld 4029, Australia.
F Corresponding author. Email: d.whiley@uq.edu.au
Sexual Health 10(4) 299-304 https://doi.org/10.1071/SH12108
Submitted: 10 July 2012 Accepted: 26 February 2013 Published: 3 May 2013
Abstract
Background: Rapid point-of-care tests (POCTs) for chlamydia (Chlamydia trachomatis) and gonorrhoea (Neisseria gonorrhoeae) have the potential to confer health benefits in certain populations even at moderate sensitivities; however, suitable POCTs for these organisms are currently lacking. Methods: In this study, we investigated the use of direct urine polymerase chain reaction (PCR), with the view of implementing a simplified PCR strategy for high-throughput chlamydia and gonorrhoea screening in remote settings. Briefly, a simple dilution of the urine was performed before adding it directly to a real-time PCR reaction. The method was evaluated using 134 stored urine specimens that had been submitted for chlamydia and gonorrhoea testing and had been tested using a commercial C. trachomatis and N. gonorrhoeae PCR method. These included samples that were PCR-positive for chlamydia (n = 87), gonorrhoea (n = 16) or both (n = 2). Direct urine testing was conducted using previously described in-house real-time PCR methods for C. trachomatis and N. gonorrhoeae as well as for recognised N.gonorrhoeae antimicrobial resistance mechanisms. Results: The overall sensitivities and specificities of the direct urine PCR were 78% and 100% for chlamydia, and 83% and 100% for gonorrhoea. N.gonorrhoeae penicillin and quinolone resistance mechanisms were characterised in 14 of the 18 N. gonorrhoeae-positive samples. Conclusions: The results of this study show that the simplified PCR strategy may be a feasible approach for rapid screening and improving chlamydia and gonorrhoea treatment in remote settings.
Additional keywords: penicillin resistance, quinone resistance, rapid point-of-care.
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