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| |  Use of Assay Can Detect Lower Genital Tract Infections in Patients With Neisseria gonorrhoeae: Presented at ICC By Louise Gagnon TORONTO -- June 22, 2009 -- The use of an assay can detect lower genital tract infections in patients with Neisseria gonorrhoeae, many of which go undetected, according to research presented here at the International Congress of Chemotherapy and Infection (ICC). Detection of N gonorrhoeae has several barriers, explained Julius Kapala, PhD, Gamma Dynacare Medical Laboratories, Brampton, Ontario, on June 20. “Physicians don’t expect gonorrhoea infection to be present,” said Dr. Kapala. “They usually order tests for chlamydia.” Dr. Kapala noted that 1 study found urogenital asymptomatic gonoccocal infections in women estimated to range from 25% to 80%. In addition, obtaining cultures from clinical samples of N gonorrhoea can be a challenge, he said. A transcription-mediated amplification assay, known as APTIMA Combo 2 (AC2), can detect both Chlamydia trachomatis and N gonorrhoeae RNA in clinical specimens, and these findings can be confirmed in alternative individual tests, explained Dr. Kapala. Investigators looked at 81,045 samples from men and women who had visited doctors’ offices in Ontario and were tested for RNA of N gonorrhoeae. Another group of swabs, where there was no culture of N gonorrhoea, were tested for chlamydia using AC2. The prevalence rate of the gonorrhoea by culture was 0.1%, with 99% of samples coming from women. Use of the AC2 assay identified all positive cultures and detected 67 additional positives from the samples that were culture-negative, raising the prevalence to 0.25%. A total of 75 samples that were ordered for chlamydia testing were found to be positive for gonorrhoea with the AC2 assay. Investigators performed confirmatory testing to find that 64 of 66 samples (97%) were positive. Overall, 142 additional cases of gonorrhoea were identified. “A number of infections would not be known if either the test was not ordered or the conventional culture was less sensitive,” explained Dr. Kapala. “If you are detecting nucleic acid, you don’t need viable organisms. You simply need to amplify the nucleic acid.” Still, it is significant to take cultures to test for antibiotic sensitivity, added Dr. Kapala. “With certain groups of patients, it is important to keep taking cultures.” If gonorrhoea goes undiagnosed and untreated, patients, even if asymptomatic, can develop pelvic inflammatory disease or sterility, noted Dr. Kapala. “It is also a public health issue,” he added, noting that accurate and early diagnosis will help control the spread of a disease like gonorrhoea. Funding for this study was provided by Gammy-Dynacare Medical Laboratories. [Presentation title: APTIMA Combo 2® Testing Detects Additional Cases of N. Gonorrhoeae in Community Settings. Abstract P258]
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