{"id":1091,"date":"2015-06-12T16:45:08","date_gmt":"2015-06-12T16:45:08","guid":{"rendered":"https:\/\/blogs.bmj.com\/sti\/?p=1091"},"modified":"2015-06-12T15:21:06","modified_gmt":"2015-06-12T15:21:06","slug":"incidental-gonorrhoea-screening-in-the-general-population-via-dual-naat-is-no-benefit","status":"publish","type":"post","link":"https:\/\/blogs.bmj.com\/sti\/2015\/06\/12\/incidental-gonorrhoea-screening-in-the-general-population-via-dual-naat-is-no-benefit\/","title":{"rendered":"Incidental gonorrhoea screening in the general population via dual NAAT is no benefit"},"content":{"rendered":"

Fifer & Ison (STIs)<\/a> express concern over the use of the \u201cdual\u201d nucleic acid amplification tests (NAATs) for the detection of chlamydia and gonorrhoea in the context of chlamydia screening in the UK.\u00a0 Additional testing for gonorrhoea, when the real target is chlamydia, does not necessarily confer an additional net benefit.\u00a0\u00a0 This is because even a high specificity test such as Cobas 4800 (Perry & Corden (STIs)<\/a>; Rockett & Limnios (STIs)<\/a>) will generate a high proportion of false positives when the infection tested for has extremely low prevalence, as in the\u00a0 case of gonorrhoea in the general population. \u00a0And the potential disbenefit of the additional test in terms of the psychological impact, and the impact on relationships, of false positive diagnoses could easily outweigh the medical benefit represented by the diagnoses which are accurate (Dixon-Woods & Shukla (STIs)<\/a>; McCaffery & Wardle (STIs)<\/a>).<\/p>\n

The potential impact of the adoption of the dual NAAT as a stand-alone test – if not confirmed by further testing using either a second NAAT or else culture – is illustrated by a recent Australian study published in the Medical Journal of Australia <\/em>(MJA). \u00a0Chow & Fairley<\/a> perform a retrospective analysis of insurance and notification data from Melbourne over the years 2008-2013.\u00a0 They seek to demonstrate that the apparent rise in identified gonorrhoea cases amongst the general female – non-indigenous – population (from 98<\/strong> to 343<\/strong>) is at least partly an \u201cartefact\u201d of the growing employment by laboratories of the dual NAAT.\u00a0 They do this by eliminating the alternative possibility of a genuine increase in gonorrhoea in the general population.\u00a0 To this purpose they use their data to investigate changes in the proportion of positive dual NAAT gonorrhoea diagnoses to the number of dual NAAT test ordered, over the period during which dual NAATs were being introduced.\u00a0 They also investigate rates of positive gonorrhoea diagnoses over this period at a \u201csentinel\u201d clinic in Victoria where culture alone was used as a means ofgGonorrhea diagnosis. \u00a0They find that the proportion of positive dual NAAT diagnoses in Victoria remained relatively constant over time (around 0.2-0.3%), as did the proportion of positive culture diagnoses at the Melbourne clinic (around 0.4-0.6%).\u00a0 Of 25 untreated women who had a positive NAAT result for gonorrhoea and were referred to the Melbourne clinic, only 10\/25 were confirmed by culture.\u00a0 The authors comment that this is in line with what might be expected in the light of the published specificity of the various NAAT tests employed.<\/p>\n

C&F recommend that laboratories suppress gonorrhoea diagnoses from the dual NAATs.\u00a0 An MJA editorial<\/a> in the same issue questions the feasibility of this.\u00a0 Instead, the editors propose that the NAAT should, in the case of Gonorrhoea, be used as either a triage<\/strong>, with positive diagnoses confirmed by culture, or as an add-on<\/strong> where high prevalence populations are first tested by culture.\u00a0 They also consider the possibility of confirming the initial NAAT with a NAAT using a different target.\u00a0 However, they come down in favour of retaining culture in the diagnostic pathway on account of its value as a means of assessing resistance.\u00a0 They also question whether even the double NAAT would guarantee adequate predictive value in very low prevalence populations.<\/p>\n

Evidently, further studies are required.<\/p>\n","protected":false},"excerpt":{"rendered":"

Fifer & Ison (STIs) express concern over the use of the \u201cdual\u201d nucleic acid amplification tests (NAATs) for the detection of chlamydia and gonorrhoea in the context of chlamydia screening in the UK.\u00a0 Additional testing for gonorrhoea, when the real target is chlamydia, does not necessarily confer an additional net benefit.\u00a0\u00a0 This is because even […]<\/p>\n

Read More…<\/a><\/p>\n","protected":false},"author":152,"featured_media":0,"comment_status":"closed","ping_status":"closed","sticky":false,"template":"","format":"standard","meta":{"footnotes":""},"categories":[81,2103,599],"tags":[],"class_list":["post-1091","post","type-post","status-publish","format-standard","hentry","category-diagnostics","category-gonorrhoea","category-screening"],"yoast_head":"\nIncidental gonorrhoea screening in the general population via dual NAAT is no benefit - Sexually Transmitted Infections<\/title>\n<meta name=\"robots\" content=\"index, follow, max-snippet:-1, max-image-preview:large, max-video-preview:-1\" \/>\n<link rel=\"canonical\" href=\"https:\/\/blogs.bmj.com\/sti\/2015\/06\/12\/incidental-gonorrhoea-screening-in-the-general-population-via-dual-naat-is-no-benefit\/\" \/>\n<meta property=\"og:locale\" content=\"en_US\" \/>\n<meta property=\"og:type\" content=\"article\" \/>\n<meta property=\"og:title\" content=\"Incidental gonorrhoea screening in the general population via dual NAAT is no benefit - 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