Appendix C6Diagnostic Accuracy Studies of Chlamydia Tests

Study, yearScreening test(s)Definition of a positive screening examReference standard(s)Country
Setting
Prevalence
NAATs vs. NAATs
Chernesky et al, 200531ACT
Site: urethral swab, FCU
Positive result from at least 1 NAAT in both urethral swab and FCU; or one specimen positive on both NAATsAC2
PTGC
Canada, U.S.
STI clinics
Gaydos et al, 201336Xpert
Site: self-collected vaginal, cervix, female FCU, male FCU
Positive result from at least 1 of the reference NAATsAC2
PTGC
U.S.
STI clinics
Schachter et al, 200337ACT, Amplicor
Site: FCU, cervix, clinician-collected vaginal, self-collected vaginal
Agreement between positive results with vaginal swab and cervical swab or FCUCultureU.S., Canada
Family planning, obstetrics/gynecology, and STI clinics
CT prevalence across sites: 5.4% to 10.2% by culture
Schoeman et al, 201240AC2
Site: endocervix, self-collected vaginal
Positive result from 1 NAAT confirmed by second NAATAptima CTUnited Kingdom
Sexual health clinic
Prevalence: NR
Shrier et al, 200438Amplicor
Site: endocervix, FCU, clinician-collected vaginal, self-collected vaginal
1 positive culture or 2 positive nonculture tests or 1 positive nonculture test confirmed by nested PCRCulture Amplicor Abbot LCx assayU.S.
University medical center and children's hospital
21.6% positive for CT at any site
Taylor et al, 201232c4800
Site: FCU
AC2, CT/GC Qx
Site: FCU, urethral swab
Positive result from ≥2 NAATs with different target regions in urethral swab and/or FCUAC2
CT/GC Qx
U.S.
Obstetrics/gynecology, family planning, and STI clinics
Prevalence ≥1%
Taylor et al, 201139CTQ, PTCT, AC2
Site: endocervical, female FCU, urethral swab, male FCU, all female sites, all male sites
≥1 positive result from each reference NAAT; for assay comparison, positive result required from each of other 2 assaysAC2
PTCT
U.S.
Family planning, obstetrics/gynecology, and STI clinics
CT prevalence across sites: 11.6% in females, 21.4% in males
Van Der Pol et al, 201233c4800, AC2, CT/GC Qx
Site: endocervical, FCU
Positive result from ≥2 NAATs with different target regions in endocervical swab and/or FCU; each NAAT was evaluated based on results of other 2 NAATsAC2
CT/GC Qx
U.S.
Family planning, obstetrics/gynecology, and STI clinics
Prevalence NR
Study, yearPopulation CharacteristicsEligibility CriteriaSample size Proportion with condition
NAATs vs. NAATs
Chernesky et al, 200531Age (mean): 28.5 y
100% male
62.2% non-Hispanic black, 24.6% white
Men ages 15 to 77 y. Excluded if they could not concurrently provide all samples, had urinated within 1 hour, had taken antibiotics in the last 21 days, or if they could not provide informed consent.1322 enrolled
17.9% CT
13.8% NG
Gaydos et al, 201336Age: ≥14 y (range or mean NR)
45% male (full sample, asymptomatic information NR separately)
Race: NR
Age ≥14 y, sexually active in the last 6 months, and attending a participating clinic. Excluded if enrolled in previous trial, received antimicrobial therapy within 21 days of study, or history of hysterectomy.2,270 asymptomatic
3.5% CT
0.7% NG
Schachter et al, 200337Age (range): 16 to 25 y
100% female
Race: NR
Females ages 16 to 25 y who were not pregnant and attending a study clinic for routine exam or birth control advice. Excluded if they had been treated with antibiotics within the last 30 days, were attending the clinic because of symptoms, or had a male partner treated for genital symptoms.2517 tested
9.6% of women with CT by culture of 1 specimen
Schoeman et al, 201240Age (mean): 25 y
100% female
Ethnicity: 80% white, 9% black, 7% mixed, 4% other
Women age ≥16 y presenting to study clinic for a new visit. Excluded if used antibiotics in the preceding 28 days, were unable or unwilling to perform self-taken swab, or have the standard exam and swabs performed by clinicians.3973 enrolled
10.3% with CT
Shrier et al, 200438Age (mean): 19 y
100% female
22% history of CT
Median time since previous CT infection: 539 days (range, 43 to 2738)
8% with history of other STI
Females ages 16 to 25 y who had ever had sexual intercourse, did not report symptoms of an STI, and were being seen at clinic for routine gynecologic care. Excluded if they were pregnant, had taken antibiotics in the previous 21 days, were diagnosed with CT in the previous 6 weeks, or had sexual contact with a partner diagnosed with an STI.139 eligible
126 analyzed
21.6% CT
2% NG or trichomoniasis (1 participant had CT and NG)
Taylor et al, 201232Age: 55% ≤30 y
100% male
Race: 64.7% black, 32.9% white, 0.4% Asian, 0.4% American Indian/Alaskan Native, 0.1% Hawaiian/Pacific Islander, 1.3% other, 0.1% unknown
Ethnicity: 82.7% non-Hispanic, 15.1% Hispanic, 2.2% unknown ethnicity
Men age ≥14 y. Excluded if they had been previously enrolled in the study or used antimicrobials effective against CT or NG in the preceding 21 days.768 enrolled
16.4% CT
9.2% NG
Taylor et al, 201139Age (range): 17 to 64 y
32% male
Race: NR
Note: 2.7% of females were pregnant
Men and women ages 17 to 64 y who presented with urogenital symptoms or were being screened for CT and NG. Excluded if they had taken antibiotics in the previous 21 days, urinated in the previous hour, had sample collection issues, did not provide informed consent, or were younger than the age required by the site's IRB.1538 enrolled
11.6% of females with CT
21.4% of males with CT
Van Der Pol et al, 201233Age: ≥14 y
100% female
43.1% black, 48.4% white, 22.1% Hispanic, 2.8% Asian/Pacific Islander, 5.7% other
Women age ≥14 y who were eligible for routine CT/NG screening as per standard practice at each enrollment site. Excluded if they had been previously enrolled, used antimicrobial agents active against CT or NG in preceding 21 days, used Raplense, a vaginal lubricant, within the past 3 days, or had a history of hysterectomy or contraindication to Pap test/cervical sampling.4479 enrolled
6.3% CT
1.5% NG
Study, yearScreening test(s)Proportion unexaminable by screening testNumber of indeterminate resultsProportion who underwent reference standard and included in analysisTrue positivesFalse positivesFalse negativesTrue negativesSensitivity (95% CI)
NAATs vs. NAATs
Chernesky et al, 200531ACT
Site: urethral swab
NRNR100%9416163498.9% (94.3 to 100)
Site: FCU9419163898.9% (94.3 to 100)
Gaydos et al, 201336Xpert
Site: self-collected vaginal
NR0.25% (total sample) were invalid and unreadable99.6%4871107698.0% (89.1 to 99.9)
Site: cervix4662107495.8% (85.7 to 99.5)
Site: female FCU4922108396.1% (86.5 to 99.5)
Site: male FCU29101102100% (90.2 to 100)
Schachter et al, 200337ACT
Site: FCU
Not reportedNot reportedUnclear86*733*1265*72.0%
Site: cervix106*1013*1262*89.1%
Site: clinician-collected vaginal107*912*1263*89.9%
Site: self-collected vaginal111*68*1266*93.3%
Amplicor
Site: FCU
63*512*501*84.0%
Site: cervix68*37*503*90.7%
Site: clinician-collected vaginal70*65*500*93.3%
Site: self-collected vaginal68*57*501*90.7%
Schoeman et al, 201240AC2
Site: endocervix
0.7%497.3%163020205089.0% (84.0 to 93.0)
Site: self-collected vaginal17815204997.0% (94.0 to 99.0)
Shrier et al, 200438Amplicor
Site: endocervix
1 participant excluded because no samples were collected by physicianNone reported; 8 participants had a single positive result that needed confirmation by nested PCR90.6% (analysis only included eligible participants with results on all tests)140139951.9% (32.0 to 71.3)
Site: FCU120159944.4% (26.9 to 63.6)
clinician-collected vaginal150129955.6% (36.4 to 73.1)
self-collected vaginal141139851.9% (32.0 to 71.3)
Taylor et al, 201232c4800
Site: FCU
2.9%NR97.1%512141898.1% (89.9 to 99.7)
AC2
Site: FCU
504141798.0% (89.7 to 99.7)
Site: urethral swab485341694.1% (84.1 to 98.0)
CT/GC Qx
Site: FCU
502241896.2% (87.0 to 98.9)
Site: urethral swab451741986.5% (74.7 to 93.3)
Taylor et al, 201139CTQ
Site: endocervical
4.7%; 13% of men had only 2 urethral swabs collected rather than 319 unable to calculate from PTCT; 7/19 resolved negative All 19 were negative by CTQ and AC295.3%538438593.0% (83.0 to 98.1)
Site: female FCU542339194.7% (85.4 to 98.9)
Site: urethral swab312417888.6% (73.3 to 96.8)
Site: Male FCU3520178100.0% (90.0 to 100.0)
All female sites2161212155994.7% (91.0 to 97.3)
All male sites1016453496.2% (90.5 to 99.0)
PTCT
Site: endocervical
510837986.4% (75.0 to 94.0)
Site: female FCU531638489.8% (79.2 to 96.2)
Site: urethral swab312517386.1% (70.5 to 95.3)
Site: male FCU351117397.2% (85.5 to 99.9)
All female sites10411476388.1% (80.9 to 93.4)
All male sites663634691.7% (82.7 to 96.9%)
AC2
Site: endocervical
524438992.9% (82.7 to 98.0)
Site: female FCU552139298.2% (90.4 to 100.0)
Site: urethral swab302316690.9% (75.7 to 98.1)
Site: male FCU350117997.2% (85.5 to 99.9)
All female sites1076578195.5% (89.9 to 98.5)
All male sites652434594.2% (85.8 to 98.4)
Van Der Pol et al, 201233c4800
Site: endocervical
3.6% of enrolled; 16.4% for primary analysis of particular specimen typeNR96.4%94111216389.5% (82.2 to 94.0)
Site: FCU98412216589.1% (81.9 to 93.6)
AC2
Site: endocervical
101123217397.1% (91.9 to 99.0)
Site: FCU9858218192.5% (85.8 to 96.1)
CT/GC Qx
Site: endocervical
10274215596.2% (90.7 to 98.5)
Site: FCU10164216196.2% (90.6 to 98.5)
Study, yearScreening test(s)Specificity (95% CI)Positive likelihood ratio (95% CI)Negative likelihood ratio (95% CI)Positive predictive value (95% CI)Negative predictive value (95% CI)SponsorQuality rating
NAATs vs. NAATs
Chernesky et al, 200531ACT
Site: urethral swab
97.5% (96.0 to 98.6)40.2 (24.8 to 65.3)*0.01 (0.00 to 0.08)*85.5% (77.5 to 91.5)*99.8% (99.1 to 100)*NRFair
ACT
Site: FCU
98.0% (96.6 to 98.9) 97.1% (95.5 to 98.3)*34.2 (22.0 to 53.3)*0.01 (0 to 0.08)*83.2% (75 to 89.6)*99.8% (99.1 to 100)*
Gaydos et al, 201336Xpert
Site: self-collected vaginal
99.4% (98.7 to 99.7)151.6 (72.3 to 317.5)*0.02 (0.00 to 0.14)*87.3% (75.5 to 94.7)99.9% (99.5 to 99.9)Cepheid, grant from National Insitute of Biomedical Imaging and BioengineeringFair
Site: cervix99.4% (98.8 to 99.8)172.5 (77.5 to 383.9)*0.04 (0.01 to 0.16)*88.5% (76.5 to 95.6)99.8% (99.3 to 99.7)
Site: female FCU99.8% (99.3 to 100)521.2 (130.4 to 2083.8)*0.04 (0.01 to 0.15)*96.1% (86.5 to 99.4)99.8% (99.3 to 99.9)
Site: male FCU99.9% (99.5 to 100)1103.0 (155.5 to 7823.6)*0.00*96.7% (82.7 to 99.4)100% (99.6 to 100)
Schachter et al, 200337ACT
Site: FCU
99.5%131.3 (62.2 to 277.2)*0.28 (0.21 to 0.37)*92.5% (85.1 to 96.9)*97.5% (96.5 to 98.2)*Roche Molecular Systems; Abbott Laboratories; GenProbe, Inc; CDCFair
Site: cervix99.3%113.3 (60.9 to 210.7)*0.11 (0.07 to 0.18)*91.4% (84.7 to 95.8)*99.0% (98.3 to 99.5)*
Site: clinician-collected vaginal99.4%127.1 (66.1 to 244.4)*0.10 (0.06 to 0.17)*92.2% (85.8 to 96.4)*99.1% (98.4 to 99.5)*
Site: self-collected vaginal99.6%197.8 (88.9 to 440.0)*0.07 (0.03 to 0.13)*94.9% (89.2 to 98.1)99.4% (98.8 to 99.7)
Amplicor
Site: FCU
99.0%85.0 (35.3 to 204.5)0.16 (0.10 to 0.27)*92.7% (83.7 to 97.5)*97.7% (96.0 to 98.8)*
Site: cervix99.4%152.9 (49.4 to 473.7)*0.09 (0.05 to 0.19)*95.8% (88.1 to 99.1)*98.6% (97.2 to 99.4)*
Site: clinician-collected vaginal98.8%78.7 (35.5 to 174.7)*0.07 (0.03 to 0.16)*92.1% (83.6 to 97.0)*99.0% (97.7 to 99.7)*
Site: self-collected vaginal99.0%91.8 (38.2 to 220.2)*0.09 (0.05 to 0.19)*93.2% (84.7 to 97.7)*98.6% (97.2 to 99.4)*
Schoeman et al, 201240AC2
Site: endocervix
100% (99.8 to 100.0)Unable to calculate0.11 (0.07 to 0.17)*100.0% (97.7 to 100.0)*99.0% (98.5 to 99.4)*None reported (GenProbe provided supplies)Good
Site: self-collected vaginal99.9% (99.7 to 100.0)1994.0 (281.0 to 14151.3)*0.03 (0.01 to 0.06)*99.4% (96.9 to 99.9)*99.8% (99.4 to 99.9)*
Shrier et al, 200438Amplicor
Site: endocervix
100% (96.5 to 100)Unable to calculate0.48 (0.33 to 0.71)*100% (77.0 to 100)88.4% (81.1 to 93.6)Roche Molecular Systems, Inc; CDC; NIMH, NIHGood
Site: FCU100% (96.5 to 100)0.56 (0.40 to 0.78)Unable to calculate100% (76.4 to 100)86.8% (79.6 to 92.3)
Site: clinician-collected vaginal100% (96.5 to 100)Unable to calculate0.44 (0.29 to 0.68)*100% (78.7 to 100)89.2% (82.4 to 94.0)
Site: self-collected vaginal99.0% (95.0 to 100)51.3 (7.1 to 373.2)*0.49 (0.33 to 0.72)*93.3% (69.8 to 99.7)88.3% (81.0 to 93.5)
Taylor et al, 201232c4800
Site: FCU
99.5% (98.3 to 99.9)206.0 (51.7 to 821.3)*0.02 (0.00 to 0.13)*96.2% (87.0 to 99.4)*99.8% (98.7 to 100.0)*Roche Molecular SystemsFair
AC2
Site: FCU
99.0% (97.6 to 99.6)103.2 (38.9 to 273.9)*0.02 (0.00 to 0.14)*92.6% (82.1 to 97.9)*99.8% (98.7 to 100.0)*
Site: urethral swab98.9% (97.3 to 99.5)79.3 (33.1 to 189.9)*0.06 (0.02 to 0.18)*90.6% (79.3 to 96.8)*99.3% (97.9 to 99.8)*
CT/GC Qx
Site: FCU
99.5% (98.3 to 99.9)201.9 (50.6 to 805.6)*0.04 (0.01 to 0.15)*96.2% (86.8 to 99.4)*99.5% (98.3 to 99.9)*
Site: urethral swab99.8% (98.7 to 100.0)363.5 (51.2 to 2581.9)*0.13 (0.07 to 0.27)*97.8% (88.4 to 99.6)*98.4% (96.6 to 99.3)*
CTQ
Site: endocervical
98.0% (96.0 to 99.1)45.7 (22.3 to 91.0)*0.07 (0.03 to 0.18)*86.9% (75.8 to 94.2)*99.0% (97.4 to 99.7)*BD DiagnosticsFair
Site: female FCU99.5% (98.2 to 99.9)186.2 (46.7 to 742.7)*0.05 (0.02 to 0.16)*96.4% (87.7 to 99.5)*99.2% (97.8 to 99.8)*
Site: urethral swab98.9% (96.0 to 99.9)79.7 (20.0 to 317.9)*0.12 (0.05 to 0.29)*93.9% (79.7 to 99.1)*97.8% (94.5% to 99.4)*
Site: Male FCU98.9% (96.0 to 99.9)90.0 (22.7 to 357.1)*0.00*94.6% (81.8 to 99.2)*100.0% (97.9 to 100.0)*
All female sites99.2% (98.7 to 99.6)124.0 (70.5 to 218.1)*0.05 (0.03 to 0.09)*94.7% (91.0 to 97.3)*99.2% (98.7 to 99.6)*
All male sites98.9% (97.6 to 99.6%)86.6 (39.0 to 192.0)*0.04 (0.01 to 0.10)*94.4% (88.2 to 97.9)*99.3% (98.1 to 99.8)*
PTCT
Site: endocervical
100.0% (99.0 to 100.0)Unable to calculate0.14 (0.07 to 0.26)*100.0% (93.0 to 100.0)*97.9% (96.0 to 99.1)*
Site: female FCU99.7% (98.6 to 100.0)345.9 (48.8 to 2453.7)*0.10 (0.05 to 0.22)*98.2% (90.1 to 99.7)*98.5% (96.7 to 99.4)*
Site: urethral swab98.9% (95.9 to 99.9)75.4 (18.9 to 300.8)*0.14 (0.06 to 0.32)*93.9% (79.7 to 99.1)*97.2% (93.6 to 99.1)*
Site: male FCU99.4% (96.8 to 100.0)169.2 (23.9 to 1195.2)*0.03 (0.00 to 0.19)*97.2% (85.4 to 99.5)*99.4% (96.8 to 99.9)*
All female sites99.9% (99.3 to 100.0)673.4 (94.9 to 4779.6)*0.12 (0.07 to 0.19)*99.1% (94.8 to 99.8)*98.2% (97.0 to 99.0)*
All male sites99.1% (97.5 to 99.8)106.6 (34.5 to 329.8)*0.08 (0.04 to 0.18)*95.6% (87.8 to 99.0)*98.3% (96.3 to 99.4)*
AC2
Site: endocervical
99.0% (97.4 to 99.7)91.2 (34.3 to 242.5)*0.07 (0.03 to 0.19)*92.9% (82.7 to 98.0)*99.0% (97.4 to 99.7)*
Site: female FCU99.5% (98.2 to 99.9)193.5 (48.5 to 771.3)*0.02 (0.00 to 0.13)*96.5% (87.9 to 99.5)*99.8% (98.6 to 100.0)*
Taylor et al, 201139AC2
Site: urethral swab
98.8% (95.8 to 99.9)76.4 (19.2 to 304.1)*0.09 (0.03 to 0.27)*93.8% (79.2 to 99.1)*98.2% (94.9 to 99.6)*BD DiagnosticsFair
Site: male FCU100.0% (98.0 to 100.0)Unable to calculate0.03 (0.00 to 0.19)*100.0% (89.9 to 100.0)*99.4% (96.9 to 99.9)*
All female sites99.2% (98.3 to 99.7)125.3 (56.4 to 278.4)*0.04 (0.02 to 0.11)*94.7% (88.8 to 98.0)*99.4% (98.5 to 99.8)*
All male sites99.4% (97.9 to 99.9)163.4 (41.0 to 651.7)*0.06 (0.02 to 0.15)*97.0% (89.6 to 99.6)*98.9% (97.1 to 99.7)*
Van Der Pol et al, 201233c4800
Site: endocervical
100.0% (99.7 to 100.0)1937.3 (272.7 to 13762.3)*0.10 (0.06 to 0.18)*99.0% (94.3 to 99.8)* Note: authors estimate PPV of 77.3% to 99.7% (based on hypothetical prevalence range of 1% to 50%)99.5% (99.1 to 99.8)*Roche Molecular SystemsFair
Site: FCU99.8% (99.5 to 99.9)483.1 (181.1 to 1288.8)*0.11 (0.06 to 0.19)*96.1% (90.3 to 98.9)*99.5% (99.0 to 99.7)*
AC2
Site: endocervical
99.5% (99.0 to 99.7)176.8 (100.5 to 311.2)*0.03 (0.01 to 0.09)*89.4% (82.2 to 94.4)*99.9% (99.6 to 100.0)*
Site: FCU99.8% (99.5 to 99.9)404.2 (168.1 to 971.8)*0.08 (0.04 to 0.15)*95.2% (89.0 to 98.4)*99.6% (99.3 to 99.8)*
CT/GC Qx
Site: endocervical
99.7% (99.3 to 99.8)297.2 (141.7 to 623.3)*0.04 (0.01 to 0.10)*93.6% (87.2 to 97.3)*99.8% (99.5 to 100.0)*
Site: FCU99.7% (99.4 to 99.9)347.4 (156.1 to 773.1)*0.04 (0.01 to 0.10)*94.4% (88.2 to 97.9)*99.8% (99.5 to 100.0)*
*

Calculated.

Abbreviations: AC2 = Aptima Combo 2; ACT = Aptima Chlamydia trachomatis test; Amplicor = Roche cobas Amplicor test; BD = Becton Dickinson; c4800= Roche cobas 4800 CT and NG test; CDC = Centers for Disease Control and Prevention; CI = confidence interval; CT = Chlamydia trachomatis; CTQ = BD ProbeTec CT Qx amplified DNA assay on the Viper system; CT/GC Qx = BD ProbeTec CT and NG Qx amplified DNA assay; EIA = enzyme immunoassay; FCU = first-catch urine; IRB = institutional review board; NAAT = nucleic acid amplification test; NG = Neisseria gonorrhea; NIH = National Institutes of Health; NIMH = National Institute for Mental Health; NR = not reported; PCR = polymerase chain reaction; PT = ProbeTech; PTCT = BD ProbeTech ET CT amplified DNA assay; PTGC = BD ProbeTech ET amplified DNA assay for CT and NG; STI = sexually transmitted infection.

From: Appendix C, Evidence and Quality Tables

Cover of Screening for Gonorrhea and Chlamydia: Systematic Review to Update the U.S. Preventive Services Task Force Recommendations
Screening for Gonorrhea and Chlamydia: Systematic Review to Update the U.S. Preventive Services Task Force Recommendations [Internet].
Evidence Syntheses, No. 115.
Nelson HD, Zakher B, Cantor A, et al.

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