Self-collected glans/meatal 'dry' swab specimen and NAAT technology detects Chlamydia trachomatis and Neisseria gonorrhoeae - implications for public policy changes.

Increasing Chlamydia trachomatis (CT) rates and ever-present Neisseria gonorrhoeae (NG) infections in women have given rise in the past to consideration of male screening programs in order to address the silent male reservoir. Non-medical venues (e.g. home collection, restrooms or other private locations) may be viable venues to reach certain populations that in the past have not been accessed. Effortlessly collected, non-invasive, self-collected male specimens that are stable and easy to transport would enhance the success of male screening programs. We designed a head-to-head study to consider the effectiveness of non-invasive self-collected glans/meatal dry swab (SCS) specimens to detect CT and NG nucleic acid when compared to traditional clinician-collected swab (CCS) specimens and first-catch urine (FCU) specimens. A total of 284 male patients were included in the study. Specimens were processed using the Becton Dickinson ProbeTec ET system. The overall sensitivity of SCS was 91.1% with a specificity of 99.2%. There was an overall SCS agreement of 97.7% with CCS specimens and 90.4% with FCU specimens. Dry swab specimens are easy to collect, transport and test. Non-invasive dry self-collected glans/meatal swab specimens are a viable specimen choice.

Laboratory aspects of screening men for Chlamydia trachomatis in the new millennium.

OBJECTIVE: To describe and review the methods for laboratory diagnosis of Chlamydia trachomatis in men. BACKGROUND: Men provide a reservoir for continued transmission of C. trachomatis to women, thus representing a population for potential targeted screening. Although there are no formal recommendations by professional organizations for screening men for chlamydia, guidance has been provided by the Centers for Disease Control and Prevention for sites wishing to screen men, who are primarily asymptomatic. METHODS: Review of the published literature for diagnostic laboratory tests for C. trachomatis in men. RESULTS: The laboratory test of choice for screening men is a nucleic acid amplification test (NAAT), and the specimen of choice is first-catch urine. The NAAT has sufficient sensitivity and specificity, and urine provides a noninvasive specimen; together, this combination provides the achievement of sensitivities of >90% to 97% and high specificity (99%). Populations of men, such as those in detention, Job Corps training, emergency departments, the military, and high schools can offer accessible target populations for easily implemented chlamydia screening. CONCLUSION: Screening more men with NAAT assays may provide the possibility of reducing the overall burden of chlamydia in both men and women.

A cluster of Escherichia coli O157: nonmotile infections associated with recreational exposure to lake water.

OBJECTIVES: To identify cases and determine risk factors for an outbreak of Escherichia coli (E. coli) O157: nonmotile (NM) infections in children attending a summer day care program in California. METHODS: The authors conducted a retrospective cohort study; the cohort comprised first and second graders who attended the day care program during the last week in August 1999. Shiga toxin testing and molecular subtyping using pulsed-field gel electrophoresis were performed on isolates. Lake water, lake bottom sediment samples, and waterfowl feces from the lake environs were cultured for E. coli O157. RESULTS: Three cases of Shiga toxin-producing E. coli O157: NM infections with matching pulsed-field gel electrophoresis patterns and four probable cases were found. Children who swallowed more than a mouthful of water had a higher attack rate than those who swallowed less than a mouthful or none at all (43% vs. 10%, relative risk = 4.43, 95% confidence interval 1.12, 17.50). CONCLUSIONS: E. coli O157: NM infections were associated with swallowing water from a freshwater lake. Potential sources of contamination include feces from humans, cattle, or deer. This outbreak illustrates the value in screening patients with diarrhea for E. coli O157, submitting isolates to public health laboratories, and using molecular techniques to identify related cases. Outbreaks associated with contaminated freshwater could be averted by prevention and early detection of contamination.