Decision analysis: point-of-care Chlamydia testing vs. laboratory-based methods.
OBJECTIVE
To evaluate and compare the performance of several different methods available for detection of Chlamydia trachomatis (Ct) infection, and to explore possible testing and treatment strategies incorporating point-of-care testing versus laboratory-based tests.


METHODS
Prospective trial and decision analysis.


METHODS
Large, urban, publicly funded sexually transmitted disease clinic.


METHODS
1,384 female patients.


METHODS
Each subject was tested for Ct infection by direct fluorescent antibody (DFA, Sanofi/Kallestad, Chaska, MN), optical immunoassay (OIA, Thermo Electron, Point of Care and Rapid Diagnostics, Louisville CO), McCoy cell culture (in-house method), and polymerase chain reaction (microwell PCR, microwell assay, Roche, Branchburg NJ).


RESULTS
Performing a rapid in-clinic test on women who did not meet empiric treatment criteria would have increased the overall proportion of infected persons receiving same-day treatment from 48.6% to 79.1% using DFA or 78.4% using OIA.


CONCLUSIONS
Use of empiric treatment criteria and same-day point-of-care testing for patients not meeting the empiric treatment threshold appears to be an appropriate, useful, and cost-effective strategy for increasing same-day treatment of Ct infections in this population.
Swain
Geoffrey R
GR
City of Milwaukee Health Department, Milwaukee, Wisconsin 53202, USA. gswain@milwaukee.gov
McDonald
Roberta A
RA
Pfister
John R
JR
Gradus
M Stephen
MS
Sedmak
Gerald V
GV
Singh
Ajaib
A
D000293:Adolescent; D000328:Adult; D002690:Chlamydia Infections / Q000175:diagnosis* / Q000453:epidemiology; D002692:Chlamydia trachomatis / Q000302:isolation & purification*; D003657:Decision Making; D005260:Female; D019085:Fluorescent Antibody Technique, Direct; D006069:Gonorrhea / Q000175:diagnosis / Q000453:epidemiology; D006801:Humans; D007118:Immunoassay; D008828:Microbiological Techniques; D009344:Neisseria gonorrhoeae / Q000302:isolation & purification; D019095:Point-of-Care Systems; D016133:Polymerase Chain Reaction; D011237:Predictive Value of Tests; D011446:Prospective Studies; D012307:Risk Factors; D012680:Sensitivity and Specificity