title: High analytical sensitivity and low rates of inhibition may contribute to detection of Chlamydia trachomatis in significantly more women by the APTIMA Combo 2 assay.
abstract: The clinical sensitivity of nucleic acid amplification tests may be determined by analytical sensitivity and inhibitors in patient samples. We established endpoints for detection of propagated Chlamydia trachomatis L2 434, diluted according to swab and urine protocols for APTIMA Combo 2 (AC2), ProbeTec ET (PT), and Amplicor (AMP) assays. AC2 was 1,000-fold more sensitive than PT and 10-fold more sensitive than AMP on mock swab specimens. For urine, AC2 analytical sensitivity was 100-fold greater than those of the other assays. Spiking an aliquot of each clinical-trial sample from 298 women demonstrated inhibition rates in first-void urine (FVU), cervical swabs (CS), and vaginal swabs (VS) of 12.1%, 12.8%, and 10.4% for AMP; 27.2%, 2%, and 2%, for PT; and 0.3%, 1.7%, and 1.3% for AC2. Inhibition of our C. trachomatis spike and the PT or AMP amplification controls from the manufacturers showed less than 50% correlation. Using an infected-patient reference standard (a specimen positive in at least two tests or a single test positive in two of three samples) in AC2, the VS identified 68/69 (98.6%) infected women compared to CS (89.9%) or FVU (81.2%). Significantly fewer women were identified by PT (65.2%, 63.8%, and 66.7%) or AMP (65.2%, 59.4%, and 56.5%) with the three specimens. By individual specimen type, AC2 confirmed virtually all PT- and AMP-positive specimens, but rates of AC2 confirmation by AMP or PT ranged from 62.9 to 80.3%. The AC2 test identified significantly more women infected with C. trachomatis (P = 0.001). Vaginal swabs appear to be the specimen of choice for screening.
authors.affiliation: St. Joseph's Healthcare, 50 Charlton Avenue East, Hamilton, ON L8N 4A6, Canada. chernesk@mcmaster.ca
authors.forename: Max
authors.initials: M
authors.lastname: Chernesky
authors.forename: Dan
authors.initials: D
authors.lastname: Jang
authors.forename: Kathy
authors.initials: K
authors.lastname: Luinstra
authors.forename: Sylvia
authors.initials: S
authors.lastname: Chong
authors.forename: Marek
authors.initials: M
authors.lastname: Smieja
authors.forename: Wenjie
authors.initials: W
authors.lastname: Cai
authors.forename: Beth
authors.initials: B
authors.lastname: Hayhoe
authors.forename: Eder
authors.initials: E
authors.lastname: Portillo
authors.forename: Cindy
authors.initials: C
authors.lastname: Macritchie
authors.forename: Cheryl
authors.initials: C
authors.lastname: Main
authors.forename: Ruth
authors.initials: R
authors.lastname: Ewert
mesh_terms: D002584:Cervix Uteri / Q000382:microbiology; D002690:Chlamydia Infections / Q000175:diagnosis* / Q000382:microbiology; D002692:Chlamydia trachomatis / Q000235:genetics / Q000302:isolation & purification*; D005260:Female; D006801:Humans; D021141:Nucleic Acid Amplification Techniques / Q000379:methods*; D011933:Reagent Kits, Diagnostic; D012680:Sensitivity and Specificity; D013048:Specimen Handling / Q000379:methods*; D014556:Urine / Q000382:microbiology; D014621:Vagina / Q000382:microbiology
chemical_list: D011933:Reagent Kits, Diagnostic