title: Can culture confirmation of gonococcal infection be improved in female subjects found to be positive by nucleic acid amplification tests in community clinics?
abstract: BACKGROUND
  Use of nucleic acid amplification tests (NAATs), such as strand displacement assay (SDA, BD ProbeTec C trachomatis/N gonorrhoeae Amplified DNA Assay), for the detection of gonococcal infection in the community is controversial because of the possibility of false-positive results in low prevalence populations.
  
  
  OBJECTIVE
  To evaluate if culture confirmation of gonococcal infection can be improved for subjects found to be positive by BD ProbeTec in community clinics.
  
  
  METHODS
  Two cervical swabs were collected for culture to confirm NAAT positive results in women aged over 16 years-a majority of whom were <25 years and asymptomatic. One swab was urgently transported (UTP) and processed in the laboratory within 2 hours whereas the other swab (RTP) was stored at 4 degrees C, transported at room temperature and processed 4-72 hours after collection depending on the time and day of collection.
  
  
  RESULTS
  Altogether, 56 subjects with NAAT positive results were recruited into the study. Nine (16.1%) subjects who were culture negative were excluded from final analysis due to prior antibiotic treatment (4/9) or the culture having been taken more than 1 month after the NAAT was positive (4/9) or an incorrect specimen being received (1/9). Overall, 41/47 (87.2%) NAAT positive subjects were confirmed by culture. In total, 40/47 (85.1%) UTP swabs and 27/47 (57.4%) RTP swabs were positive (p<0.05).
  
  
  CONCLUSIONS
  This study shows that culture confirmation in NAAT positive subjects in a community gonococcus screening programme can be significantly improved by urgent transportation to and processing of specimens in the laboratory.
authors.affiliation: Microbiology Department, University Hospital, London, UK. guduru.gopalrao@nwlh.nhs.uk
authors.forename: G
authors.initials: G
authors.lastname: Gopal Rao
authors.forename: L
authors.initials: L
authors.lastname: Bacon
authors.forename: J
authors.initials: J
authors.lastname: Evans
authors.forename: Y
authors.initials: Y
authors.lastname: Dejahang
authors.forename: R
authors.initials: R
authors.lastname: Hardwick
authors.forename: P
authors.initials: P
authors.lastname: Michalczyk
authors.forename: J
authors.initials: J
authors.lastname: Wong
authors.forename: A
authors.initials: A
authors.lastname: Donaldson
mesh_terms: D000293:Adolescent; D000328:Adult; D001431:Bacteriological Techniques / Q000592:standards*; D005260:Female; D006069:Gonorrhea / Q000175:diagnosis*; D006801:Humans; D008131:London; D021141:Nucleic Acid Amplification Techniques; D012680:Sensitivity and Specificity; D013048:Specimen Handling; D014626:Vaginal Smears; D055815:Young Adult