title: Multisite Direct Determination of the Potential for Environmental Contamination of Urine Samples Used for Diagnosis of Sexually Transmitted Infections.
abstract: BACKGROUND
  The detection of a sexually transmitted infection (STI) agent in a urine specimen from a young child is regarded as an indicator of sexual contact. False positives may conceivably arise from the transfer of environmental contaminants in clinic toilet or bathroom facilities into urine specimens.
  
  
  METHODS
  The potential for contamination of urine specimens with environmental STI nucleic acid was tested empirically in the male and female toilets or bathrooms at 10 Northern Territory (Australia) clinics, on 7 separate occasions at each. At each of the 140 experiments, environmental contamination with Chlamydia trachomatis, Neisseria gonorrhoeae, and Trichomonas vaginalis nucleic acid contamination was determined by swabbing 10 locations, and urine collection was simulated 5 times, using a (1) synthetic urine surrogate and (2) a standardized finger contamination procedure.
  
  
  RESULTS
  The most contaminated toilets and bathrooms were in remote Indigenous communities. No contamination was found in the Northern Territory Government Sexual Assault Referral Centre clinics, and intermediate levels of contamination were found in sexual health clinics and in clinics in regional urban centres. The frequency of surrogate urine sample contamination was low but non-zero. For example, 4 of 558 of the urine surrogate specimens from remote clinics were STI positive.
  
  
  CONCLUSIONS
  This is by far the largest study addressing the potential environmental contamination of urine samples with STI agents. Positive STI tests arising from environmental contamination of urine specimens cannot be ruled out. The results emphasize that urine specimens from young children taken for STI testing should be obtained by trained staff in clean environments, and duplicate specimens should be obtained if possible.
authors.affiliation: Division of Global and Tropical Health, Menzies School of Health Research, Charles Darwin University, Tiwi, Northern Territory, Australia.
authors.forename: Patiyan
authors.initials: P
authors.lastname: Andersson
authors.affiliation: Division of Global and Tropical Health, Menzies School of Health Research, Charles Darwin University, Tiwi, Northern Territory, Australia.
authors.forename: Steven Y C
authors.initials: SY
authors.lastname: Tong
authors.affiliation: Division of Global and Tropical Health, Menzies School of Health Research, Charles Darwin University, Tiwi, Northern Territory, Australia.
authors.forename: Rachael A
authors.initials: RA
authors.lastname: Lilliebridge
authors.affiliation: Division of Global and Tropical Health, Menzies School of Health Research, Charles Darwin University, Tiwi, Northern Territory, Australia.
authors.forename: Nicole C
authors.initials: NC
authors.lastname: Brenner
authors.affiliation: Royal Darwin Hospital, Tiwi, Australia.
authors.forename: Louise M
authors.initials: LM
authors.lastname: Martin
authors.affiliation: Royal Darwin Hospital, Tiwi, Australia.
authors.forename: Emma
authors.initials: E
authors.lastname: Spencer
authors.affiliation: Northern Territory Government Sexual Assault Referral Centre (Alice Springs), Australia.
authors.forename: Jennifer
authors.initials: J
authors.lastname: Delima
authors.affiliation: Royal Darwin Hospital, Tiwi, Australia Division of Child Health, Menzies School of Health Research, Charles Darwin University, Tiwi, Australia.
authors.forename: Gurmeet
authors.initials: G
authors.lastname: Singh
authors.affiliation: Northern Territory Government Sexual Assault Referral Centre (Darwin), Casuarina Health Service Centre, Casuarina Northern Territory, Australia.
authors.forename: Frances
authors.initials: F
authors.lastname: McCann
authors.affiliation: Northern Territory Government Sexual Assault Referral Centre (Alice Springs), Australia.
authors.forename: Carolyn
authors.initials: C
authors.lastname: Hudson
authors.affiliation: Northern Territory Government Sexual Assault Referral Centre (Darwin), Casuarina Health Service Centre, Casuarina Northern Territory, Australia.
authors.forename: Tracy
authors.initials: T
authors.lastname: Johns
authors.affiliation: Division of Global and Tropical Health, Menzies School of Health Research, Charles Darwin University, Tiwi, Northern Territory, Australia.
authors.forename: Philip M
authors.initials: PM
authors.lastname: Giffard
keywords: contamination; diagnosis; false positive; sexually transmitted infection; urine