Leucocyte esterase dip-stick test as a point-of-care diagnostic for urogenital chlamydia in male patients: A multi-center evaluation in two STI outpatient clinics in Paramaribo and Amsterdam.
BACKGROUND
Point-of-care (POC) tests are an important strategy to address the epidemic of sexually transmitted infections (STIs). The leucocyte esterase test (LET) can be used as a POC test for chlamydia. The aim of this study was to determine the diagnostic accuracy of the LET to detect urogenital chlamydia among men at STI clinics in Paramaribo, Suriname and Amsterdam, the Netherlands.


METHODS
Recruitment of patients took place in 2008-2010 in Suriname and in 2009-2010 in the Netherlands. Urine of patients was examined with the LET. The reference test was a nucleic acid amplification test (NAAT).


RESULTS
We included 412 patients in Suriname and 645 in the Netherlands. Prevalence of chlamydia in Suriname and the Netherlands was respectively 22.8 and 13.6 %. The sensitivity of the LET was 92.6 % (95 % CI = 85.3-97.0) and 77.3 % (95 % CI = 67.1-85.5) respectively, the specificity was 38.1 % (95 % CI = 32.7-43.6 %) and 58.1 % (95 % CI = 53.9-62.3) respectively. The positive predictive value was 30.6 % (95 % CI = 27.3-36.4) and 22.6 % (95 % CI = 18.0-27.7) respectively and the negative predictive value was 94.5 % (95 % CI = 89.1-97.8) and 94.2 % (95 % CI = 91.1-96.4) respectively. The kappa was respectively 0.179 and 0.176.


CONCLUSIONS
To diagnose urogenital chlamydia in men the LET performs poorly. It has a high negative but low positive predictive value. If the LET result is negative, chlamydia is accurately excluded, yet a positive result has a low predictive value. Whether the advantages of direct management based on LET outweigh the disadvantages of overtreatment is a subject for further studies.
Department of Infectious Diseases, STI Outpatient Clinic, Public Health Service of Amsterdam (GGD Amsterdam), Weesperplein 1, 1018, XA, Amsterdam, The Netherlands. mbartelsman@ggd.amsterdam.nl.
Menne
http://orcid.org/0000-0003-3347-9508
M
Bartelsman
Department of Infectious Diseases, STI Outpatient Clinic, Public Health Service of Amsterdam (GGD Amsterdam), Weesperplein 1, 1018, XA, Amsterdam, The Netherlands.|Center for Infection and Immunology Amsterdam (CINIMA), Academic Medical Center (AMC), University of Amsterdam, Amsterdam, The Netherlands.|Department of Dermatology, Academic Medical Center (AMC), University of Amsterdam, Amsterdam, The Netherlands.
Henry J C
HJ
de Vries
Center for Infection and Immunology Amsterdam (CINIMA), Academic Medical Center (AMC), University of Amsterdam, Amsterdam, The Netherlands.|Department of Research, Public Health Service of Amsterdam (GGD Amsterdam), Nieuwe Achtergracht 100, 1018, WT, Amsterdam, The Netherlands.
Maarten F
MF
Schim van der Loeff
Dermatological Service, Ministry of Health Suriname, Tourtonnelaan 5, Paramaribo, Suriname.
Leslie O A
LO
Sabajo
Department of Infectious Diseases, STI Outpatient Clinic, Public Health Service of Amsterdam (GGD Amsterdam), Weesperplein 1, 1018, XA, Amsterdam, The Netherlands.|Department of Research, Public Health Service of Amsterdam (GGD Amsterdam), Nieuwe Achtergracht 100, 1018, WT, Amsterdam, The Netherlands.
Jannie J
JJ
van der Helm
D000328:Adult; D000554:Ambulatory Care Facilities; D002265:Carboxylic Ester Hydrolases / Q000652:urine*; D002690:Chlamydia Infections / Q000175:diagnosis* / Q000453:epidemiology / Q000652:urine; D002692:Chlamydia trachomatis / Q000235:genetics; D006801:Humans; D008297:Male; D009426:Netherlands / Q000453:epidemiology; D021141:Nucleic Acid Amplification Techniques; D000067716:Point-of-Care Testing; D015995:Prevalence; D012680:Sensitivity and Specificity; D012749:Sexually Transmitted Diseases / Q000175:diagnosis* / Q000453:epidemiology / Q000652:urine; D013532:Suriname / Q000453:epidemiology; D014526:Urethritis / Q000175:diagnosis* / Q000453:epidemiology / Q000652:urine; D055815:Young Adult
C021443:leukocyte esterase; D002265:Carboxylic Ester Hydrolases
Chlamydia; Chlamydia trachomatis; Leucocyte esterase test; Point-of-care test; Sensitivity; Specificity