DIAGNOSIS OF CHLAMYDIA-TRACHOMATIS INFECTIONS IN ASYMPTOMATIC MEN ANDWOMEN BY PCR ASSAY

A PCR assay was evaluated for its ability to detect genital chlamydial infection in asymptomatic men and women. Urethral swab specimens were collected from 472 men for culture and PCR assay, and first-void urin e (FVU) specimens were collected from 379 of these men for enzyme immu noassay (EIA) and PCR assay. Cervical swab specimens were collected fr om 242 women for culture, EIA, and PCR assay. Patients were considered infected if they were culture positive or positive by PCR with both p lasmid- and major outer membrane protein-based primers. By using this extended ''gold standard,'' the prevalence of infection in this popula tion was 7.6% for men and 7.9% for women. For men, the sensitivities o f urethral swab specimen culture and PCR and FVU specimen EIA and PCR were 61, 72, 55, and 91%, respectively. All assays had specificities o f greater than or equal to 99.8%. The positive and negative predictive values for PCR testing of FVU specimens were 100 and 99.4%, respectiv ely, compared with values of 96.3 and 97.8%, respectively, for PCR of urethral swab specimens. The sensitivities of cervical swab specimen c ulture and PCR testing were 42 and 90%, respectively, with correspondi ng specificities of 100 and 99.3%. All cervical swabs were negative by EIA. Molecular techniques such as PCR assays are valuable tools for t he detection of asymptomatic genital chlamydial infection. In particul ar, PCR assays of FVU specimens from men offer a highly sensitive, non invasive screening tool that will likely improve patient compliance fo r diagnostic testing.