UNSATISFACTORY PERFORMANCE OF THE LEUKOCYTE ESTERASE TEST OF FIRST VOIDED URINE FOR RAPID DIAGNOSIS OF URETHRITIS

Background and Objectives-The objective of this study was to determine the performance characteristics of a dipstick test for leukocyte este rase (LE), (Chemstrip 2LN, Boehringer Mannheim) in predicting the pres ence of urethritis and urethral pathogens in men presenting to a busy sexually transmitted disease clinic and to street outreach facilities. Methods-Urethral swabs for polymorphonuclear (pmn) cell count, gonorr hoea culture and chlamydia enzyme immunoassay (EIA) as well as 15 mi o f first voided urine (FVU) were collected from 737 symptomatic and 726 asymptomatic men. Gonorrhoea cultures and pmn counts were processed a ccording to standard methods. Either Abbott Chlamydiazyme EIA (confirm ed) or Syva Microtrak EIA (confirmed) test was employed to detect C tr achomatis. The LE test was immediately dipped in FVU, read after 60-12 0 seconds by the clinician and considered positive if trace, 1+ or 2+. Results-Microscopic evidence of urethritis (greater than or equal to = 4 pmn cells per 1000 x field) was found on urethral smear of 782 (53 .5%) patients. Chlamydia, gonorrhoea or both were present in 104 (7.1% ) patients. Performance characteristics of the LE test were as follows : (table below) Conclusion-The LE test did not have adequate sensitivi ty to be considered a reliable rapid diagnostic test for urethritis or urethral pathogens, particularly in the asymptomatic portion of this STD clinic population.