The Diagnosis of Gonococcal Infection in High Risk Women Using a Rapid Test
- D Mabey ( )
- Published Online First 21 November 2006
Objective: To assess the performance and acceptability for patients and health care workers of the NGThermo Biostar (GC OIA) to diagnose gonococcal infection compared with culture using modified Thayer Martin medium.
Methods: This study involved 326 high-risk women presenting with vaginal discharge or referral by sexual partner with urethral discharge at an STI clinic in Manaus, Brazil. Endocervical swabs collected from the women were tested with both the NG Biostar and modified Thayer Martin culture as the reference standard test. Clinic staff were trained to perform the NG Biostar on site and the culture was performed in the laboratory of the clinic.
Results: The prevalence of gonococcal infection as measured by the reference standard was 15% (50/326) overall. Among asymptomatic participants, the prevalence of infection was 17.7% (25/141) and among symptomatic women it was 13.5% (25/185) (p=0.3). Sensitivity, specificity, PPV, and NPV values for the NG Biostar test, with 95% confidence intervals, were 60% (46.4-73.6), 89.9% (86.2-93.6), 55.6% (42.4-68.8), and 92.6% (89.5-95.7) respectively. 98.8% of study participants were willing to wait approximately 1 hour in the clinic for test results.
Conclusion: Syndromic management protocols for treatment of STI in developing countries require refinement because, as currently described, they lead to over-treatment of cervical infection. A rapid test done during patients' initial presentation and leading to immediate treatment if positive would help improve the accuracy of diagnosis and could also be used to screen asymptomatic women. Even though the NG Biostar had a low sensitivity and PPV, which is less than ideal, it could still improve the rates of treatment over the gold standard test that requires return visits for patients to receive results and to benefit from treatment. Cost- effectiveness studies using rapid point-of-care tests for N. gonorrhoeae infection compared to syndromic approach should be carried out to assess their value in STI diagnosis and treatment in developing nations. Key words: gonoccocal rapid test, sensitivity, specificity and acceptability The NG Biostar, while displaying many of the ideal characteristics of a point-of-care test, had a low sensitivity and PPV. There is a clear need for a low- cost, easily performed, and highly sensitive test that can be performed on site at a primary health clinic. More investigation must be done into alternative rapid tests ideal for this setting.