Urinary leukocyte esterase screening for asymptomatic sexually transmitted disease in adolescent males

doi:10.1016/0197-0070(91)90008-A

Journal of Adolescent Health

Volume 12, Issue 4, June 1991, Pages 326-328

https://doi.org/10.1016/0197-0070(91)90008-A Get rights and content

Abstract

The objective of this study was to evaluate the effectiveness of urinary leukocyte esterase on random urine specimens as a screening test for chlamydial and gonococcal urethral infections in asymptomatic males. Random urine specimens were obtained on 106 consecutive asymptomatic adolescent males during intake physical examination at a residential vocational training program. Results of urinary leukocyte esterase were compared to those of urethral cultures for Chlamydia trachomatis and Neisseria gonorrhoeae. Five subjects had positive chlamydia cultures, three subjects had positive gonococcal cultures, and one patient had positive cultures for both organisms. Sixteen subjects had leukocyte esterase tests reported as “trace” or greater. When compared to positive culture results for either Chlamydia or gonorrhea, urinary leukocyte esterase activity had a sensitivity of 78%, specificity of 91%, and positive predictive value of 44%. A random urine specimen for urinary leukocyte esterase activity is a cost-effective screening method for chlamydial and gonococcal urethral infections in asymptomatic adolescent males.

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Cited by (19)

Chlamydia trachomatis: Common misperceptions and misunderstandings
2005, Journal of Pediatric and Adolescent Gynecology
Citation Excerpt :
Finally, when treating teenagers, special care must be taken to stay within the confines of confidentiality and privacy provisions afforded by individual state and federal mandates and the Health Insurance Portability and Accountability Act.64,129 The risks of under-diagnosis and under-treatment are common themes in the CT-literature.64,75–85 This is particularly true of the adolescent STD literature, as in comparison to most other groups, teenagers have higher STD prevalence rates, are especially vulnerable to the adverse reproductive consequences of untreated STDs, and are generally perceived as promiscuous and non-compliant with follow-up.64
Performance of urine leukocyte esterase in asymptomatic male youth: Another look with nucleic acid amplification testing as the gold standard for Chlamydia detection
2005, Journal of Adolescent Health
To re-evaluate the sensitivity and specificity of leukocyte esterase (LE) for screening adolescent and young adult males for Chlamydia trachomatis using a nucleic acid amplification test (NAAT) as the gold standard.
This study was conducted at two Massachusetts Department of Youth Services sites and one Job Corps site. Recently admitted asymptomatic sexually active male youth aged 14 to 25 years (mean 16.6 years) were recruited between January 2001 and July 2003 (N = 1008). Participants provided first part voided urine specimens for testing with LE and Chlamydia NAAT. The sensitivity, specificity, and positive and negative predictive value of urine LE for identification of Chlamydia infection were determined using NAAT as the gold standard.
Fifty-seven (5.7%) participants were infected with Chlamydia as defined by a positive NAAT. Defining trace + as the LE cut point resulted in sensitivity and specificity of 57.9% and 78.3%, respectively. Defining 1+ as the cut point resulted in sensitivity and specificity of 47.4% and 96.1%, respectively.
Urine leukocyte esterase is a moderately sensitive method to screen for Chlamydia. Nevertheless, a substantial proportion of infections are not detected with LE screening. When feasible, urine NAAT provides a much more sensitive and equally noninvasive method of detecting Chlamydia. However, if LE is used as an initial screen followed by NAAT confirmation of LE positive samples, we recommend using trace LE as the cut point for positive results.
Urine leukocyte esterase as a screening tool for sexually transmissible diseases and vulvovaginitis in adolescent females
1993, Adolescent and Pediatric Gynecology
Study Objective: To determine the predictive value of leukocyte esterase as a means of screening for sexually transmissible disease or vulvovaginitis in adolescent females.
Design: A prospective study was performed comparing the results of urine leukocyte esterase and the finding of sexually transmissible diseases or vulvovaginitis.
Participants: Seventy-four females (mean age = 17.4 years) from a Chicago suburban adolescent family planning clinic who were requesting birth control services were enrolled in the study.
Interventions: Patients submitted an initial 10–20 cc of a voided urine specimen for leukocyte esterase testing prior to undergoing a pelvic examination for Neisseria gonorrhoeae culture, Chlamydia trachomatis microtrak, vaginal wet mount preparation, and a Pap smear. Urine leukocyte esterase was recorded as positive (trace, +1, + 2) or negative and compared with the results of other laboratory tests for sexually transmissible diseases or vulvovaginitis.
Results: Thirty-eight leukocyte esterase-negative subjects had no detectable infections. Thirty-six subjects were leukocyte-esterase positive: 2 had urinary tract infection, 9 had a sexually transmissible disease or vulvovaginitis, and 25 had no detectable infections.
Conclusion: Urine leukocyte esterase was found to have a statistically significant predictive value for sexually transmissible disease and vulvovaginitis (p = 0.003).
Screening for urethral infection in adolescent and young adult males
1993, Journal of Adolescent Health
We evaluated the urinary leukocyte esterase (LE) dipstick as a predictor of a positive urethral culture for Neisseria gonorrhoeae andlor Chlamydia trachomatis in adolescent and young adult males. Sexual and sexually transmitted disease (STD) histories were also analyzed to determine predictors of infection. Subjects were recruited from sexually active males attending an adolescent medicine clinic. Patients were interviewed regarding presence of symptoms of urethritis and a variety of clinical variables. First-voided urine for LE dipstick and urethral swabs for gonorrhea and C. trachomatis cultures were obtained. One hundred patients (mean age, 19.2 years) were asymptomatic; 50 patients (mean age, 19.0 years) had symptoms of urethritis. In asymptomatic patients, the sensitivity, specificity, predictive value positive (PVP), and predictive value negative (PVN) of the LE dipstick were 0.31, 0.92,0.57, and 0.90, respectively. These values were 0.66, 0.71, 0.76, and 0.60, respectively, in symptomatic patients. In each patient group the dipstick was more sensitive in detecting, and a better predictor of, a positive culture for gonorrhea than Chlamydia. LE dipstick results and clinical variables were evaluated as correlates of infection using stepwise logistic regression. A positive LE dipstick and four additional variables increased the probability of obtaining a positive culture for one or both organisms from symptomatic patients. These variables were the following: sexual contact in the previous month with a partner diagnosed as having a sexually transmitted disease, having ever used a condom, five or more lifetime sexual partners, and more than one sexual partner in the past month. Only a positive LE dipstick entered the model as a predictor of infection in asymptomatic patients. We concluded that the LE dipstick is the only available noninvasive screening instrument for asymptomatic urethral infection. It can be used to identify asymptomatic, sexually active males for whom culture for STDs is appropriate. The sexual and STD history do not assist in predicting positive culture(s) in asymptomatic patients, although several variables were associated with infection in symptomatic patients. Symptomatic patients should be evaluated using standard techniques regardless of LE dipstick results.
Low Sensitivity of the Leukocyte Esterase Test (LET) in Detecting Chlamydia trachomatis Infections in Asymptomatic Men Entering a County Jail
2004, Journal of Correctional Health Care
The clinical and economic consequences of screening young men for genital chlamydial infection
2003, Sexually Transmitted Diseases

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: This work was funded, in part, by MCH Grant no. OH-964.

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Journal of Adolescent Health

Abstract

References (14)

Epidemiology of sexually transmitted diseases

Urol Clin North Am

Microflora of urethra in adolescent boys: Relationships to sexual activity and non-gonococcal urethritis

J Pediatr

Screening asymptomatic adolescent males for Chlamydia

J Adolesc Health Care

Screening for Chlamydia trachomatis and Neisseria gonorrhoeae in adolescent males

Lancet

Chlamydia trachomatis infection in sexually active adolescents: Prevalence and risk factors

Pediatrics

Dipstick leukocyte esterase activity in first-catch urine specimens

JAMA

Chlamydia trachomatis urethral infections in men: Prevalence, risk factors, and clinical manifestations

Ann Intern Med

Cited by (19)

Chlamydia trachomatis: Common misperceptions and misunderstandings

Performance of urine leukocyte esterase in asymptomatic male youth: Another look with nucleic acid amplification testing as the gold standard for Chlamydia detection

Urine leukocyte esterase as a screening tool for sexually transmissible diseases and vulvovaginitis in adolescent females

Screening for urethral infection in adolescent and young adult males

Low Sensitivity of the Leukocyte Esterase Test (LET) in Detecting Chlamydia trachomatis Infections in Asymptomatic Men Entering a County Jail

The clinical and economic consequences of screening young men for genital chlamydial infection

Original articleUrinary leukocyte esterase screening for asymptomatic sexually transmitted disease in adolescent males

Abstract

Urol Clin North Am

J Pediatr

J Adolesc Health Care

Lancet

Chlamydia trachomatis infection in sexually active adolescents: Prevalence and risk factors

Pediatrics

Dipstick leukocyte esterase activity in first-catch urine specimens

JAMA

Chlamydia trachomatis urethral infections in men: Prevalence, risk factors, and clinical manifestations

Ann Intern Med

Original article
Urinary leukocyte esterase screening for asymptomatic sexually transmitted disease in adolescent males