Objectives: The enhanced sensitivity of nucleic acid amplification tests (NAAT) provides an opportunity for estimating the prevalence of untreated Chlamydia trachomatis infections. The transmissibility and public health significance of some NAAT-identified infections are, however, not known.
Methods: Adults attending an urban emergency department provided specimens for C trachomatis screening using NAAT. Participants testing positive were offered follow-up including re-testing for C trachomatis using NAAT and traditional methods, eg culture and direct fluorescent antibody, and were treated. Partners were offered identical evaluation and treatment. Overall, 90 C trachomatis-positive participants had one or more sexual partners enrolled.
Results: Evidence of transmission, as defined by infection concordance between partnerships, was observed among 75% of partners of index cases testing positive by both NAAT and traditional assay but only 45% of partners of index cases testing positive by NAAT only (prevalence ratio 1.7, 95% CI 1.1 to 2.5). Among index participants returning for follow-up, 17% had no evidence of C trachomatis infection by NAAT or traditional assay (median follow-up three weeks).
Conclusions: A substantial proportion of positive NAAT results for chlamydial infection may be of lower transmissibility and may not persist after a short follow-up. The long-term health effects of some positive NAAT are uncertain.
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Funding: Primary support for this research was provided by National Institutes of Health (NIH) grant R01-HD039633 to SMR. RR was supported in part by a grant from NCRR NIH 3M01RR00052-39-5(S1).
Competing interests: None.
Author contributions: SMR, WCM, CFT, PL, JE, RR and DK contributed to the conception and design of the study. SMR, WCM, CFT, JE, JZ, RR, CG and MH contributed to the acquisition of data. SMR, WCM, MAV, AA-T and DK contributed to questionnaire design. SMR, MAV and LG contributed to data management. SR, WCM, MAV and CFT contributed to the analysis and interpretation of data. All authors contributed to writing the manuscript.
Role of the funding source: The National Institutes of Health did not participate in the design and conduct of the study, in the collection, analysis, and interpretation of the data, or in the preparation, review, or approval of the manuscript. The corresponding author had full access to all of the data in the study and takes responsibility for the integrity of the data and the accuracy of the data analysis.