@article {Bartelsman479, author = {M Bartelsman and M S van Rooijen and S Alba and K Vaughan and W R Faber and M Straetemans and H J C de Vries}, title = {Point-of-care management of urogenital Chlamydia trachomatis via Gram-stained smear analysis in male high-risk patients. Diagnostic accuracy and cost-effectiveness before and after changing the screening indication at the STI Clinic in Amsterdam}, volume = {91}, number = {7}, pages = {479--484}, year = {2015}, doi = {10.1136/sextrans-2014-051941}, publisher = {The Medical Society for the Study of Venereal Disease}, abstract = {Objectives To measure the effect of changing the point-of-care (POC) testing algorithm of urogenital chlamydia for all male high-risk patients to those with only symptoms with respect to: diagnostic accuracy, loss to follow-up, correctly managed consultations and costs.Methods Retrospective comparison of the diagnostic accuracy and cost-effectiveness of Gram-stained urethral smear analysis for the POC management of urogenital Chlamydia trachomatis infections. Between 2008 and 2009 Gram-stained urethral smear analysis was offered to all men irrespective of symptoms; between 2010 and 2011 only to those with symptoms. The Aptima CT assay was the reference diagnostic test.Results The number of examined Gram-stained smears in the two periods was respectively 7185 (2008{\textendash}2009 period) and 18 852 (2010{\textendash}2011 period). The sensitivity of the Gram stain analysis was respectively 83.8\% (95\% CI 81.2\% to 86.1\%) and 91.0\% (95\% CI 89.5\% to 92.3\%) (p\<0.001). The specificity was respectively 74.1\% (95\% CI 73.0\% to 75.2\%) and 53.1\% (95\% CI 51.8\% to 54.4\%) (p\<0.001). The positive predictive value was low in both periods, respectively 31.7\% (95\% CI 29.8\% to 33.6\%) and 35.6\% (95\% CI 34.1\% to 37.1\%) (p=0.002), whereas the negative predictive value was high, respectively 97.0\% (95\% CI 96.4\% to 97.4\%) and 95.4\% (95\% CI 94.6\% to 96.1\%) (p=0.002). The loss to follow-up rate between 2008{\textendash}2009 and 2010{\textendash}2011 was, respectively, 1.8\% (95\% CI 1.0\% to 2.9\%) vs 2.3\% (95\% CI 1.7\% to 3.0\%) (p=0.36). There was a small difference in overtreatment, 68.0\% (95\% CI 66.0\% to 69.8\%) vs 64.1\% (95\% CI 62.6\% to 65.5\%) (p=0.001). The cost per correctly managed consultation was 14.3\% lower in the 2010{\textendash}2011 period ({\texteuro}94.31 vs {\texteuro}80.82). The percentage of delayed treated infections was significantly lower in the 2008{\textendash}2009 period (10.5\%) compared with the 2010{\textendash}2011 period (22.8\%) (p\<0.001).Conclusions With a high sensitivity in male high-risk patients, the Gram-stained urethral smear is a useful POC test to detect urogenital C. trachomatis. When offered only to men with urogenital symptoms the specificity decreases but the cost per correctly managed consultation is reduced with 14.3\% without a significant difference in loss to follow-up but with a significantly higher rate of delayed treatment.}, issn = {1368-4973}, URL = {https://sti.bmj.com/content/91/7/479}, eprint = {https://sti.bmj.com/content/91/7/479.full.pdf}, journal = {Sexually Transmitted Infections} }