TY - JOUR
T1 - Value of light microscopy to diagnose urogenital gonorrhoea: a diagnostic test study in Indonesian clinic-based and outreach sexually transmitted infections services
AU - Hananta, I. Putu Yuda
AU - van Dam, Alje P.
AU - Bruisten, Sylvia Maria
AU - Schim van der Loeff, Maarten Franciscus
AU - Soebono, Hardyanto
AU - de Vries, Henry John Christiaan
PY - 2017
Y1 - 2017
N2 - Introduction Gonorrhoea is a common sexually transmitted disease caused by Neisseria gonorrhoeae (Ng) infection. Light microscopy of urogenital smears is used as a simple tool to diagnose urogenital gonorrhoea in many resource-limited settings. We aimed to evaluate the accuracy of light microscopy to diagnose urogenital gonorrhoea as compared with a PCR-based test. Methods In 2014, we examined 632 male urethral and 360 endocervical smears in clinic-based and outreach settings in Jakarta, Yogyakarta and Denpasar, Indonesia. Using the detection of Ng DNA by a validated PCR as reference test, we evaluated the accuracy of two light microscopic criteria to diagnose urogenital gonorrhoea in genital smears: (1) the presence of intracellular Gram-negative diplococci (IGND) and (2) >= 5 polymorphonuclear leucocytes (PMNL)/oil-immersion field (oif) in urethral or >= 20 PMNL/oif in endocervical smears. Results In male urethral smears, IGND testing had a sensitivity (95% CI), specificity (95% CI) and kappa +/- SE of 59.0% (50.1 to 67.4), 89.4% (86.3 to 91.9) and 0.49 +/- 0.04, respectively. For PMNL count, these were 59.0% (50.1 to 67.4), 83.7% (80.2 to 86.9) and 0.40 +/- 0.04, respectively. The accuracy of IGND in the clinic-based settings (72.0% (57.5 to 83.3), 95.2% (91.8 to 97.5) and 0.68 +/- 0.06, respectively) was better than in the outreach settings (51.2% (40.0 to 62.3), 83.4% (78.2 to 87.8) and 0.35 +/- 0.06, respectively). In endocervical smears, light microscopy performed poorly regardless of the setting or symptomatology, with kappas ranging from -0.09 to 0.24. Conclusion Light microscopy using IGND and PMNL criteria can be an option with moderate accuracy to diagnose urethral gonorrhoea among males in a clinic-based setting. The poor accuracy in detecting endocervical infections indicates an urgent need to implement advanced methods, such as PCR. Further investigations are needed to identify the poor diagnostic outcome in outreach services
AB - Introduction Gonorrhoea is a common sexually transmitted disease caused by Neisseria gonorrhoeae (Ng) infection. Light microscopy of urogenital smears is used as a simple tool to diagnose urogenital gonorrhoea in many resource-limited settings. We aimed to evaluate the accuracy of light microscopy to diagnose urogenital gonorrhoea as compared with a PCR-based test. Methods In 2014, we examined 632 male urethral and 360 endocervical smears in clinic-based and outreach settings in Jakarta, Yogyakarta and Denpasar, Indonesia. Using the detection of Ng DNA by a validated PCR as reference test, we evaluated the accuracy of two light microscopic criteria to diagnose urogenital gonorrhoea in genital smears: (1) the presence of intracellular Gram-negative diplococci (IGND) and (2) >= 5 polymorphonuclear leucocytes (PMNL)/oil-immersion field (oif) in urethral or >= 20 PMNL/oif in endocervical smears. Results In male urethral smears, IGND testing had a sensitivity (95% CI), specificity (95% CI) and kappa +/- SE of 59.0% (50.1 to 67.4), 89.4% (86.3 to 91.9) and 0.49 +/- 0.04, respectively. For PMNL count, these were 59.0% (50.1 to 67.4), 83.7% (80.2 to 86.9) and 0.40 +/- 0.04, respectively. The accuracy of IGND in the clinic-based settings (72.0% (57.5 to 83.3), 95.2% (91.8 to 97.5) and 0.68 +/- 0.06, respectively) was better than in the outreach settings (51.2% (40.0 to 62.3), 83.4% (78.2 to 87.8) and 0.35 +/- 0.06, respectively). In endocervical smears, light microscopy performed poorly regardless of the setting or symptomatology, with kappas ranging from -0.09 to 0.24. Conclusion Light microscopy using IGND and PMNL criteria can be an option with moderate accuracy to diagnose urethral gonorrhoea among males in a clinic-based setting. The poor accuracy in detecting endocervical infections indicates an urgent need to implement advanced methods, such as PCR. Further investigations are needed to identify the poor diagnostic outcome in outreach services
U2 - https://doi.org/10.1136/bmjopen-2017-016202
DO - https://doi.org/10.1136/bmjopen-2017-016202
M3 - Article
C2 - 28801418
SN - 2044-6055
VL - 7
SP - e016202
JO - BMJ Open
JF - BMJ Open
IS - 8
ER -