Comparison of cervical, urethral and urine specimens for the detection of Chlamydia trachomatis in

Cervical, urethral, and first void urine (FVU) specimens from 937 women were tested for Chlamydia trachomatis by culture or EIA to determine the most sensitive combination of tests and specimens. For cervical and urethral specimens the prevalence of infection by culture or confirmed EIA was 7.2 % (67/937) at either site, 6.8 % (64/937) at the cervix, and 4.3 % (40/937) at the urethra. Of 67 specimens, 37 (55.2%) yielded a positive test from both the cervical and urethral swabs. Three (4.5%) ofthe 67 infections were only at the urethra and none were only in FVU. Only 37.3 % (25/67) of all positive women had a positive FVU. The most sensitive combina-tion was cervical swab culture and EIA, which detected 95.5 % (64/67) of the infections, a sub-stantial increase over culture only (76.1%) or EIA of the cervical swab (79.1%). The testing of urethral and FVU specimens apparently offers only minimal advantage over testing of cervical specimens only for chlamydia. Selective testing of women for Chlamydia trachomatis ap-pears efficient and cost effective [I, 2], but such consider-ations as use of culture or antigen assays and the best sites to sample [3, 4] have not been well studied, Whether a urethral swab in addition to a cervical swab gives an important im-provement in sensitivity is not clear [5-7]; unlike studies of infection in men, few studies have examined the role offirst void urine (FVU) for the diagnosis of infection in women [8, 9]. We report here the effect of sampling the cervix, urethra, and FVU and testing by culture and EIA for the identifica-tion of chlamydia-infected women attending family plan-ning clinics