Comparison of detection meth-ods for Chlamydia trachomatis in specimens obtained from pediatric victims of suspected sexual abuse.Confirmation was specified as use of another NAAT that utilized a different genetic target.The 2010 STD Guidelines now recommend that NAATs can be used in children with some limitations.Two studies evaluated LCR and an additional study evaluated PCR.
Two of the studies primarily evaluated girls, most of whom were postpubertal and many were consensually sexually active. These studies utilized LCR, an assay which was removed from the mar-ket in 2002 5. There were major limitations, including failure to use an independent reference standard in estimating test performance, and failure to separately analyze test performance by age and gender (when applicable). The third study evaluated PCR and an EIA to culture and also included many postpubertal girls. The data from these studies were insufficient to make any recommendation on the use of NAATs in children being evaluated for suspected sexual abuse. The study evaluated the use of SDA and TMA using urine and genital swabs (vagina and urethra) compared to culture for diagnosis of C. Cultures for C. trachomatis were performed at the clinical or hospital laboratories of each center, according to their own standard protocols. The commercial NAAT tests were performed at the CDC (SDA and TMA). All samples were processed and tested according to manufacturers protocols except for the TMA tests which were performed on previously frozen urine or swabs collected in the BD ProbeTec sample collection medium. There were no discrepant results in any of the participants tested by two commercial NAATs for C. In contrast, the sensitivities of urine and vaginal swab NAATs were 100 and 85 in all female children, respectively, for detection of C. One cannot extrapolate from these results to other NAATs, specifically PCR. One cannot extrapolate to extragential specimens. One cannot make any recommendations on the use of these assays in any site in prepubertal boys. Performing a confirmatory NAAT may be problematic as most hospital laboratories only use one assay. Some of the more recently available commercial NAATs, such as TMA (Aptima 2), offer an alternate target confirmation method that can be used on the same testing platform, however there are no data on the use of this confirmatory test in this setting. Additional options include sending blinded specimens to an independent or reference laboratory for confirmation testing, confirming a NAAT-positive result by culture test (requires a separate, invasive specimen), or use of a second, alternate technology commercial NAAT. All specimens should be retained for additional testing if necessary. No data are available regarding the use of NAATs in boys or for extragential specimens (e.g. Culture remains the preferred method for extragential sites.. ![]() As new NAATs become available they will have to be evaluated for this indication. In addition we also need more studies on the performance of these assays in boys and for extragential sites in children. Acquiring these data are very important as identification of C.
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