The previous gold standard of cell culture is being outperformed by more sensitive molecular techniques; confirmatory studies of discrepant test results frequently find true positives that were negative by cell culture. Amplification tests based on the detection of chlamydial DNA or specific chlamydial ribosomal RNA are now available. Both detect C. trachomatis in urine or in self-administered vaginal swab specimens, with sensitivity comparable to that obtained with urogenital swab specimens, and make noninvasive testing for chlamydial infections possible (Gaydos et al., 2004; Johnson et al., 2002).
Recent prevalence studies of C. trachomatis infection in sexually active adolescent girls suggest that testing for C. trachomatis should be offered twice per year to this population (Johnson et al., 2002). A recent cost effectiveness study in women attending family planning clinics revealed that a strategy that combined use of PCR on cervical specimens in women receiving pelvic examinations, and PCR of urine in women with no medical indication for a pelvic examination prevented the most cases of pelvic inflammatory disease and provided the highest cost savings (Howell et al., 1998).
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