Accuracy of Screening Tests

Nucleic acid amplification tests (NAATs), such as polymerase chain reaction (PCR) and transcription-mediated amplification (TMA), can identify chlamydial infection in asymptomatic women (nonpregnant and pregnant) and asymptomatic men. NAATs have high sensitivity (>80%) and specificity (>99%) and can be used with urine, vaginal, and cervical swabs (Meyers et al., 2007). It is important to remember that even with a test with high sensitivity, in a low-prevalence population, a positive screening result is more likely to be a false positive than an actual case. When screening a 20-year-old woman with no other risk factors other than her young age, given a prevalence rate of 1%, the positive predictive value for a positive chlamydial screen with an NAAT is only 47%. Point-of-care tests are becoming available that can be conducted in the office setting in about 30 minutes. Their sensitivity remains substantially lower than for laboratory-conducted NAATs, although their specificity is high (Mahi-lum-Tapay et al., 2007).

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