slide1 l.
Download
Skip this Video
Loading SlideShow in 5 Seconds..
Region I Laboratory Update CDC National Infertility Prevention Project Boston, Massachusetts November 15, 2010 PowerPoint Presentation
Download Presentation
Region I Laboratory Update CDC National Infertility Prevention Project Boston, Massachusetts November 15, 2010

Loading in 2 Seconds...

play fullscreen
1 / 15

Region I Laboratory Update CDC National Infertility Prevention Project Boston, Massachusetts November 15, 2010 - PowerPoint PPT Presentation


  • 153 Views
  • Uploaded on

Region I Laboratory Update CDC National Infertility Prevention Project Boston, Massachusetts November 15, 2010. Richard Steece, Ph.D., D(ABMM ) Laboratory Consultant CDC National Infertility Prevention Project DrRSteece@aol.com. Laboratory Update. CDC Laboratory Guidelines for

loader
I am the owner, or an agent authorized to act on behalf of the owner, of the copyrighted work described.
capcha
Download Presentation

PowerPoint Slideshow about 'Region I Laboratory Update CDC National Infertility Prevention Project Boston, Massachusetts November 15, 2010' - reed


An Image/Link below is provided (as is) to download presentation

Download Policy: Content on the Website is provided to you AS IS for your information and personal use and may not be sold / licensed / shared on other websites without getting consent from its author.While downloading, if for some reason you are not able to download a presentation, the publisher may have deleted the file from their server.


- - - - - - - - - - - - - - - - - - - - - - - - - - E N D - - - - - - - - - - - - - - - - - - - - - - - - - -
Presentation Transcript
slide1

Region I Laboratory UpdateCDC National Infertility Prevention ProjectBoston, MassachusettsNovember 15, 2010

Richard Steece, Ph.D., D(ABMM)

Laboratory Consultant

CDC National Infertility Prevention Project

DrRSteece@aol.com

laboratory update

Laboratory Update

CDC Laboratory Guidelines for

CT/GC and Syphilis

guidelines for the laboratory detection of chlamydia trachomatis and neisseria gonorrhoeae testing
Guidelines for the Laboratory Detection of Chlamydia trachomatis and Neisseria gonorrhoeae Testing

Recommendations from the expert consultation meeting

January 13-15, 2009

key questions ct gc
Key Questions (CT/GC)
  • Performance Characteristics
    • All culture and non-culture tests may generate false-positive and false-negative results
    • Nucleic acid amplification tests (NAATs) have superior performance to all other tests
    • Culture is still useful in certain circumstances
      • GC susceptibility testing
    • Serology
      • Should not be used for the Dx of non-LGV CT infections
key questions ct gc5
Key Questions (CT/GC)
  • Screening Applications
    • Vaginal swabs are the optimal specimen type for use with NAATs
      • Vaginal swab and urine specimens are not intended to replace cervical exams and endocervical specimens for the Dx of female urogenital infections
    • Urine is the preferred specimen type for testing males with NAATs
    • NAATs have superior performance to culture for the detection of rectal CT and GC infections and for the detection of pharyngeal GC infections
      • NAATs are not cleared for rectal and pharyngeal specimens by the FDA
key questions ct gc6
Key Questions (CT/GC)
  • Laboratory Confirmation
    • Routine repeat testing of NAAT positive specimens is not recommended for CT
    • Routine repeat testing of NAAT positive specimens is not recommended for GC unless there are a significant number of false-positive test results, in clinical studies, due to cross-reaction with non-gonococcal Neisseria species
    • Medico-legal issues (ASM Symposia 05-2010)
      • Data supports the use of NAATs in adult cases of sexual abuse
      • Limited data on the use of NAATs in cases involving children
cdc syphilis testing guidelines

CDC Syphilis Testing Guidelines

Recommendations from the expert consultation meeting

January 13-15, 2009

key questions syphilis
Key Questions (Syphilis)
  • Direct Detection of T. pallidum (Tp)
    • Darkfield Microscopy
    • Immunostaining
    • Nucleic Acid Amplification Tests
  • Congenital Syphilis
    • A reactive IgM test may be useful and should be used in conjunction with direct detection
    • A four-fold or greater ratio of neonatal to maternal titers is rarely useful
  • Neurosyphilis
    • Neurosyphilis cannot be diagnosed serologically
    • The use of VDRL in evaluating CSF may still be worthwhile
  • Serology
serology testing syphilis
Serology Testing(Syphilis)
  • Non-treponemal tests
    • RPR, VDRL, TRUST
  • Treponemal tests
    • FTA-ABS, TP-PA
    • EIA, CLIA, Microsphere
  • Point of Care tests
    • None available in U.S.
non treponemal screening
Non-Treponemal Screening

PROS

  • High Sensitivity
  • Low cost
  • Does not detect past infections
  • Requires little equipment for testing
  • Usually requires only one reflex test
  • Useful for treatment monitoring

CONS

  • Lower specificity
  • Labor-intensive
  • Subjective results
  • Manual data manipulations
treponemal screening
Treponemal Screening

PROS

  • High Sensitivity
  • High Specificity
  • Objective results
  • Automation / high throughput
  • Interface with LIS

CONS

  • Cannot distinguish between active and previously treated disease
  • Potential for over diagnosis and over treatment
  • May require more resources for EPI/DIS investigations
  • Specific, potentially costly instrumentation
  • May require multiple reflex tests for resolving discrepants
slide12

Non-Treponemal Test

RPR, VDRL, TRUST

Nonreactive

Not syphilis (or early syphilis)

Reactive

Titer

Treponemal Test

FTA-ABS, TP-PA

Reactive

Syphilis - Treat

Traditional Testing Algorithm Using Non-Treponemal Initial Screen

Nonreactive

False positive Non-Treponemal Test

Pope Infect Med 2004

slide13

A1

Syphilis EIA or CLIA

A1-

Negative for Syphilis antibodies

A1+

A2

Quantitative Nontreponemal (i.e. RPR)

A1+ A2-

A1+ A2+

Consistent with Syphilis (past or current infection)

A3

Treponemal Test that uses a different antigen or platform from A1 (i.e. TPPA, FTA)

A1+ A2- A3-

Unconfirmed EIA; Unlikely to be Syphilis; If patient is at risk for syphilis, re- test in 1 month

A1+ A2- A3+

Possible Syphilis infection; Requires further historical and clinical evaluation

Testing Algorithm Using EIA or CLIA as Initial Screen

* Laboratory should report the results of all three assays (if applicable) within 7 days

slide14
Guidelines for the Laboratory Detection of Chlamydia trachomatis and NeisseriagonorrhoeaeandSyphilis Testing Guidelines

Next Steps

  • Proceedings from the Expert Consultation Meetings is available on the APHL website
    • www.aphl.org/aphlprograms/infectious/std/Documents/CTGCLabGuidelinesMeetingReport.pdf
  • Publish the entire revised laboratory guidelines document as a Reports and Recommendations supplement in MMWR
    • Targeted for late 2010
the end

The End

Questions?