Gonorrhea laboratory tests: Difference between revisions
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==Laboratory tests== | ==Laboratory tests== | ||
Several laboratory tests are available to diagnose gonorrhea. A doctor or nurse can obtain a sample for testing from the parts of the body likely to be infected (cervix, urethra, rectum, or throat) and send the sample to a laboratory for analysis. Gonorrhea that is present in the cervix or urethra can be diagnosed in a laboratory by testing a urine sample.<ref name=CDC-Guid>Workowski, Kimberly A., and Gail A. Bolan. "Sexually transmitted diseases treatment guidelines (2015)." Reproductive Endocrinology 24 (2015): 51-56.http://www.cdc.gov/std/tg2015/gonorrhea.htm Accessed on September | Several laboratory tests are available to diagnose gonorrhea. A doctor or nurse can obtain a sample for testing from the parts of the body likely to be infected (cervix, urethra, rectum, or throat) and send the sample to a laboratory for analysis. Gonorrhea that is present in the cervix or urethra can be diagnosed in a laboratory by testing a urine sample.<ref name=CDC-Guid>Workowski, Kimberly A., and Gail A. Bolan. "Sexually transmitted diseases treatment guidelines (2015)." Reproductive Endocrinology 24 (2015): 51-56.http://www.cdc.gov/std/tg2015/gonorrhea.htm Accessed on September 22, 2016</ref><ref name=WHO-lab>Unemo M, Ison C. 2013. Gonorrhoea, p 21–54 In Laboratory diagnosis of sexually transmitted infections, including human immunodeficiency virus. World Health Organization (WHO), Geneva, Switzerland</ref> | ||
===Gram stain=== | ===Gram stain=== | ||
*Gram stain is highly sensitive and specific in men with symptomatic [[urethritis]]. However, because of lower sensitivity, detection of infection using Gram stain of endocervical, pharyngeal, and rectal specimens also is insufficient and is not recommended. | *Gram stain is highly sensitive and specific in men with symptomatic [[urethritis]]. However, because of lower sensitivity, detection of infection using Gram stain of endocervical, pharyngeal, and rectal specimens also is insufficient and is not recommended. | ||
*In symptomatic men, [[Polymorphonuclear leukocytes|polymorphonuclear leukocytes (PMNs)]] with intracellular [[Gram-negative diplococci]] can be considered diagnostic for infection with ''[[Neisseria gonorrhea]]''. | *In symptomatic men, [[Polymorphonuclear leukocytes|polymorphonuclear leukocytes (PMNs)]] with intracellular [[Gram-negative diplococci]] can be considered diagnostic for infection with ''[[Neisseria gonorrhea]]''. | ||
*Common anatomic sites for taking samples include:<ref name=CDC-Guid>Workowski, Kimberly A., and Gail A. Bolan. "Sexually transmitted diseases treatment guidelines (2015)." Reproductive Endocrinology 24 (2015): 51-56.http://www.cdc.gov/std/tg2015/gonorrhea.htm Accessed on September | *Common anatomic sites for taking samples include:<ref name=CDC-Guid>Workowski, Kimberly A., and Gail A. Bolan. "Sexually transmitted diseases treatment guidelines (2015)." Reproductive Endocrinology 24 (2015): 51-56.http://www.cdc.gov/std/tg2015/gonorrhea.htm Accessed on September 22, 2016</ref><ref name=WHO-lab>Unemo M, Ison C. 2013. Gonorrhoea, p 21–54 In Laboratory diagnosis of sexually transmitted infections, including human immunodeficiency virus. World Health Organization (WHO), Geneva, Switzerland</ref><ref name="pmid24622331">Centers for Disease Control and Prevention (2014) [https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&retmode=ref&cmd=prlinks&id=24622331 Recommendations for the laboratory-based detection of Chlamydia trachomatis and Neisseria gonorrhoeae--2014.] ''MMWR Recomm Rep'' 63 (RR-02):1-19. PMID: [https://pubmed.gov/24622331 24622331]</ref> | ||
**[[Cervical]] Gram stain in women | **[[Cervical]] Gram stain in women | ||
**[[Urethral|urethral discharge]] Gram stain in men | **[[Urethral|urethral discharge]] Gram stain in men | ||
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Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]; Associate Editor(s)-in-Chief: Sara Mehrsefat, M.D. [2]
Overview
Laboratory tests
Several laboratory tests are available to diagnose gonorrhea. A doctor or nurse can obtain a sample for testing from the parts of the body likely to be infected (cervix, urethra, rectum, or throat) and send the sample to a laboratory for analysis. Gonorrhea that is present in the cervix or urethra can be diagnosed in a laboratory by testing a urine sample.[1][2]
Gram stain
- Gram stain is highly sensitive and specific in men with symptomatic urethritis. However, because of lower sensitivity, detection of infection using Gram stain of endocervical, pharyngeal, and rectal specimens also is insufficient and is not recommended.
- In symptomatic men, polymorphonuclear leukocytes (PMNs) with intracellular Gram-negative diplococci can be considered diagnostic for infection with Neisseria gonorrhea.
- Common anatomic sites for taking samples include:[1][2][3]
- Cervical Gram stain in women
- urethral discharge Gram stain in men
- Synovial fluid Gram stain
-
![Neisseria gonorrhoeae in cervical smear using the Gram-stain[4]](/images/0/0c/Gonorrhea14.jpeg)
Neisseria gonorrhoeae in cervical smear using the Gram-stain[4]
-
![Urethral discharge for Neisseria gonorrhea revealed Gram-negative intracellular rods[4]](/images/a/a2/Gonorrhea13.jpeg)
Urethral discharge for Neisseria gonorrhea revealed Gram-negative intracellular rods[4]
-
![Intracellular Gram-negative diplococcal[4]](/images/a/aa/Gonorrhea05.jpeg)
Intracellular Gram-negative diplococcal[4]
![Neisseria gonorrhoeae in cervical smear using the Gram-stain[4]](/index.php/File:Gonorrhea14.jpeg)
![Urethral discharge for Neisseria gonorrhea revealed Gram-negative intracellular rods[4]](/index.php/File:Gonorrhea13.jpeg)
![Intracellular Gram-negative diplococcal[4]](/index.php/File:Gonorrhea05.jpeg)
Cultures
Culture is the historical standard for detection of Neisseria gonorrhea.
- Culture test dvantages over non-culture tests include:[1][5]
- Low cost
- Suitable for a variety of specimen sites
- Antimicrobial susceptibility testing can be performed
Thayer-Martin medium is one example of a medium used for Neisseria gonorrhoeae culture. Cultures can provide a preliminary diagnosis often within 24 hours and a confirmed diagnosis within 72 hours.
- Common anatomic sites for taking samples include:
- Vaginal and cervical culture
- Urethral discharge culture in men
- Throat swab culture
- Rectal culture
- Synovial fluid culture
- Blood cultures
Nucleic Acid Amplification Tests (NAATs)
NAATs are the most sensitive test to detect infections. Amplified tests include:[1][6][7]
- Polymerase chain reaction (PCR)
- Transcription-mediated amplification (TMA)
- Strand displacement amplification (SDA)
NAAT is FDA-cleared for:
- Endocervical swabs from women
- Urethral swabs from men
- Urine specimens from both males and females
- Vaginal swabs (some NAATs are clear)
NAAT is not FDA-cleared for detection of rectal, oropharyngeal, and conjunctival gonococcal infection.
- Some laboratories have met CLIA regulatory requirements and established performance specifications for using NAAT with rectal and oropharyngeal swab specimens that can inform clinical management.
- Antimicrobial susceptibility cannot be determined with these tests. However, the same specimen can be evaluated for Chlamydia trachomatis.
- There is a concern about cross-reactivity with other Neisseria species when used at the oropharyngeal site.[5]
Non-amplified tests
Non-amplified tests used for Neisseria gonorrhea include:
- DNA probe (e.g., Gen-Probe PACE 2 and Digene Hybrid Capture II)
Antimicrobial susceptibility cannot be determined with these tests. However, the same specimen can be evaluated for Chlamydia trachomatis.
Non disseminated gonococcal infection
Disseminated gonococcal infection
In general, disseminated gonococcal infection (DGI) should be consider in all young sexually active individuals (young women and all men who have sex with men) who present with arthralgias or joint pain or suspected septic arthritis. Laboratory findings for disseminated gonococcal infection (DGI) may include the following:[8]
Blood Culture
- Blood cultures are diagnostic and more likely to be positive in patients with arthritis-dermatitis syndrome (two sets of blood cultures need to be taken)
- Blood cultures are helpful in differentiating DGI from other conditions such as septic arthritis due to Neisseria meningitidis or Staphylococcus aureus
Synovial fluid
- Synovial fluid analysis is usually sent for cell count, differential, Gram stain, bacterial culture and NAAT in patients with suspected DGI[9]
- Synovial fluid cultures are positive for Neisseria gonorrhoeae in approximately 50% patients with purulant arthritis
- Synovial fluid cultures are less likely to be positive in patients with arthritis-dermatitis syndrome[10]
- Synovial fluid leukocyte count in gonococcal arthritis is approximately range from 10,000 cells/mm to 50,000 cells/mm3.[11]
- Synovial fluid glucose, lactate dehydrogenase, or protein in gonococcal arthritis have only limited value
Mucosal sites specimens
- Urogenital, rectal, and pharyngeal specimens should be sent for culture and NAAT in all patients with suspected DGI.
- Positive urogenital, rectal, or pharyngeal infection are generally seen in patients with DGI. However, most patients with DGI are asymptomatic at these sites.
Skin lesion specimens
- In the pustular skin lesions, the specimens can be sent for Gram stain, culture and NAAT
- NAAT and cultures are not routinely done in patients with suspected DGI[12]
References
- ↑ 1.0 1.1 1.2 1.3 Workowski, Kimberly A., and Gail A. Bolan. "Sexually transmitted diseases treatment guidelines (2015)." Reproductive Endocrinology 24 (2015): 51-56.http://www.cdc.gov/std/tg2015/gonorrhea.htm Accessed on September 22, 2016
- ↑ 2.0 2.1 Unemo M, Ison C. 2013. Gonorrhoea, p 21–54 In Laboratory diagnosis of sexually transmitted infections, including human immunodeficiency virus. World Health Organization (WHO), Geneva, Switzerland
- ↑ Centers for Disease Control and Prevention (2014) Recommendations for the laboratory-based detection of Chlamydia trachomatis and Neisseria gonorrhoeae--2014. MMWR Recomm Rep 63 (RR-02):1-19. PMID: 24622331
- ↑ 4.0 4.1 4.2 Centers for Disease Control and Prevention. Public Health Image Library (PHIL) http://phil.cdc.gov/phil/details.asp Accessed on September 22, 2016
- ↑ 5.0 5.1 Papp, John R., et al. "Recommendations for the laboratory-based detection of Chlamydia trachomatis and Neisseria gonorrhoeae—2014." MMWR. Recommendations and reports: Morbidity and mortality weekly report. Recommendations and reports/Centers for Disease Control 63 (2014): 1.http://www.cdc.gov/mmwr/preview/mmwrhtml/rr6302a1.htm
- ↑ Schachter J, Moncada J, Liska S, et al. Nucleic acid amplification tests in the diagnosis of chlamydial and gonococcal infections of the oropharynx and rectum in men who have sex with men. Sex Transm Dis 2008;35:637–42.
- ↑ Bachmann LH, Johnson RE, Cheng H, et al. Nucleic acid amplification tests for diagnosis of Neisseria gonorrhoeae oropharyngeal infections. J Clin Microbiol 2009;47:902–7.
- ↑ Rice PA (2005). "Gonococcal arthritis (disseminated gonococcal infection)". Infect Dis Clin North Am. 19 (4): 853–61. doi:10.1016/j.idc.2005.07.003. PMID 16297736.
- ↑ Muralidhar B, Rumore PM, Steinman CR (1994). "Use of the polymerase chain reaction to study arthritis due to Neisseria gonorrhoeae". Arthritis Rheum. 37 (5): 710–7. PMID 8185698.
- ↑ Liebling MR, Arkfeld DG, Michelini GA, Nishio MJ, Eng BJ, Jin T; et al. (1994). "Identification of Neisseria gonorrhoeae in synovial fluid using the polymerase chain reaction". Arthritis Rheum. 37 (5): 702–9. PMID 8185697.
- ↑ Goldenberg, D. L. "Gonococcal arthritis and other Neisserial infections." Arthritis and allied conditions, 12th ed. Philadelphia: Lea and Febiger (1993): 2025-33.
- ↑ Read P, Abbott R, Pantelidis P, Peters BS, White JA (2008). "Disseminated gonococcal infection in a homosexual man diagnosed by nucleic acid amplification testing from a skin lesion swab". Sex Transm Infect. 84 (5): 348–9. doi:10.1136/sti.2008.030817. PMID 18809698.