Intended for healthcare professionals

Rapid response to:

Research

New point of care Chlamydia Rapid Test—bridging the gap between diagnosis and treatment: performance evaluation study

BMJ 2007; 335 doi: https://doi.org/10.1136/bmj.39402.463854.AE (Published 06 December 2007) Cite this as: BMJ 2007;335:1190

Rapid Response:

Chlamydia Rapid Test Vs Syndromic Manangement-Cost effectiveness in Resource Poor Setting.

It is indeed a fascinating finding to my mind to finally reach the
point of rapid testing for Chlamydia. Chlamydia up to this moment remains
the world's most prevalent sexually transmitted bacterial infection. The
diagnosis of this infection is increasing steadily in the developed world
where tools are not only readily available for testing but also the
awareness is there on the need to get tested. I say this in comparison to
the developing world, where doubtfully most of the infections may be
present but yet undiagnosed specifically as a result of unavailability of
essential tools for this purpose. The World Health Organization’s
recommendation for the low and middle -income countries which is the
syndromic diagnosis and management has been the practice up till now.

The advent of this novel approach to testing seems to be very well
appropriate to match the possible prevalence in the developing world
setting and the possible number of women that may require testing. Of
course, it would be more apposite than the previously preferred method of
testing which is the molecular test also known as nucleic acid
amplification tests (NAAT) which is based on amplification of the DNA that
is present in Chlamydia trachomatis. This is because the latter would
require training of staff, having readily available reagents and equipment
for this test, more hospital visits for patients, and loss of patients to
follow up because of weeks of waiting to get the result. (Looking from a
developing country viewpoint).

Comparing rapid test with the syndromic diagnosis and treatment, one
may be tempted to say, time has come to finally stop treating everyone
‘blindly’. That the true prevalence of Chlamydia can now be fully
documented, for further action to be taken in developing world by rapid
test, which is fast, less invasive or more private (very well appreciated
in some developing countries). However, the question of the cost
effectiveness of having specific diagnosis obtained before treatment
compared to the arguably effective syndromic approach would need further
research in resource poor settings. How sensitive and reproducible would
the test be following treatment of first suspicion?

Further questions that could be raised would be how the men would get
tested? Would this replace the urine test in men?

Competing interests:
None declared

Competing interests: No competing interests

05 December 2007
Olufunso S Ojo
Medical Doctor
Currently applying, UK