Region II Infertility Prevention Project New York City, New York May 31, 2006

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Region IIInfertility Prevention Project New
York City, New YorkMay 31, 2006

• Richard Steece, Ph.D., D(ABMM)
• National Infertility Prevention Project
• DrRSteece_at_aol.com

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Region IIInfertility Prevention Project New
York City, New YorkMay 31, 2006

• Supplemental Testing (Repeat Testing)
• Alternate Specimens (vaginal, rectal and
  pharyngeal)
• CDC/APHL 2004 National STD Laboratory Survey

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Supplemental Testing

• Zanto, et.al. Region VIII
• Gen-Probe ACT and AGC reagents can be used
  effectively as a supplemental test
• Supplemental testing (repeat Gen-Probe AC2) is
  equally as effective as an alternate target (ACT)
• Reporting the initial positive AC2 screening
  result in this low prevalence (7.5) population
  had a greater than 95 positive predictive value
  (PPV) for CT
• Reporting the initial positive AC2 screening
  result in this low prevalence (1.6) population
  had a 91.3 PPV for GC
• Based on these PPVs, supplemental or repeat
  testing need not be routinely performed with NAAT
  screening, resulting in cost savings.

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Alternate Specimens (vaginal, rectal and
pharyngeal)

• References
• California Action Coalition (CAA)
• CDC/FDA Dr. Papp
• Workshop NIAID (June 28-29, 2006)

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Sexually Transmitted Diseases Laboratory Survey,
2004
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Methods Laboratory Survey

• Surveyed 162 public, private and university
  laboratories in February 2005
• All members of the Association of Public Health
  Laboratories (APHL)
• All laboratories that participate in CDCs
  Regional Infertility Prevention Project
• An on-line survey was developed that requested
  the following information for calendar year 2004
• Volume and type of testing for chlamydia and
  gonorrhea
• Volume and type of testing for HSV, Trichomonas,
  Syphilis, Bacterial Vaginosis, HPV, and Pap Smears

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Methods Laboratory Survey

• An e-mail was sent to each laboratory director
  with link to survey
• 34/162 e-mails not successfully transmitted
  corrected some addresses and resent.
• 25/34 e-mails failed to transmit again FAXes
  sent to those lab directors with the link to the
  survey.
• Asked for responses in two weeks
• Non-responder follow-up
• 2 follow-up e-mails were sent at the end of weeks
  1 2
• Additional e-mails and phone calls were made
  after 3 weeks

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Results Laboratory Survey Response

• Survey was completed by 119 laboratories (73
  response rate)
• Responding laboratories were from 49 states and
  two U.S. territories
• 51 state laboratories (n61)
• 34 county laboratories (n41)
• 10 city laboratories (n12)
• 2 U.S. territory laboratories (n2)
• 2 university laboratories (n2)
• 1 private laboratories (n1)
• Focused on public health laboratories (95 of
  responding laboratories)
• Survey was completed by 114 of 144 public health
  laboratories (79 response rate)

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Testing for Chlamydia and Gonorrhea Public
Health Laboratories2000 vs. 2004
Sexually of Labs that
of all Tests that Transmitted
Reported Doing were
NAATs Disease NAATs

2000 2004
2000 2004 Chlamydia
58.0 87.0 24.5
63.5 Gonorrhea 38.4
78.7 11.7 60.8
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Status of Gonorrhea Culture Public Health
Laboratories2000 vs. 2004
Sexually of Labs that
of all Tests done Transmitted
Reported Doing that were
Culture Disease GC
Culture
2000
2004 2000 2004 Gonorrhea
79.8 77.8 18.0
8.5
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Laboratory Survey Next Steps

• Compiled and distributed survey results
• Available via the APHL website
• Distributed to IPP Coordinators (Word)
• Chlamydia and Gonorrhea data was presented in a
  poster at ISSTDR, July 2005
• Collected information from test kit manufacturers
• Number of CT GC test kits sold in 2004
• or sold to public health laboratories
• Prepared and submitted manuscript on survey
  results to JSTD (July)

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Male Chlamydia Screening ConsultationMarch
28-29, 2006

• Urine is the specimen of choice when screening
  males (NAATS)
• Leukocyte Esterase Test (LET) is not recommended
  in any venue.
• Pooling should strongly be considered in low
  prevalence populations (lt10).