Region II Infertility Prevention Project New York City_ New York

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




  Richard Steece, Ph.D., D(ABMM)
National Infertility Prevention Project
           DrRSteece@aol.com
             Region II
 Infertility Prevention Project
           New York City, New York
                May 31, 2006

Supplemental Testing (Repeat Testing)

Alternate Specimens (vaginal, rectal and
pharyngeal)

CDC/APHL 2004 National STD Laboratory
Survey
         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.
    Alternate Specimens (vaginal,
        rectal and pharyngeal)


•   References
•   California Action Coalition (CAA)
•   CDC/FDA – Dr. Papp
•   Workshop NIAID (June 28-29, 2006)
Sexually Transmitted Diseases
  Laboratory Survey, 2004
     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 CDC’s 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
     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
   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 (n=61)
   – 34% county laboratories (n=41)
   – 10% city laboratories (n=12)
   – 2% U.S. territory laboratories (n=2)
   – 2% university laboratories (n=2)
   – 1% private laboratories (n=1)
• Focused on public health laboratories (95% of responding
  laboratories)
• Survey was completed by 114 of 144 public health
  laboratories (79% response rate)
Testing for Chlamydia and Gonorrhea
      Public Health Laboratories
                2000 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
           Status of Gonorrhea Culture
            Public Health Laboratories
                    2000 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
 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)
      Male Chlamydia Screening
            Consultation
                March 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 (<10%).

				
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