OBJECTIVE: To determine utility of a polymerase chain reaction(PCR) based urine screening for C. trachomatis (CT) in the care of females in an urban adolescent clinic.

METHOD: Study design was a cross-sectional screening of non-sterile, random samples of urine with a PCR-based lab test for CT(PCR-CT). Females ≥ 15 years of age attending the target clinic between 3/95 and 11/95 were approached consecutively with an explanation of the study:“CT is one of the most common STD among young women; may remain free of symptoms for a long time; a urine screening is offered; if positive, treatment will be offered”. Reason(s) for the index visit, past history of CT, gonorrhea (GC) and PID, and genitourinary/ abdominal (GU) complaints were obtained from each subject. An endocervical CT culture was done during the index visit, if the subject had a clinical indication for pelvic exam at the index visit.

RESULTS: 315 subjects (75% B, 25% W; mean age 17 yrs) were enrolled. Primary reason for the visit was family planning in 41%, check-up in 32%, contact with STD in 2% and a wide range of other complaints in the rest. A GU complaint was present in 24%. Reported Hx of STDs were: CT in 16%, GC in 11% and PID in 7%. 27% (86) had an endocervical CT culture during the index visit. A positive urine PCR-CT was identified in 47 (15%). A pelvic examination with a CT culture of endocervical swab was done in 40% (19/47) of those with positive urine PCR-CT; the remaining 28 were not among those who had pelvic examinations.

CONCLUSION: Utility of PCR-based urine screening for CT in care of adolescent females is demonstrated in this study. A urine specimen is much easier to collect than an endocervical swab and the result of PCR-CT, if batched and performed daily, is available within 24 hours in contrast to 48-72 hours for the culture. Without PCR-CT, 60%(28/47) of CT infected cases in our study would have been undiagnosed.