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Background: Genital Chlamydia trachomatis infection is a worldwide public health burden. A screening program for C. trachomatis was therefore initiated by the public health insurers in Germany ("Gemeinsamer Bundesausschuss", GBA) in April 2008., Objectives: To estimate C. trachomatis prevalence from screening 115,766 asymptomatic females and 20,033 female patients with unspecific abdominal pain., Study Design: Urine samples (pooled by five for the asymptomatic screening subjects) and cervical swabs were analyzed using semi-automated real-time PCR. Infection prevalence was determined separately in four categories of women, defined by health status (asymptomatic screening vs. non-screening with unspecified symptoms) and test material used. Comparative analyses were stratified by age and pregnancy status., Results: Experimental evaluation of the assay used revealed a detection limit of 379 genome copies/ml urine. For pooled urine samples, the positive predictive value was 100% whereas the negative predictive value equaled 98.1%. The observed infection prevalence was higher for cervical swabs than for urine samples. Prevalence estimates also differed significantly between pregnant and non-pregnant adolescents (< or = 20 years), irrespective of the test material used (10.2% vs. 7.3% for cervical swabs, 10.9% vs. 6.1% for pooled urine samples)., Conclusions: Our retrospective study, based upon a very large number of females from all parts of Germany, revealed a high infection prevalence in adolescents, particularly in pregnant adolescents, thereby justifying the screening directive of the German GBA., (Copyright 2009 Elsevier B.V. All rights reserved.)

Objective: To evaluate the effectiveness of systematic investigation for Group B Streptococcus (GBS) in urine samples to detect colonization in pregnant women., Methods: This study included 1036 pregnant women whose urine samples were cultured in our laboratory during 2006. Any colony consistent with GBS was identified in urine or in rectovaginal samples submitted for screening of GBS colonization., Results: GBS was recovered in urine samples from 111 of the 1036 women (10.7%), and in 77 of them bacterial count was <10(4) colony forming units/mL. Screening for GBS in rectovaginal samples was performed in 841 of the 925 pregnant women who did not have GBS bacteriuria (10.1% positive results) and in 61 of the 111 with GBS bacteriuria (60.7% positive results; no significant differences were found when results were stratified by colony count). Estimated rectovaginal colonization was 15.4%, and colonization exclusively detected in urine was 4.2%. Only 30% of pregnant women with GBS bacteriuria, but negative antenatal screening cultures who were admitted to our hospital for delivery received intrapartum antibiotic prophylaxis., Conclusions: Systematic investigation of the presence of GBS in urine samples from pregnant women improves the detection of carriers who are candidates for receiving intrapartum prophylaxis to prevent perinatal GBS infection, when compared with rectovaginal screening culture in the last trimester of gestation alone.

Objective: To test the utility of screening the urine samples used to diagnose pregnancies at urban teen clinics for Chlamydia trachomatis and Neisseria gonorrhoeae by polymerase chain reaction (PCR). We hypothesized that urine screening would increase the proportion of teenagers treated for these two sexually transmitted diseases (STDs) before they initiated pregnancy-related care., Design: A randomly selected subset of the urine samples used to diagnose 212 teen pregnancies were tested for C. trachomatis and N. gonorrhoeae by PCR. Endocervical testing was at the providers' discretion. Bivariate analyses were used to compare the teenagers randomized to the urine screening group (n = 102) and the non-screening group (n = 110)., Results: Of the 102 urine PCR tests, 14 (13.7%) were positive. Endocervical swabs were obtained in 31 (14.6%) of the 212 teenagers and five (16.1%) were positive. Since pelvic examinations were performed so infrequently, the net endocervical swab detection rate was significantly lower than the urine-based detection rate (1.8% compared to 13.7%; p = 0.001). Only one infected teenager was untreated when she initiated pregnancy-related care. Thus, the treatment rate was more than six times higher when urine samples were screened (12.7% compared to 1.8%; p = 0.003)., Conclusions: Screening the urine samples used to diagnose teen pregnancies for two common STDs is a simple, non-invasive procedure that is acceptable to providers and patients, and significantly increases the number of teenagers who are treated for genital infection before they initiate pregnancy-related care.

In order to develop a possible strategy for chlamydia testing throughout the British Pregnancy Advisory Service (BPAS), it was decided to first find the prevalence of the infection in women attending and to examine the practicalities involved in offering tests and dealing with positive results. Urine samples at initial consultation were tested by a method based on the Ligase Chain Reaction (LCR). Five hundred and eighty seven women were tested with an overall chlamydia positivity of 8.1 per cent, but of 12.4 per cent (25/202) in women up to and including 20 years of age. Tests in women over 25 years showed a positivity of only 0.7 per cent (1/147). Urine testing proved to be a convenient, non-intrusive means of chlamydia detection with the potential to lead to prompt management of positive cases. However, in comparison with EIA testing of endocervical swabs, detection of chlamydia in the population studied was not enhanced and some limitations were demonstrated, imposed by requirements for controlled temperature for transport and storage of specimens. Alternative approaches to testing and management was discussed. The time and commitment required to offer this service effectively were observed to be important factors when staff and client were focused on the direct issues relating to the current pregnancy. Modified request forms enabled uniform data to be collated in the laboratory and compared with that from other services currently studied. Ongoing monitoring of chlamydia positivity in this nationwide termination service could provide useful sentinel data about the infection.

Repeated screening for asymptomatic bacteriuria using a reagent strip-test was conducted in a population of 859 pregnant women. The women performed 4,125 tests at home, and 2,867 tests were performed by the nursing staff at the antenatal clinics. The tests done by the women at home had a higher predictive value than the tests done in the antenatal clinics (24% versus 10%). The sensitivity was 47%, specificity 90% and negative predictive value 98.8%. The tests performed by the women at home were well accepted and detected.

We evaluated a bioluminescence assay as a screening test for the detection of bacteriuria in pregnancy. A total of 1,000 urine specimens from a randomly selected group of pregnant women undergoing prenatal surveillance was investigated. Sequential dilution of urine specimens on CLED agar plates served as a reference method. Set against the reference group, bioluminescence screening scored a 93% sensitivity, a 78% specificity and a 99% predictive accuracy for negative results. All urine specimens were also analysed chemically for the presence of nitrite and leucocyte esterase by dip sticks. Dip sticks proved to be insufficient because of poor sensitivities of 54% and 59%, respectively. The bioluminescence assay is an effective, time- as well as labor-saving but questionably cost-effective method for the detection of bacteriuria in pregnancy.

Two hundred urine samples were obtained at the out-patient Obstetric-Gynecology Clinic, Loyola University Medical Center, from women in various stages of pregnancy. The specimens were screened for bacteriuria using a new dehydrated and miniaturized culture medium and the results compared with standard agar cultures. Of the urines examined, 6.5% proved to be bacteriuruic (greater than 10(5) organisms/ml) based on agar cultures; results from the new culture method correlated well, yielding 11 true positives versus 13 from the agar plate and only 2 false positives in 200.