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

2. 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

3. 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.

4. Alternate Specimens (vaginal, rectal and pharyngeal)
References
California Action Coalition (CAA)
CDC/FDA – Dr. Papp
Workshop NIAID (June 28-29, 2006)

5. Sexually Transmitted Diseases Laboratory Survey, 2004
***Introduction Slide

6. 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

7. Methods: Laboratory Survey
An was sent to each laboratory director with link to survey
34/162 s not successfully transmitted; corrected some addresses and resent.
25/34 s 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 s were sent at the end of weeks 1 & 2
Additional s and phone calls were made after 3 weeks

8. 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)

9. Testing for Chlamydia and Gonorrhea Public Health Laboratories 2000 vs
Sexually % of Labs that % of all Tests that
Transmitted Reported Doing were NAATs
Disease NAATs
Chlamydia
Gonorrhea

10. 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
Gonorrhea

11. 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)

12. 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%).