Chlamydia Trachomatis Proportion on Urine and Endoservical

Swabs in Non Specific Genital Infection with Polymerase Chain

Reaction Method

Mutia Sari, Isramiharti, Qaira Anum, Hardisman, Andani Eka Putra

Dermato-Venereology Department of Dr. M Djamil Hospital/

Medical Faculty of Andalas University, Padang, West Sumatera, Indonesia

Keywords: diagnostic test, specimen urin,specimen endoservic swabs, PCR.

Abstract: Non-specific genital infection (NSGI) is a sexually transmitted infection such as inflammation in the urethra,

rectum, or cervix caused by germs nonspecific. Causes of Chlamydia trachomatis most IGNS that

approximately 30-50%. Center for diseases control and prevention recommend a type specimen for laboratory

examination CT in women can be derived from the urine, endocervical swabs and vaginal swabs. Urine

specimens procedure is easier and less invasive. Objective: To know the results of the urine specimen and

endoservical swabs as a diagnostic specimen test on a non-specific genital infections caused by Chlamydia

trachomatis. Subject and method: A cross-sectional study conducted in patients who had been diagnosed

with non-specific cervicitis at the Outpatient Clinic Dermatology Venereology Dr. M. Djamil Hospital

Padang. The total number of samples 39. Chlamydia trachomatis is checked by PCR. This study was

conducted from June 2015 - April 2017. Result: The proportion of positive results on non-specific cervicitis

caused by Chlamydia trachomatis with PCR were found both in urine specimens and endocervical swabs

(2.5%), only on urine specimens (21%) and only on endocervical swabs (8%).Conclusion: The proportion of

positive results in urine specimens of patients with non-specific genital infections caused by Chlamydia

trachomatis was higher than endocervical swabs specimens.

1 INTRODUCTION

Non-specific genital infections (NSGI) are sexually

transmitted infections (STIs) of inflammation in the

urethra, rectum, or cervix caused by non-specific

germs. The term NSGI began to be used in the UK

since 1972, covering a range of non ur specific

conditions of urethritis and cervicitis non specific in

women (Lumintang, 2007).The causes of most

Chlamydia trachomatis (CT) NSGI are about 30-

50%, whereas 10-20% of cases are caused by

Ureaplasma urealyticum and or Mycoplasma

genitalium. (Handy P, 2010), (Horner 2014).

Clinical symptoms of NSGI caused by CT may be

urethritis, cervicitis, endometritis, salpingitis,

perihepatitis. The Center for Disease Control and

Prevention (CDC) recommends that laboratory

specimen type for CT in women may be from urine,

endocervical swabs and vaginal swabs. In first catch

urine (FCU) or first portion of urine as genital lavage

and sample containing material from the urethra.

(Centers for Disease Control and Prevention, 2010)

(Haugland, 2010). The gold standard diagnostic tool

for CT-induced IGNS detection is PCR. PCR

examination method there are two conventional PCR

and real time. (Fraga ,2008). In this study the authors

use conventional PCR as a tool of examination.

Deoxyribose nucleic acid (DNA) from CT can be

found in the urine because of frequent ureter

infections in NSGI caused by CT, so that PCR can

detect CT on a urine specimen. (Chernesky, 2005).

The research aims to support the results of several

studies that support the urine specimen can be used

for NSGI examination caused by CT, such as Earlia

N, et al. (Surabaya, 2010) reported PCR examination

results in 22 non-specific genital infection patients,

with positive results in 16 samples of urine specimens

(72.7%) and 14 samples of endocervical smear

(63.6%).

Blake DR, et al. (USA, 2008) obtained a

comparison of test specimens for CT with DNA probe

tests, obtained sensitivity of urine specimens and

endocervical swabs having the same value: (91.7%).

Sari, M., Anum, Q., Hardisman, . and Putra, A.

Chlamydia Trachomatis Proportion on Urine and Endoservical Swabs in Non Speciﬁc Genital Infection with Polymerase Chain Reaction Method.

DOI: 10.5220/0008154402230226

In Proceedings of the 23rd Regional Conference of Dermatology (RCD 2018), pages 223-226

ISBN: 978-989-758-494-7

223

(Roberts, 2011). The aim of our study was to estimate

the positive proportion of urine specimens and

endoservical swabs on non-specific genital infections

caused by Chlamydia trachomatis.

2 MATERIALS AND METHODS

This study is an observational analytic study with

cross-sectional design. The study was conducted at

the Division of Sexually Transmitted Infections of

Outpatient Clinic Dermatology Venereology of Dr.

M. Djamil Hospital Padang and Microbiology

Laboratory

Medical Faculty of Andalas University.

Subjects were patients with a diagnosis non-specific

genital infection patients of who came to Division of

Sexually Transmitted Infections of Outpatient Clinic

at the of Dr. M. Djamil Hospital Padang. The study

was approved by the Ethics Committee of Medical

Faculty of Andalas University Padang.

The number of samples is determined by the

consecutive sampling method. The samples in this

study were 39 who matched the inclusion and

exclusion criteria. The study was conducted from

January - February 2017.

3 RESULTS

Table. 1 show the highest age group of the study was

the 26-35 years (43.6%). The level of education of

patients has the same value for medium to low

(48.7%). Most of patients as unemployement (51%),

married status (62%), free sex (67%) and

contraception IUD (67%).

Table 1.Demographic characteristic of cervicitis non

spesific

Characteristic

f (n = 39)

Age

17-25 4 10

26-35 17 44

36-45 13 33

46-55 3 8

56-65 1 3

Education

Low 19 49

Medium 19 49

High 1 2

Occupation

Work 19 49

Unemployement 20 51

Marital status

Married 24 62

Divorce 15 38

Free sex

Never 11 28

Ever 26 67

Type of

Contraceptive

Oral 12 31

IUD 26 67

Condom 1 2

Table 2. Show positive examination results of

urine specimens with PCR in non-specific cervicitis

caused by Chlamydia trachomatis were present

(23%).

Table 2. Examination results of urine specimens with PCR

in non-specific cervicitis caused by Chlamydia trachomatis.

Chlamydia trachomatis

on urine specimens

f %

Positive 9 23

ative 30 77

Total 39 100

Tabel 3. Show positive examination result of

endoservic swabs with PCR in non-specific cervicitis

caused by Chlamydia trachomatis were present

(10%).

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224

Table 3. Examination result of endoservic swabs with PCR

in non-specific cervicitis caused by Chlamydia trachomatis.

Chlamydia trachomatis

On endoservic swabs

F %

Positive 4 10

ative 35 90

Total 39 100

Table 4. Show positive results of examination on

non-specific cervicitis caused by Chlamydia

trachomatis with PCR were found both in urine

specimens and endocervical swabs (2.5%), only on

urine specimens (21%) and only on endocervical

swabs (8%).

Table 4. Results of examination on non-specific cervicitis

caused by Chlamydia trachomatis with PCR on urine

specimens and endocervical swabs

Specimens

Urine

Specimen Endocervic

swabs

Positive Negative

Positive 1 8

Negative 3 27

4 DISCUSSION

Based on age, this study found the age group 26-35

years suffered the most non-specific cervicitis

followed by the second most with the age range 36-

45 years. Chlamydia trachomatis infection is most

common in young women, because in this age it is a

productive age for sexual intercourse so the

possibility of getting a sexually transmitted infection

is higher and is often found in cervical ectopics.

(Sirait, 2002)

In this study PCR examination results to detect

Chlamydia trachomatis found positive results in 9

samples of urine specimen (23%) and 4 samples

endocervic swabs (10%). This study has more

positive results on urine specimens than endocervical

swabs, as well as Earlies N (Surabaya, 2010) reported

positive test results on urine specimens (72.7%) and

endocervical swabs (63.6%) with conventional PCR

Amplicor® kit.( Earlia,2010)

Mittal V (India, 2010) reported positive results

examination on urine specimens with PCR (11.11%)

in 10 patients from 90 total patients with genital

infection. (Mittal,2010). This study had positive

results on urine specimens (23%), which is higher

than Mittal V (11.11%). The difference betwen this

study is samples taken are those who have been

diagnosed with non-specific cervicitis, whereas in the

study Mittal V patients who entered into the inclusion

criteria when suffering from genital infections only

with genital discharge complaints.

Quinn TC, et al. (Georgia, 1996) reported positive

results with PCR on urine and endocervical

specimens (70%), urine specimens (18%) and

endocervical specimens (12%). There are multiple

study with positive results only on urine specimens or

endocervical swabs specimens alone may reflect the

finding that 10% to 20% of infected women may be

infected only locally on the urethra or locally on

endocervix alone without involvement from the other

side. (Quinn, 1996).Different with this study found

positive results in both of urine and endocervical

specimens (2.5%), urine specimens (20%) and

endocervical specimens (7.6%).

Initial infection of Chlamydia trachomatis may

occur in the cervix or urethra. Complaints may

include abnormal discharge and burning during

urination. (Reza, 2015)There is possibility many of

these studies initial infection of Chlamydia

trachomatis in the urethra, so this factor that caused

more Chlamydia trachomatis in the urine in this study

because urine contains epithelial cells of urethra.

Although most Chlamydia trachomatis infections

occur in the cervix. (Wiesenfeld,1996).

Lumintang H. Infeksi genital non spesifik. In:

Daili SF, Makes WIB, Zubier F, Judanarso J, editors.

Infeksi menular seksual. 3rd edition. Jakarta: Balai

Penerbit FKUI; 2007.h.77-83.

5 CONCLUSIONS

The proportion of positive results in urine specimens

of patients with non-specific genital infections caused

by Chlamydia trachomatis was higher than

endocervical swabs specimens.

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