Region II Infertility Prevention Project New York City

Region II Infertility Prevention Project New York City, New York May 31, 2006 Richard Steece, Ph. D. , D(ABMM) National Infertility Prevention Project Dr. RSteece@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 AC 2) is equally as effective as an alternate target (ACT) – Reporting the initial positive AC 2 screening result in this low prevalence (7. 5%) population had a greater than 95% positive predictive value (PPV) for CT – Reporting the initial positive AC 2 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 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 Gonorrhea GC Culture 2000 2004 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%).