Context: Neisseria gonorrhoeae is a Gram-negative diplococcus, an obligate human pathogen, and the etiologic agent of the sexually transmitted infection (STI), gonorrhoea. culture is the standard procedure for diagnosis, which may be supported by nucleic acid tests and microscopy. Aims: To determine the best possible method of diagnosis for Gonococcus infection in resource-limited settings. Settings and Design: The meta-analyses were designed to determine the difference in diagnosis between Culture and nucleic acid amplification tests (NAATs) and also between the different Amplification Tests and widely available Roche COBAS AMPLICOR test. Subjects and Methods: Databases searched were Pubmed, Medline, Google Scholar and Cochrane reviews. Risk ratio (RR) with 95% confidence intervals was estimated for the dichotomous outcomes. The random-effect model was applied for all the studies in the analysis. Statistical Analysis Used: The meta-analysis was computed in RevMan Version 5.3, Copenhagen, Denmark. Results: In the first analysis, NAATs significantly improved the chances of detection in comparison to the standard culture and final RR was 1.24 (1.05–2.51), which put the diamond on the right of no-effect axis, indicating more positives by NAATs. In the second analysis, AMPLICOR had the more positive results, which may have indicated better detection rate, as well as less specificity and final RR was 0.809 (0.737–0.888), which put the diamond on the left of the non-effect axis, indicating more positives by AMPLICOR. Conclusions: In a resource-limited scenario like India, the syndromic management of STIs are considered to be the norm. A positive diagnosis is only given if the tests are confirmed by Culture, as it is still considered to be the gold standard of diagnosis. However, in many cases, due to suboptimal transportation and lack of proper handling, culture in unable to grow even if the patient is infected. In such cases, Nucleic Acid Tests should be able to detect an infection.


中文翻译：

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在资源有限的情况下检测淋球菌感染的不同诊断程序的系统评价和荟萃分析


背景： 淋病奈瑟菌是一种革兰氏阴性双球菌，是一种人类专性病原体，也是性传播感染 (STI) 淋病的病原体。培养是诊断的标准程序，可能得到核酸检测和显微镜检查的支持。目的：确定资源有限地区淋球菌感染的最佳诊断方法。设置和设计：荟萃分析旨在确定培养和核酸扩增测试 (NAAT) 之间以及不同扩增测试和广泛使用的罗氏 COBAS AMPLICOR 测试之间的诊断差异。主题和方法：搜索的数据库包括 Pubmed、Medline、Google Scholar 和 Cochrane 评论。对二分结果估计具有 95% 置信区间的风险比 (RR)。随机效应模型应用于分析中的所有研究。使用的统计分析：荟萃分析在 RevMan 5.3 版中计算，哥本哈根，丹麦。结果：在第一次分析中，与标准培养相比，NAAT 显着提高了检测机会，最终 RR 为 1.24 (1.05-2.51)，这使菱形位于无效应轴的右侧，表明 NAAT 的阳性率更高。在第二次分析中，AMPLICOR 的阳性结果更多，这可能表明检出率更高，但特异性更低，最终 RR 为 0.809 (0.737–0.888)，菱形位于无效应轴的左侧， AMPLICOR 表明更多的积极因素。结论：在像印度这样资源有限的情况下，性传播感染的综合管理被认为是常态。只有通过文化确认测试才能给出阳性诊断，因为它仍然被认为是诊断的金标准。然而，在许多情况下，由于运输不理想和缺乏适当的处理，即使患者被感染，培养物也无法生长。在这种情况下，核酸检测应该能够检测到感染。