What is the role of polymerase chain reaction (PCR) and ligand chain reaction (LCR) in the workup of gonorrhea?

Updated: Sep 07, 2018
  • Author: Brian Wong, MD; Chief Editor: Pranatharthi Haran Chandrasekar, MBBS, MD  more...
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Answer

PCR and ligand chain reaction (LCR) are gene amplification techniques that markedly increase the sensitivity of specimen testing. Both techniques amplify the genetic fingerprint of specimens with very few organisms present in order to more easily detect and identify the organisms.

These methods have a high sensitivity and a high specificity (78.6% and 96.4%, respectively). They are easily performed on urethral specimens and can even be performed on first-void urine specimens. PCR and LCR are noninvasive, rapid, sensitive, and specific, and they have facilitated the diagnosis of gonococcal infection. [45] However, they cannot report antibiotic sensitivities; therefore, these techniques do not eliminate the need for culture in these patients.

In addition, specific molecular tests may produce erroneous results. [43] In certain circumstances, it may be advisable, in consultation with a medical microbiologist, to take a sample for culture or to perform a second molecular test aimed at a different part of the bacterial genome.

N gonorrhoeae was identified as the causative agent in a case of culture-negative dermatitis-arthritis syndrome using real-time PCR. [46] This technology can improve the speed and sensitivity of diagnosis and consequent management of patients with this syndrome.

Some studies have been shown promise in the use of DNA polymerase chain reaction (PCR) assay for porA pseudogene detection, possibly even in nongenital sites. [47]


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