What is the role of nucleic acid amplification tests (NAATs) in the workup of vaginitis?

Updated: Dec 04, 2018
  • Author: Hetal B Gor, MD, FACOG; Chief Editor: Michel E Rivlin, MD  more...
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Answer

The use of nucleic acid amplification tests (NAATs) has been implemented in many office and emergency settings. Tests such as polymerase chain reaction (PCR) can be performed by using swabs of the cervix or vagina or by collecting a urine sample. NAATs may be performed as a screen in pubertal and adult women. They may also be used for initial screening in prepubertal children, but in view of medicolegal concerns, confirmation testing should be ensured. [7]

DNA amplification assays of genital tract specimens are both sensitive and specific. First-void urine specimens for NAATs have also been shown to be sensitive and specific in females. They are less invasive than swabs, and with confirmation (eg, repeat testing with a different NAAT), urine NAATs may be used for the evaluation of chlamydial infection and gonorrhea in cases of suspected sexual abuse.

Although NAATs are generally performed to test for these common sexually transmitted diseases, their utilization for the diagnosis of bacterial vaginosis has also been studied, and they have been shown to be potentially more sensitive and specific than Gram staining and clinical diagnosis. [7, 8]

The Affirm DNA hybridization method is 80% sensitive for Trichomonas and 94% sensitive for bacterial vaginosis. Oligonucleotide probes detect high (> 107/mL) concentrations of Gardnerella vaginalis and can also can detect Candida. Antigen-detecting immunoassays, the Trichomonas Rapid Test (an enzyme-linked immunosorbent assay [ELISA] strip test with 80% sensitivity), DNA probes, and PCR are useful for detecting trichomonads.


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