Accuracy of light microscopic criteria and syndromic approach to diagnose urogenital gonorrhoea in 632 males/transwomen in Jakarta, Yogyakarta and Denpasar, Indonesia (January–December 2014)
| Diagnosis criterion | N | Diagnosis outcome | Sensitivity | Specificity | PPV | NPV | Kappa± SE | |||||
| Ng-PCR positive n=134 (21.2%) | Ng-PCR negative n=498 (78.2%) | % (95% CI) | p | % (95% CI) | p | % (95% CI) | % (95% CI) | |||||
| Met criterion | Did not meet criterion | Met criterion | Did not meet criterion | |||||||||
| 1. PMNL | ||||||||||||
| Overall | 632 | 79 | 55 | 81 | 417 | 59.0 (50.1 to 67.4) | – | 83.7 (80.2 to 86.9) | – | 49.4 (41.4 to 57.4) | 88.4 (85.1 to 91.1) | 0.40±0.04 |
| Service settings | 0.018 | <0.001 | ||||||||||
| Clinic based | 301 | 36 | 14 | 21 | 230 | 72.0 (57.5 to 83.8) | 91.6 (87.5 to 94.8) | 63.2 (49.3 to 75.6) | 94.3 (90.6 to 96.8) | 0.60±0.05 | ||
| Outreach | 331 | 43 | 41 | 60 | 187 | 51.2 (40.0 to 62.3) | 75.7 (69.9 to 80.9) | 41.8 (32.1 to 51.9) | 82.0 (76.4 to 86.8) | 0.25±0.05 | ||
| Urogenital symptoms* | 0.07 | <0.001 | ||||||||||
| Absent | 523 | 59 | 48 | 50 | 366 | 55.1 (45.2 to 64.8) | 88.0 (84.5 to 91.0) | 54.1 (44.3 to 63.7) | 88.4 (84.9 to 91.3) | 0.42±0.04 | ||
| Present | 109 | 20 | 7 | 31 | 51 | 74.1 (53.7 to 88.9) | 62.2 (50.8 to 72.7) | 39.2 (25.8 to 53.9) | 87.9 (76.7 to 95.0) | 0.28±0.09 | ||
| 2. IGND | ||||||||||||
| Overall | 632 | 79 | 55 | 53 | 445 | 59.0 (50.1 to 67.4 | – | 89.4 (86.3 to 91.9) | - | 59.9 (51.0 to 68.3) | 89.0 (85.9 to 91.6) | 0.49±0.04 |
| Service settings | 0.018 | <0.001 | ||||||||||
| Clinic based | 301 | 36 | 14 | 12 | 239 | 72.0 (57.5 to 83.8 | 95.2 (91.8 to 97.5) | 75.0 (60.4 to 86.4) | 94.5 (90.9 to 96.9) | 0.68±0.06 | ||
| Outreach | 331 | 43 | 41 | 41 | 206 | 51.2 (40.0 to 62.3 | 83.4 (78.2 to 87.8) | 51.2 (40.0 to 62.3) | 83.4 (78.2 to 87.8) | 0.35±0.06 | ||
| Urogenital symptoms* | 0.07 | <0.001 | ||||||||||
| Absent | 523 | 59 | 48 | 30 | 386 | 55.1 (45.2 to 64.8 | 92.8 (89.9 to 95.1) | 66.3 (55.5 to 76.0) | 88.9 (85.6 to 91.7) | 0.51±0.04 | ||
| Present | 109 | 20 | 7 | 23 | 59 | 74.1 (53.7 to 88.9 | 72.0 (60.9 to 81.3) | 46.5 (31.2 to 62.4) | 89.4 (79.4 to 95.6) | 0.38±0.09 | ||
| 3. Urogenital symptoms* | ||||||||||||
| Overall | 632 | 27 | 107 | 82 | 416 | 20.2 (13.7 to 28.0) | – | 83.5 (80.0–86.7) | – | 24.8 (18.0 to 34.0) | 79.5 (79.5 to 82.9) | 0.04±0.04 |
| Service settings | <0.001 | 0.06 | ||||||||||
| Clinic-based | 301 | 19 | 31 | 49 | 202 | 38.0 (24.7 to 52.8) | 80.5 (75.0 to 85.2) | 27.9 (17.7 to 40.2) | 86.7 (81.7 to 90.8) | 0.16±0.06 | ||
| Outreach | 331 | 8 | 76 | 33 | 214 | 9.5 (4.2 to 17.9) | 86.6 (81.8 to 90.6) | 19.5 (8.8 to 34.9) | 73.8 (68.3 to 78.8) | −0.05±0.05 | ||
*Reported genital discharge and/or genital pain at the day of consultation.
IGND, intracellular Gram-negative diplococcus; Ng-PCR, Neisseria gonorrhoeae PCR; NPV, negative predictive value; p, p values calculated using χ2 test; PMNL, polymorphonuclear leucocytes; PPV, positive predictive value.