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Article

Combination of Individual Tests to Improve Diagnostic Accuracy in Chlamydia trachomatis Detection

by
Jelena Tošić-Pajić
1,
Predrag Sazdanović
1,2,3,
Aleksandar Nikolov
1,2,4,
Dragan R. Milovanović
5,6,
Violeta Ninković
7,
Jelena Čukić
7,
Slobodan Subotić
8,
Marija Šorak
1,2,4,* and
Dejan Baskić
7,9
1
Center for Biomedically Assisted Fertilisation, University Clinical Center Kragujevac, 34000 Kragujevac, Serbia
2
Gynecology and Obstretics Clinic, University Clinical Center Kragujevac, 34000 Kragujevac, Serbia
3
Department for Anatomy, Faculty of Medical Sciences, University of Kragujevac, 34000 Kragujevac, Serbia
4
Department of Gynecology and Obstetrics, Faculty of Medical Sciences, University of Kragujevac, 34000 Kragujevac, Serbia
5
Department of Pharmacology and Toxicology, Faculty of Medical Sciences, University of Kragujevac, 34000 Kragujevac, Serbia
6
Department of Clinical Pharmacology, University Clinical Centre Kragujevac, 34000 Kragujevac, Serbia
7
Institute of Public Health Kragujevac, 34000 Kragujevac, Serbia
8
College of Health Studies “Milutin Milanković” Belgrade, 11000 Belgrade, Serbia
9
Center for Molecular Medicine and Stem Cell Research, Faculty of Medical Sciences, University of Kragujevac, 34000 Kragujevac, Serbia
*
Author to whom correspondence should be addressed.
Medicina 2025, 61(4), 714; https://doi.org/10.3390/medicina61040714
Submission received: 14 March 2025 / Revised: 3 April 2025 / Accepted: 5 April 2025 / Published: 12 April 2025
(This article belongs to the Special Issue Management and Diagnosis of Infertility and Recurrent Abortions in Obstetrics and Gynecology)
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Abstract

Background and Objectives: Chlamydial infection is the most common asymptomatic infection worldwide. Despite all national programs, strategies and guidelines, chlamydial infection is still the leading infection worldwide, especially in young populations. We have tried to summarize the best diagnostic tools for its detection. Materials and Methods: In the study, 225 sexually active patients who were tested for chlamydial infection at the Institute of Public Health Kragujevac participated. Results: Combinations of direct immunofluorescence (DIF) and a rapid lateral immunochromatographic test (RT) and combinations of an RT and immunoglobulin G (IgG) do not improve diagnostic efficiency when compared to a rapid test that individually had the best parameters. In situations that require high specificity, the recommended combination is RT/IgA, which as a highly specific test has few false positive results, while the combinations of DIF + RT and RT + IgG, although showing a specificity of 100%, have low sensitivity (33.30%), due to which we prefer the RT/IgA combination. The combinations DIF + RT, DIF + RT + IgG and RT + IgG, although with low sensitivity, have the highest values of specificity, and the positive predictive value (PPV) and negative predictive value (NPV) show the highest values of the extended Youden index of 130.30% and the highest values of total diagnostic accuracy of 97.00%. Based on the results of the extended Youden index, taking into account PPV and NPV, the RT/IgA combination shows the highest value of 94.60%, as well as the highest value of total diagnostic accuracy of 93.00%. Conclusions: “Two or more positive tests” or “any test positive” did not improve the diagnostic efficiency compared to a single “rapid test”.
Keywords: Chlamydia trachomatis; diagnostic accuracy; combination of tests; single test; efficiency Chlamydia trachomatis; diagnostic accuracy; combination of tests; single test; efficiency

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MDPI and ACS Style

Tošić-Pajić, J.; Sazdanović, P.; Nikolov, A.; Milovanović, D.R.; Ninković, V.; Čukić, J.; Subotić, S.; Šorak, M.; Baskić, D. Combination of Individual Tests to Improve Diagnostic Accuracy in Chlamydia trachomatis Detection. Medicina 2025, 61, 714. https://doi.org/10.3390/medicina61040714

AMA Style

Tošić-Pajić J, Sazdanović P, Nikolov A, Milovanović DR, Ninković V, Čukić J, Subotić S, Šorak M, Baskić D. Combination of Individual Tests to Improve Diagnostic Accuracy in Chlamydia trachomatis Detection. Medicina. 2025; 61(4):714. https://doi.org/10.3390/medicina61040714

Chicago/Turabian Style

Tošić-Pajić, Jelena, Predrag Sazdanović, Aleksandar Nikolov, Dragan R. Milovanović, Violeta Ninković, Jelena Čukić, Slobodan Subotić, Marija Šorak, and Dejan Baskić. 2025. "Combination of Individual Tests to Improve Diagnostic Accuracy in Chlamydia trachomatis Detection" Medicina 61, no. 4: 714. https://doi.org/10.3390/medicina61040714

APA Style

Tošić-Pajić, J., Sazdanović, P., Nikolov, A., Milovanović, D. R., Ninković, V., Čukić, J., Subotić, S., Šorak, M., & Baskić, D. (2025). Combination of Individual Tests to Improve Diagnostic Accuracy in Chlamydia trachomatis Detection. Medicina, 61(4), 714. https://doi.org/10.3390/medicina61040714

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