Session 5 – Molecular Diagnostics for Infectious Disease: The Good, the Bad, and the Ugly

Infectious Diseases account for a major burden of disease worldwide.  For STDs, for example, WHO estimated that 357 million new curable infections caused by Chlamydia trachomatis, Neisseria gonorrhea, Trichomonas vaginalis, and Treponema pallidum occurred in 2012. Molecular assays such a nucleic acid amplification assays (NAATs) are rapidly replacing older conventional diagnostic assays. There are now many commercially available NAATs for infectious diseases, especially chlamydia, gonorrhea, and trichomonas. Point-of-care (POC) assays are highly desirable where diagnostic results can be obtained rapidly and patients treated before leaving clinics. [The GOOD]. However, all molecular assays are often too expensive for low- and middle-income countries (LMIC). [The BAD].  Such assays, especially POC assay are improving in accuracy and will aide in diagnostic abilities. These POC tests can expedite appropriate therapy and reduce empiric overtreatment, which improves antibiotic stewardship. Overtreatment often happens with syndromic management instead of molecular/POC tests.  [The UGLY]. Treating infected patients before they leave a clinic can also reduce the period of transmission of an infectious disease while waiting for routine diagnostic test results. Of interest is the issue of self-collection of clinical specimens by patients, thus alleviating clinicians’ workload in some instances.  Good evidence exists that self-collection of swabs, such as vaginal, penile, rectal, and oropharyngeal swabs provide accurate results and are highly acceptable to patients. New, improved, and cheaper POC tests, used for LMIC, along with self-collection can assist progress towards ending STI epidemics. New diagnostic tools are available and providing the situational awareness and ability to employ them successfully is a goal to be achieved to reduce infectious diseases worldwide.

Charlotte Gaydos, DrPH MPH – Johns Hopkins University
Yukari Manabe, MD – Johns Hopkins University
Amy Krafft, PhD – National Institute of Allergy and Infectious Diseases, NIH
Barbara Van Der Pol, PhD, MPH, UAB
Catherine Klapperich, PhD, Boston University
Gary Schoolnik, MD – Stanford University, Click Diagnostics
Benjamin Larman, PhD, Johns Hopkins University
Adam de la Zerda, PhD, Stanford University, Click Diagnostics