Nucleic-Acid Amplification Test for STDs

Nucleic-acid amplification tests, also known as NAATs, are used to identify small amounts of DNA or RNA in test samples. They can, therefore, be used to identify bacteria, viruses, and other pathogens even when the material of interest is present in very small amounts. NAATs can even detect a variety of different sexually transmitted diseases (STDs). In fact, most urine tests for STDs are performed using NAATs.

A blood sample being held with a row of human samples for analytical testing including blood, urine, chemistry, proteins, anticoagulants and HIV in lab
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How Do Nucleic-Acid Amplification Tests Work?

Though there are several different kinds of NAATs, all are based on the same principles. First, scientists have to figure out the sequence of the nucleic acids they want to identify and make probes that will attach to them. Then, the NAAT uses a series of repeated chemical reactions to make numerous copies of the DNA or RNA that doctors are trying to detect. These reactions selectively amplify the signal of the interesting nucleic acids in the test sample so that they are easier to identify. It's much simpler to find 10,000 copies of a gene than 10.

What Does This Have to Do With STD Testing?

The process of amplifying bacterial or viral nucleic acids is not in itself the STD test. Instead, once the amount of DNA or RNA has been increased in the sample using PCR or LCR, more conventional tests are used to detect it.

These tests usually involve some form of nucleic acid hybridization. In those tests, the sample is probed with an artificially produced complementary strand of DNA or RNA that has been labeled in some way that makes it easy to detect. It may help to picture it as a glow in the dark tag that only sticks to one very specific piece of identifying information.

NAATs are incredibly useful for STD testing. They allow doctors to detect an STD pathogen even when only a very small number of organisms are present.

The nucleic acid test technology has made it possible to do urine testing for STDs that were previously only detectable by the swab.

Furthermore, since NAATs are incredibly sensitive to even small amounts of viral DNA, they are very important for screening the blood supply. These tests make it possible to detect tiny amounts of HIV and other blood-borne pathogens that might otherwise be missed.

Example of This Test in Action

NAATs are incredibly sensitive methods of detecting whether a bacteria or virus is present in a biological sample. When it comes to detecting genital herpes in a sore from a person who has symptoms, these tests serve as a viable alternative to viral culture. Viral cultures can be difficult for some laboratories to perform.

Unlike herpes blood tests, a NAAT still involves the direct determination of whether a virus is present in the sample rather than looking for anti-herpes antibodies.

Nucleic-acid amplification has also allowed for an expansion of chlamydia and gonorrhea screening around the country. Now such screening can now be done on urine samples instead of requiring a urethral or cervicovaginal swab. It has thus become easy to test large numbers of young men and women for these STDs in a variety of both clinical and non-clinical settings. Collecting urine requires no medical expertise. People are also more likely to be willing to pee in a cup than undergo a genital swab.

Researchers have also used NAATs to get more information about the extent of the problem of asymptomatic STDs in the United States. Large-scale NAAT-based screening programs have been implemented in the military, in urban teenagers, in men who have sex with men, and in other high-risk and low-risk groups. These tests allow for the detection of STDs in the small urine or blood samples that are often taken as part of large research studies on population health. 

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  3. Centers for Disease Control and Prevention. Recommendations for the laboratory-based detection of Chlamydia trachomatis and Neisseria gonorrhoeae--2014. MMWR Recomm Rep. 2014;63(RR-02):1-19.

  4. Rönn MM, Mc Grath-Lone L, Davies B, Wilson JD, Ward H. Evaluation of the performance of nucleic acid amplification tests (NAATs) in detection of chlamydia and gonorrhoea infection in vaginal specimens relative to patient infection status: a systematic review. BMJ Open. 2019;9(1):e022510. doi:10.1136/bmjopen-2018-022510

  5. Harbertson J, Scott P, Graf P, et al. 1583Randomized, Active-duty U.S. Military Population-based NAAT Screening for Asymptomatic Neisseria gonorrhoeae, Chlamydia trachomatis, and Trichomonas vaginalis Infection using De-identified Urine Samples Received by the Navy Drug Screening Laboratory, San Diego. Open Forum Infect Dis. 2014;1(suppl_1):S422-S422. doi:10.1093/ofid/ofu052.1129

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