{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,7,24]],"date-time":"2026-07-24T19:19:17Z","timestamp":1784920757136,"version":"3.55.0"},"reference-count":30,"publisher":"BMJ","issue":"8","funder":[{"name":"The Excellence Scholarship (Beasiswa Unggulan) Program, Ministry of Research, Technology and Higher Education, Republic of Indonesia"}],"content-domain":{"domain":["bmj.com"],"crossmark-restriction":true},"short-container-title":["BMJ Open"],"accepted":{"date-parts":[[2017,6,20]]},"published-print":{"date-parts":[[2017,8]]},"abstract":"<jats:sec>\n                    <jats:title>Introduction<\/jats:title>\n                    <jats:p>\n                      Gonorrhoea is a common sexually transmitted disease caused by\n                      <jats:italic>Neisseria gonorrhoeae<\/jats:italic>\n                      (Ng) infection. Light microscopy of urogenital smears is used as a simple tool to diagnose urogenital gonorrhoea in many resource-limited settings. We aimed to evaluate the accuracy of light microscopy to diagnose urogenital gonorrhoea as compared with a PCR-based test.\n                    <\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Methods<\/jats:title>\n                    <jats:p>In 2014, we examined 632 male urethral and 360 endocervical smears in clinic-based and outreach settings in Jakarta, Yogyakarta and Denpasar, Indonesia. Using the detection of Ng DNA by a validated PCR as reference test, we evaluated the accuracy of two light microscopic criteria to diagnose urogenital gonorrhoea in genital smears: (1) the presence of intracellular Gram-negative diplococci (IGND) and (2) \u22655\u2009polymorphonuclear leucocytes (PMNL)\/oil-immersion field (oif) in urethral or \u226520\u2009PMNL\/oif in endocervical smears.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>In male urethral smears, IGND testing had a sensitivity (95% CI), specificity (95%\u2009CI) and kappa\u00b1SE of 59.0% (50.1 to 67.4), 89.4% (86.3 to 91.9) and 0.49\u00b10.04, respectively. For PMNL count, these were 59.0% (50.1 to 67.4), 83.7% (80.2 to 86.9) and 0.40\u00b10.04, respectively. The accuracy of IGND in the clinic-based settings (72.0% (57.5 to 83.3), 95.2% (91.8 to 97.5) and 0.68\u00b10.06, respectively) was better than in the outreach settings (51.2% (40.0 to 62.3), 83.4% (78.2 to 87.8) and 0.35\u00b10.06, respectively). In endocervical smears, light microscopy performed poorly regardless of the setting or symptomatology, with kappas ranging from \u22120.09 to 0.24.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusion<\/jats:title>\n                    <jats:p>Light microscopy using IGND and PMNL criteria can be an option with moderate accuracy to diagnose urethral gonorrhoea among males in a clinic-based setting. The poor accuracy in detecting endocervical infections indicates an urgent need to implement advanced methods, such as PCR. Further investigations are needed to identify the poor diagnostic outcome in outreach services.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1136\/bmjopen-2017-016202","type":"journal-article","created":{"date-parts":[[2017,8,11]],"date-time":"2017-08-11T20:25:24Z","timestamp":1502483124000},"page":"e016202","update-policy":"https:\/\/doi.org\/10.1136\/crossmarkpolicy","source":"Crossref","is-referenced-by-count":4,"title":["Value of light microscopy to diagnose urogenital gonorrhoea: a diagnostic test study in Indonesian clinic-based and outreach sexually transmitted infections services"],"prefix":"10.1136","volume":"7","author":[{"ORCID":"https:\/\/orcid.org\/0000-0001-8200-3480","authenticated-orcid":false,"given":"I Putu Yuda","family":"Hananta","sequence":"first","affiliation":[{"name":"Deartment of Dermatology, Academic Medical Center, University of Amsterdam, Amsterdam, Noord Holland, The Netherlands"},{"name":"Department of Infectious Diseases, Public Health Service (GGD) of Amsterdam, Amsterdam, Noord Holland, The Netherlands"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Alje P","family":"van Dam","sequence":"additional","affiliation":[{"name":"Department of Infectious Diseases, Public Health Service (GGD) of Amsterdam, Amsterdam, Noord Holland, The Netherlands"},{"name":"Onze Lieve Vrouwe Gasthuis (OLVG) Hospital, Amsterdam, The Netherlands"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Sylvia Maria","family":"Bruisten","sequence":"additional","affiliation":[{"name":"Department of Infectious Diseases, Public Health Service (GGD) of Amsterdam, Amsterdam, Noord Holland, The Netherlands"},{"name":"Center for Infections and Immunology Amsterdam (CINIMA), Academic Medical Center, University of Amsterdam, Amsterdam, The Netherlands"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Maarten Franciscus Schim","family":"van der Loeff","sequence":"additional","affiliation":[{"name":"Department of Infectious Diseases, Public Health Service (GGD) of Amsterdam, Amsterdam, Noord Holland, The Netherlands"},{"name":"Amsterdam Infection and Immunity Institute (AI&II), Academic Medical Center, University of Amsterdam, Amsterdam, The Netherlands"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Hardyanto","family":"Soebono","sequence":"additional","affiliation":[{"name":"Department of Dermatology and Venereology, Faculty of Medicine, Universitas Gadjah Mada, Yogyakarta, Indonesia"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Henry John","family":"Christiaan de Vries","sequence":"additional","affiliation":[{"name":"Deartment of Dermatology, Academic Medical Center, University of Amsterdam, Amsterdam, Noord Holland, The Netherlands"},{"name":"Amsterdam Infection and Immunity Institute (AI&II), Academic Medical Center, University of Amsterdam, Amsterdam, The Netherlands"},{"name":"Department of Infectious Diseases, Public Health Service (GGD) of Amsterdam, Amsterdam, Noord Holland, The Netherlands"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"239","published-online":{"date-parts":[[2017,8,11]]},"reference":[{"key":"2025121515161478000_7.8.e016202.1","doi-asserted-by":"crossref","DOI":"10.1371\/journal.pone.0143304","article-title":"Global estimates of the prevalence and incidence of four curable sexually transmitted infections in 2012 based on systematic review and global Reporting","volume":"10","author":"Newman","year":"2015","journal-title":"PLoS One"},{"key":"2025121515161478000_7.8.e016202.2","unstructured":"Unemo M , Ballard R , Ison C , et al . 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