{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2025,12,5]],"date-time":"2025-12-05T06:41:44Z","timestamp":1764916904302,"version":"3.46.0"},"reference-count":32,"publisher":"Frontiers Media SA","license":[{"start":{"date-parts":[[2025,12,5]],"date-time":"2025-12-05T00:00:00Z","timestamp":1764892800000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":["frontiersin.org"],"crossmark-restriction":true},"short-container-title":["Front. Public Health"],"abstract":"<jats:sec>\n                    <jats:title>Objectives<\/jats:title>\n                    <jats:p>\n                      This study evaluates the feasibility of a sample pooling strategy for\n                      <jats:italic>Chlamydia trachomatis<\/jats:italic>\n                      detection in pre-marital and pre-pregnancy screening in China, where pooled testing for CT remains limited despite its use in COVID-19 and HIV screening.\n                    <\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Methods<\/jats:title>\n                    <jats:p>From January to May 2024, 8,142 urine samples were collected from participants in pre-marital and pre-pregnancy health checks in Nanshan District. Positive urine samples with different Ct value ranges were selected, and negative urine samples were used as diluents to simulate mixed samples. We compared the sensitivity, specificity, and other metrics between the pooling tests and individual tests. A paired t-test was used to assess the statistical significance of the mean \u0394Ct values.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>\n                      The 6-sample pool (1 positive:5 negative) demonstrated high sensitivity (96.7%; 95% CI: 94.1\u201399.3%) with a mean Ct value of 35.6 (range: 33.6\u201337.4). The specificity was 100% (3\/3), PPV was 100% (175\/175), and NPV was 33.3% (3\/9). The total agreement with single testing was 96.7% (178\/184; 95% CI: 94.2\u201399.3%). The mean \u0394Ct value between single and pooled tests was 2.8 (range: 2\u20133.2), with a statistically significant difference (\n                      <jats:italic>p<\/jats:italic>\n                      \u2009&amp;lt;\u20090.05).\n                    <\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusion<\/jats:title>\n                    <jats:p>The 6-sample pooling strategy demonstrated acceptable sensitivity (96.7%) and significantly improved screening efficiency, suggesting its potential utility for large-scale pre-marital and pre-pregnancy screening programs in appropriate settings.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.3389\/fpubh.2025.1697573","type":"journal-article","created":{"date-parts":[[2025,12,5]],"date-time":"2025-12-05T06:29:55Z","timestamp":1764916195000},"update-policy":"https:\/\/doi.org\/10.3389\/crossmark-policy","source":"Crossref","is-referenced-by-count":0,"title":["Exploring Chlamydia trachomatis screening in Shenzhen: a cost-effective sample pooling strategy for pre-marital and pre-pregnancy populations"],"prefix":"10.3389","volume":"13","author":[{"given":"Li","family":"Zhang","sequence":"first","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Yannan","family":"Xu","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Hailing","family":"Ye","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Yu","family":"Xie","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Lishan","family":"Tian","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Qiuhong","family":"Wu","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Yi","family":"Ding","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Tao","family":"Zhang","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Lifeng","family":"Tong","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Xiangsheng","family":"Chen","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Jun","family":"Yuan","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"1965","published-online":{"date-parts":[[2025,12,5]]},"reference":[{"key":"ref1","doi-asserted-by":"publisher","first-page":"111","DOI":"10.1186\/1741-7015-9-111","article-title":"The epidemic of sexually transmitted infections in China: implications for control and future perspectives","volume":"9","author":"Chen","year":"2011","journal-title":"BMC Med"},{"key":"ref2","year":"2025"},{"key":"ref3","doi-asserted-by":"publisher","first-page":"596","DOI":"10.35541\/cjd.20200317","article-title":"Epidemiologic features of genital Chlamydia trachomatis infection at national sexually transmitted disease surveillance sites in China, 2015-2019","volume":"53","author":"Yue","year":"2020","journal-title":"Chin J Dermatol"},{"key":"ref4","doi-asserted-by":"publisher","first-page":"907","DOI":"10.1086\/428287","article-title":"The natural course of Chlamydia trachomatis infection in asymptomatic Colombian women: a 5-year follow-up study","volume":"191","author":"Molano","year":"2005","journal-title":"J Infect Dis"},{"key":"ref5","doi-asserted-by":"publisher","first-page":"333","DOI":"10.1177\/0956462415618837","article-title":"European guideline on the management of Chlamydia trachomatis infections","volume":"27","author":"Lanjouw","year":"2015","journal-title":"Int J STD AIDS"},{"key":"ref6","doi-asserted-by":"publisher","first-page":"1212890","DOI":"10.3389\/fpubh.2023.1212890","article-title":"Evaluation of Chlamydia trachomatis screening from the perspective of health economics: a systematic review","volume":"11","author":"Yao","year":"2023","journal-title":"Front Public Health"},{"key":"ref7","doi-asserted-by":"publisher","first-page":"1212","DOI":"10.1016\/j.cmi.2021.04.007","article-title":"Sample pooling: burden or solution?","volume":"27","author":"Grobe","year":"2021","journal-title":"Clin Microbiol Infect"},{"key":"ref8","doi-asserted-by":"publisher","first-page":"1248","DOI":"10.1016\/j.cmi.2020.06.009","article-title":"Large-scale implementation of pooled RNA extraction and RT-PCR for SARS-CoV-2 detection","volume":"26","author":"Ben-Ami","year":"2020","journal-title":"Clin Microbiol Infect"},{"key":"ref9","doi-asserted-by":"publisher","first-page":"436","DOI":"10.1214\/aoms\/1177731363","article-title":"The detection of defective members of large populations","volume":"14","author":"Dorfman","year":"1943","journal-title":"Ann Math Stat"},{"key":"ref10","doi-asserted-by":"publisher","first-page":"796","DOI":"10.1016\/j.pathol.2020.09.005","article-title":"Sample pooling is a viable strategy for SARS-CoV-2 detection in low-prevalence settings","volume":"52","author":"Chong","year":"2020","journal-title":"Pathology"},{"key":"ref11","doi-asserted-by":"publisher","first-page":"194","DOI":"10.1097\/QAI.0b013e3181ba37a7","article-title":"Pooled nucleic acid testing to identify antiretroviral treatment failure during HIV infection","volume":"53","author":"May","year":"2010","journal-title":"J Acquir Immune Defic Syndr"},{"key":"ref12","doi-asserted-by":"publisher","first-page":"e0243721","DOI":"10.1128\/spectrum.02437-21","article-title":"Three-stage pooled plasma hepatitis C virus RNA testing for the identification of acute HCV infections in at-risk populations","volume":"10","author":"Sun","year":"2022","journal-title":"Microbiol Spectr"},{"key":"ref13","doi-asserted-by":"publisher","first-page":"S59","DOI":"10.4103\/ijmr.IJMR_981_15","article-title":"Detection of Chlamydia trachomatis infections by polymerase chain reaction in asymptomatic pregnant women with special reference to the utility of the pooling of urine specimens","volume":"146","author":"Sethi","year":"2017","journal-title":"Indian J Med Res"},{"key":"ref14","doi-asserted-by":"publisher","first-page":"4866","DOI":"10.1128\/JCM.42.10.4866-4867.2004","article-title":"Pooling of clinical specimens prior to testing for Chlamydia trachomatis by PCR is accurate and cost saving","volume":"42","author":"Currie","year":"2004","journal-title":"J Clin Microbiol"},{"key":"ref15","doi-asserted-by":"publisher","first-page":"2480","DOI":"10.1128\/JCM.38.7.2480-2483.2000","article-title":"Pooling cervical swabs and testing by ligase chain reaction are accurate and cost-saving strategies for diagnosis of Chlamydia trachomatis","volume":"38","author":"Kapala","year":"2000","journal-title":"J Clin Microbiol"},{"key":"ref16","doi-asserted-by":"publisher","first-page":"324","DOI":"10.1016\/j.ijid.2020.08.063","article-title":"A simple approach to optimum pool size for pooled SARS-CoV-2 testing","volume":"100","author":"Regen","year":"2020","journal-title":"Int J Infect Dis"},{"key":"ref17","doi-asserted-by":"publisher","first-page":"693","DOI":"10.1111\/rssc.12085","article-title":"Optimal retesting configurations for hierarchical group testing","volume":"64","author":"Black","year":"2015","journal-title":"J R Stat Soc Ser C Appl Stat"},{"key":"ref18","doi-asserted-by":"publisher","first-page":"1679","DOI":"10.1128\/JCM.38.4.1679-1680.2000","article-title":"Pooling of urine specimens for detection of asymptomatic Chlamydia trachomatis infections by PCR in a low-prevalence population: cost-saving strategy for epidemiological studies and screening programs","volume":"38","author":"Morr\u00e9","year":"2000","journal-title":"J Clin Microbiol"},{"key":"ref19","doi-asserted-by":"publisher","first-page":"66","DOI":"10.1136\/sti.74.1.66","article-title":"Pooling of urine specimens for PCR testing: a cost-saving strategy for Chlamydia trachomatis control programmes","volume":"74","author":"Peeling","year":"1998","journal-title":"Sex Transm Infect"},{"key":"ref20","doi-asserted-by":"publisher","first-page":"481","DOI":"10.1128\/JCM.36.2.481-485.1998","article-title":"Pooling urine samples for ligase chain reaction screening for genital Chlamydia trachomatis infection in asymptomatic women","volume":"36","author":"Kacena","year":"1998","journal-title":"J Clin Microbiol"},{"key":"ref21","doi-asserted-by":"publisher","first-page":"1011","DOI":"10.3390\/antibiotics13111011","article-title":"Detection of Chlamydia trachomatis and Neisseria gonorrhoeae (and its resistance to ciprofloxacin): validation of a molecular biology tool for rapid diagnosis and treatment","volume":"13","author":"Peris","year":"2024","journal-title":"Antibiotics"},{"key":"ref22","doi-asserted-by":"publisher","first-page":"193","DOI":"10.35541\/cjd.20230712","article-title":"Guideline for the diagnosis and treatment of Chlamydia trachomatis urogenital infection in China","volume":"57","year":"2024","journal-title":"Chin J Dermatol"},{"key":"ref23","doi-asserted-by":"publisher","first-page":"1372","DOI":"10.1128\/JCM.43.7.1372-1373.2005","article-title":"Confirming positive results of nucleic acid amplification tests (NAATs) for Chlamydia trachomatis: all NAATs are not created equal","volume":"43","author":"Schachter","year":"2005","journal-title":"J Clin Microbiol"},{"key":"ref24","doi-asserted-by":"publisher","first-page":"1199740","DOI":"10.3389\/frph.2023.1199740","article-title":"Use of viability PCR for detection of live Chlamydia trachomatis in clinical specimens","volume":"5","author":"Vojtech","year":"2023","journal-title":"Front Reprod Health"},{"key":"ref25","doi-asserted-by":"publisher","first-page":"e122","DOI":"10.1097\/OLQ.0000000000001344","article-title":"Universal prenatal screening and testing and Chlamydia trachomatis conjunctivitis in infants","volume":"48","author":"Kohlhoff","year":"2021","journal-title":"Sex Transm Dis"},{"key":"ref26","doi-asserted-by":"publisher","first-page":"1967","DOI":"10.1001\/jama.2020.5445","article-title":"Sample pooling as a strategy to detect community transmission of SARS-CoV-2","volume":"323","author":"Hogan","year":"2020","journal-title":"JAMA"},{"key":"ref27","doi-asserted-by":"publisher","first-page":"107269","DOI":"10.1016\/j.ijid.2024.107269","article-title":"Spontaneous clearance of Chlamydia trachomatis and its associated factors among women attending screening for chlamydia in Shenzhen, China","volume":"149","author":"Zou","year":"2024","journal-title":"Int J Infect Dis"},{"key":"ref28","doi-asserted-by":"publisher","first-page":"541","DOI":"10.1136\/sextrans-2019-054267","article-title":"Spontaneous clearance of Chlamydia trachomatis accounting for bacterial viability in vaginally or rectally infected women (FemCure)","volume":"96","author":"Dukers-Muijrers","year":"2020","journal-title":"Sex Transm Infect"},{"key":"ref29","doi-asserted-by":"publisher","first-page":"112","DOI":"10.1097\/OLQ.0000000000001905","article-title":"A narrative review on spontaneous clearance of urogenital Chlamydia trachomatis: host, microbiome, and pathogen-related factors","volume":"51","author":"Klasner","year":"2024","journal-title":"Sex Transm Dis"},{"key":"ref30","doi-asserted-by":"publisher","first-page":"2580","DOI":"10.1128\/jcm.33.10.2580-2583.1995","article-title":"Improved PCR detection of Chlamydia trachomatis by using an altered method of specimen transport and high-quality endocervical specimens","volume":"33","author":"Kellogg","year":"1995","journal-title":"J Clin Microbiol"},{"key":"ref31","doi-asserted-by":"publisher","first-page":"400","DOI":"10.1002\/jcla.21932","article-title":"Sensitivity of the standard Chlamydia trachomatis culture method is improved after one additional in vitro passage","volume":"30","author":"Shao","year":"2016","journal-title":"J Clin Lab Anal"},{"key":"ref32","doi-asserted-by":"publisher","first-page":"111373","DOI":"10.1016\/j.microc.2024.11137","article-title":"Recent advances in laboratory detection of Chlamydia trachomatis using gold (au) nanoparticle-based methods; another evolution of nanotechnology in diagnostic bacteriology","author":"Moradi","year":"2024","journal-title":"Microchem J"}],"container-title":["Frontiers in Public Health"],"original-title":[],"link":[{"URL":"https:\/\/www.frontiersin.org\/articles\/10.3389\/fpubh.2025.1697573\/full","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2025,12,5]],"date-time":"2025-12-05T06:29:56Z","timestamp":1764916196000},"score":1,"resource":{"primary":{"URL":"https:\/\/www.frontiersin.org\/articles\/10.3389\/fpubh.2025.1697573\/full"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2025,12,5]]},"references-count":32,"alternative-id":["10.3389\/fpubh.2025.1697573"],"URL":"https:\/\/doi.org\/10.3389\/fpubh.2025.1697573","relation":{},"ISSN":["2296-2565"],"issn-type":[{"value":"2296-2565","type":"electronic"}],"subject":[],"published":{"date-parts":[[2025,12,5]]},"article-number":"1697573"}}