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Aid in the diagnosis of infections, including medical/legal cases caused by Chlamydia trachomatis (eg, cervicitis, trachoma, conjunctivitis, PID, pneumonia, urethritis, nongonococcal urethritis, pneumonitis, and sexually-transmitted diseases).
Culture may be negative in the presence of Chlamydia infection. Although culture is the legal standard, it is not the gold standard for the detection of C trachomatis. The sensitivity of culture is only 70% to 90% because C trachomatis may not survive transit to the laboratory, inadequate sampling, or low numbers of organisms in asymptomatic infection.1 Chlamydia pneumoniae is not detected/isolated in this culture.
This organism infects the endocervical columnar epithelial cells and will not be found in the inflammatory cells. In obtaining the specimen, clean the area of inflammatory cells and then attempt to use another swab to scrape epithelial cells for culturing. Stamm et al noted that Chlamydia trachomatis was recovered from approximately 50% of female patients with anterior urethral syndrome and “sterile” bladder urine.2 The results of cytological diagnosis of chlamydial infection of the female genital tract have been disappointing. Papanicolaou-stained cervical smears are not reliable enough to help establish or exclude the presence of Chlamydia. Dorman et al have noted that in patients with vaginal discharge or other genital tract symptomatology of unknown etiology, cervical cytology can be useful in identifying patients who should be cultured for Chlamydia.3 Direct immunofluorescence techniques and nucleic acid amplification assays are available to detect Chlamydia in clinical specimens. These methods usually provide reliable results in high- and low-prevalence populations and detect both viable and nonviable organisms.4 Urine culture for Chlamydia is not a sensitive procedure and generally should not be done. The incidence of cervical infection with Chlamydia trachomatis is two to three times that of gonorrhea: 4% to 9% in private office settings, 6% to 23% in family planning clinics, and 20% to 30% in sexually-transmitted diseases clinics.4
Culture should be the test-of-choice in cases of child abuse, rectal and throat infections, and when a test for cure is desired.
Chlamydia is a single genus and consists of the following:
• C trachomatis (serotypes A-K): inclusion conjunctivitis, trachoma, and genital infections
• C trachomatis (serotypes L1-L3): lymphogranuloma venereum
• C psittaci: psittacosis
• C pneumoniae (TWAR): respiratory infections
Serology to detect antibodies to all three species of Chlamydia is available.
1. Harper M, Johnson R. The predictive value of culture for the diagnosis of gonorrhea and Chlamydia infections. Clin Microbiol Newslet. 1990; 12:54-56.
2. Stamm WE, Wagner KF, Amsel R, et al. Causes of the acute urethral syndrome in women. N Engl J Med. 1980 Aug 21; 303(8):409-415. PubMed 6993946
3. Dorman SA, Danos LM, Wilson DJ, et al. Detection of chlamydial cervicitis by Papanicolaou stained smear and culture. Am J Clin Pathol. 1983 Apr; 79(4):421-425. PubMed 6837510
4. Phillips RS, Aronson MD, Taylor WC, Safran C. Should tests for Chlamydia trachomatis cervical Infection be done during routine gynecologic visits? An analysis of the costs of alternative strategies. Ann Intern Med. 1987 Aug; 107(2):188-194. PubMed 3300458 Barnes RC. Laboratory diagnosis of human chlamydial infections. Clin Microbiol Rev. 1989 Apr; 2(2):119-136. PubMed 2650858
Chirgwin K, Roblin PM, Gelling M, Hammerschlag MR, Schachter J. Infection with Chlamydia pneumoniae in Brooklyn. J Infect Dis. 1991 Apr; 163(4):757-761. PubMed 2010629
Fraiz J, Jones RB. Chlamydial infections. Annu Rev Med. 1988; 39:357-370. PubMed 3285782
Le Scolea LJ Jr. The value of nonculture chlamydial diagnostic tests. Clin Microbiol Newslet. 1991; 13(3):21-24.
Lombardo JM, Gadol CL. Chlamydia trachomatis: A perfect test? Clin Microbiol Newslet. 1990; 12(13):100-102.
Schachter J. Laboratory aspects of chlamydial infections. Adv Exp Med Biol. 1987; 224:73-77. PubMed 3329814
