Detection of Chlamydia trachomatis in endocervical specimens by polymerase chain reaction

A rapid and sensitive polymerase chain reaction (PCR)-based assay for detection of Chlamydia trachomatis in cervical specimens is described. This assay consists of (i) sample preparation which avoids the use of heat, centrifugation, or organic extractions; (ii) rapid, two-temperature PCR amplification of C. trachomatis cryptic plasmid sequences; and (iii) capture and colorimetric detection of amplified DNA in microwell plates. PCR was compared with culture by using 503 cervical specimens. After resolution of discrepant specimens with a confirmatory PCR assay directed against the chlamydial major outer membrane protein gene, PCR had a sensitivity of 97% and a specificity of 99.7% while culture had a sensitivity of 85.7% and a specificity of 100%. In a separate study, PCR was compared with a direct specimen enzyme immunoassay (Chlamydiazyme; Abbott Diagnostics) by using 375 cervical specimens. After resolution of discrepant specimens, PCR had a sensitivity and specificity of 100%, while the enzyme immunoassay had a sensitivity of 58.8% and a specificity of 100%.

Multicenter evaluation of the AntigEnz Chlamydia enzyme immunoassay for diagnosis of Chlamydia trachomatis genital infection

To evaluate the AntigEnz Chlamydia enzyme immunoassay (EIA) (Baxter/Bartels, Issaquah, Wash.), we studied 320 men and 1,209 women attending clinics for sexually transmitted diseases in Baltimore, San Francisco, and Seattle. At examination, two separate swabs were obtained from each patient, one for chlamydial culture and one for EIA. Cervical samples were collected from women, and urethral samples were collected from men. The prevalence of chlamydial infection by culture was 9% in Baltimore (n = 532), 11% in Seattle (n = 500), and 9% in San Francisco (n = 497). To resolve specimens with discrepant culture and EIA results, the EIA transport buffer was centrifuged and the resuspended pellet was stained by direct immunofluorescence to determine whether elementary bodies were present. Overall sensitivity of the AntigEnz Chlamydia assay compared with culture was 87% in men and 86% in women, and overall specificities were 94 and 97%, respectively. Differences between centers were seen, with sensitivities ranging from 76% among men and 79% among women in Seattle to 100% among men and 95% among women in Baltimore. With a true positive considered to be either a culture-positive or an EIA- and direct immunofluorescence-positive specimen, the revised sensitivity was 91% in men and 88% in women. Overall revised specificity was 99% in both men and women. We conclude that in this high-prevalence population, the sensitivity and specificity of this assay compare favorably with those of other noncultural antigen detection tests for the diagnosis of chlamydial genital infection.

Comparison of cytobrushes with swabs for recovery of endocervical cells and for Chlamydiazyme detection of Chlamydia trachomatis

Endocervical swab and cytobrush specimens from 1,301 symptomatic women were microscopically analyzed for adequacy and tested using Chlamydiazyme (CZ) (Abbott Laboratories). When the swab specimen was collected first, blocking antibody-confirmed CZ-positive results were obtained from 48 (8.0%) of 599 patients, 42 (87.5%) from swabs and 46 (95.8%) from cytobrushes (not significant). When the swab specimen was collected second, confirmed CZ-positive results were obtained from 46 (6.6%) of 702 patients, 44 (95.6%) from swabs and 41 (89.1%) from cytobrushes (not significant). Cytobrushes offered no significant advantage over swabs for CZ detection of Chlamydia trachomatis.

Comparison of two culture approaches, blind passage and dual observation, for detecting Chlamydia trachomatis in various prevalence populations

Chlamydia trachomatis diagnosis in our laboratory consisted of dual inoculation of shell vials and detection of inclusions by using fluorescein-conjugated monoclonal antiserum; the second culture vial was conventionally used for blind passage when the first vial was negative. We compared the increase in positivity using blind passage with that of a strategy utilizing observation of two stained monolayers (dual observation) without blind passage, in an effort to reduce the reporting time and labor associated with the conventional approach. A total of 4,329 specimens were obtained from an obstetrics and gynecology (OB-GYN) clinic (2,563 specimens) and the sexually transmitted disease clinic (1,766 specimens). These specimens were used to compare the two strategies. Blind passage of 1,269 initially culture-negative specimens from the OB-GYN clinic resulted in an additional 6 positive chlamydial diagnoses. In comparison, a similar number of specimens (1,294) from the OB-GYN clinic collected subsequently to the first group were tested by dual observation. There were five additional positive findings. A similar evaluation of specimens from the sexually transmitted disease clinic was performed. Blind passage of 313 initially culture-negative specimens yielded 3 additional positive diagnoses, whereas dual observation of 1,435 similar specimens resulted in 9 positive diagnoses. On the basis of analysis of 4,332 specimens, sensitivity of dual observation is comparable to that of blind passage; labor, cost, and reporting time of dual observation are reduced in comparison to those of blind passage.

Infection with a plasmid-free variant Chlamydia related to Chlamydia trachomatis identified by using multiple assays for nucleic acid detection

Clinical samples in transport media from 40 patients exhibiting pathologies potentially caused by Chlamydia trachomatis infection were analyzed for chlamydial nucleic acid, and the results were compared with those of culture. Chlamydial culture was performed by a shell vial centrifugation method with HeLa 229 host cells. Polymerase chain reaction (PCR) assays were used to detect either regions on a 7.5-kb plasmid characteristic of C. trachomatis (plasmid-PCR) or a segment of the 16S rRNA genes (rRNA-PCR). All PCR results were confirmed by hybridization with probes for the specific amplified products in either a Southern or a dot blot format. An RNase protection (RNP) assay was used to detect genus-specific chlamydial 16S rRNA directly from the clinical samples. The PCR assays detected C. trachomatis but not other bacteria, including Chlamydia spp. C. trachomatis was isolated from six samples which were positive by the rDNA-PCR and plasmid-PCR assays. Five of the culture-positive specimens were positive by the RNP assay. Twenty-two samples were negative by all criteria. Surprisingly, nine samples were positive by rRNA-PCR and RNP assays only. Nucleic acid sequencing of the rRNA-PCR-amplified products indicated a close relationship between the variants and C. trachomatis. The data may indicate an unrecognized process in C. trachomatis infection or that these patients were infected by a variant strain of C. trachomatis which lacks the C. trachomatis-specific plasmid.

Evaluation of three immunoassays for detection of Chlamydia trachomatis in urine specimens from asymptomatic males

The performances of three commercially available immunoassays (Chlamydiazyme/Antibody Blocking Assay [Abbott Diagnostics, Abbott Park, Ill.], IDEIA [Analytab Products, Plainview, N.Y.], and Microtrak EIA [Syva Co. Palo Alto, Calif.]) were evaluated for the detection of Chlamydia trachomatis in urine specimens from asymptomatic males. Assay results were compared with direct specimen immunofluorescence (DFA) analysis of urine sediment (Syva Microtrak; Syva Co.), which was chosen as the study confirmation assay. An overall Chlamydia prevalence of 7% (24 of 340) was found in our study population, with peak incidences occurring in the adolescent (8 of 93 specimens) and young adult (11 of 146 specimens) age groups. Sensitivity and specificity data among the Chlamydiazyme, IDEIA, and Microtrak enzyme immunoassays (EIAs) were determined to be 79.1 and 99%, 91.7 and 98%, and 95.8 and 99%, respectively. The Microtrak EIA and IDEIA products demonstrated sensitivities and specificities equal to or greater than those claimed for urine specimens. The diagnostic accuracies of these assays on asymptomatic subjects, along with the ease of this collection method, suggest a role for these products as screening tools. The sensitivity of the Chlamydiazyme assay was lower than that claimed previously in symptomatic patients, with 5 of 24 positive specimens demonstrating false-negative results. In those cases, centrifugation of the original immunoassay aliquot material and then DFA examination confirmed specimen positivity. Urine immunoassay screening in combination with DFA confirmation (which was chosen because it has antibody epitopic specificity different from that of the primary assay) provides a high degree of diagnostic precision. The use of noninvasive collection methods could result in greater testing compliance among asymptomatic males and, subsequently, could reduce the incidences of both symptomatic and silent chlamydial infections.

A study of the incidence of urogenital Chlamydia trachomatis in patients attending specialized departments of Rome, Milan and Turin, Italy

A study of Chlamydia trachomatis was conducted in 5270 subjects seen at clinics of the Faculty of Medicine and Surgery at La Sapienza University in Rome, the S. Anna Hospital in Turin, and the Provincial Maternity Hospital Institute in Milan. In these areas, C. trachomatis was present in 5.8% of the cases examined; in addition it was present with statistically significant frequencies in cases of salpingitis (49.1) and epididymitis (21.7). It may also be found in cases of extrauterine pregnancy, sterility and abortion. Those most affected were women who had begun their sexual activity at an early age, were under 25, had several sexual partners and who used the coil and/or spermicides. A routine check for C. trachomatis should be considered for those women with those risk factors.

Update on bacterial sexually transmitted disease

Sexually transmitted diseases (STDs) are the most frequently reported bacterial infections. In 1990, slightly more than 700,000 cases of gonococcal disease were reported to the Centers for Disease Control, and the estimated incidence of chlamydial infections is 3 million to 4 million annually. Bacterial genital ulcer diseases such as syphilis and chancroid are increasing in epidemic proportions. The author reviews bacterial STDs in two categories: exudative mucosal infections and genital ulcer diseases.

Sexually transmitted diseases: bacterial infections. Committee on Sexually Transmitted Diseases of the American Academy of Dermatology

This update reviews the latest diagnostic and therapeutic methods regarding sexually transmitted diseases caused by bacteria. The following mucocutaneous bacterial disorders will be discussed: syphilis, chancroid, lymphogranuloma venereum, granuloma inguinale, and gonorrhea.

Approach to men with urethritis and urologic complications of sexually transmitted diseases

The most important causes of urethritis, and epididymitis in younger men, are C. trachomatis and N. gonorrhoeae. Management of these syndromes requires a thorough sexual history, genital examination, evaluation for objective and laboratory evidence of infection, antimicrobial therapy directed toward the major etiologies, and evaluation and treatment of sexual partners. Treatment of N. gonorrhoeae requires use of a single-dose regimen active against this organism, plus a 7- to 10-day tetracycline regime active against C. trachomatis and nongonococcal urethritis. With recommended regimens, microbiologic failure is infrequent in compliant patients. Recurrent urethritis is frequent, however. The management of patients with persistent or recurrent symptoms requires careful reevaluation of the patient, documentation of urethritis, and re-treatment with antimicrobials if urethritis is documented by positive cultures or increased numbers of polymorphonuclear leukocytes in urethral secretions. Additional treatment beyond this point usually is not indicated, even though a proportion of men will remain symptomatic and some of these will have increased numbers of polymorphonuclear leukocytes in urethral secretions. The most important causes of prostatitis, and epididymitis in older men or men with urethral structural abnormalities, are classical urinary tract pathogens rather than sexually transmitted pathogens. Management of these infections includes documentation of the infection and treatment directed toward the specific pathogen. Men with symptoms of "prostatitis" must be evaluated using both urine and prostatic secretions to document infection and inflammation. The majority of men with such symptoms do not have an infection that can be documented. These men respond poorly to medications. Men with documented chronic bacterial prostatitis require long courses of antimicrobials to effect cure. In some cases, however, the disease is intractable, and chronic suppression with antimicrobials may be necessary.

Epididymitis in the young adult male

Epididymitis, the most common intrascrotal inflammation, accounts for more than 600,000 yearly visits to health care providers in the United States. Previously though to be of idiopathic origin, most cases in young male adults now are recognized as arising from sexually transmitted pathogens. Appropriate assessment depends on a high index of clinical suspicion, evaluation for the presence of urethritis, and appropriate cultures. Antibiotic therapy is the most important aspect of treatment, and sexual partners must be evaluated and treated. The high incidence of this disorder and its implication for future male fertility present a challenge to the health care provider in the ambulatory care setting.

Recent developments in sexually transmitted diseases: chancroid--epidemiology, diagnosis, and treatment

The most important recent developments concerning chancroid have been in its epidemiology (a tremendous increase in the incidence of the disease in the United States over the past several years), diagnosis (better culture media), and treatment (several newer and older drugs that have been shown to be effective against chancroid in recent studies).

[A microbiology clinic in outpatient gynecologic service]

The authors report on their experiences gained at the sexually transmitted disease clinic they established at the First Department of Obstetrics and Gynecology of Semmelweis Medical University. A total of 456 patients presenting with signs and symptoms of lower genital tract infection have been examined in one year. The investigation of patients included aerobic and anaerobic culture of vaginal bacteria, vaginal smear and the identification of sexually transmitted Chlamydia trachomatis, Neisseria gonorrhoeae, Mycoplasmatales and Gardnerella vaginalis. The authors conclude that a sexually transmitted disease clinic is appropriate to contribute to the prevention of horizontal and vertical spread of the sexually transmitted bacterial infections.

Chlamydia trachomatis infections

The diversity in chlamydial syndromes and their consequences especially the impact on human reproduction and fertility, the asymptomatic characteristics of infections and the ever-increasing incidence have been the focus of considerable attention in the 1980s. The current status of the clinical spectrum of ocular-genital infections due to Chlamydia trachomatis and the laboratory tests for accurate, rapid diagnosis and effective treatment are reviewed.

Abdominal pain. Chlamydia as culprit

Chlamydia trachomatis infection in the lower part of the genital tract of young girls and women may ascend to produce endometritis, salpingitis, perihepatitis, and other localized or generalized abdominal diseases. The resultant pain syndromes mimic a number of other common conditions that must be differentiated. A careful history and physical examination, with attention to historical and physical evidence of sexually transmitted disease, will alert the clinician to the possibility of chlamydial infection. Laboratory tests for C trachomatis may be helpful. However, tests of specimens from the lower genitourinary tract may yield negative results in patients with disease of the upper part of the genital tract and abdomen. Prompt recognition and treatment not only alleviate pain but also may help prevent inflammatory sequelae such as chronic painful adhesions, small-bowel obstruction, and tubal infertility. Costly workups and unnecessary surgery may also be avoided.

In vitro activity of lomefloxacin against Chlamydia trachomatis, Neisseria gonorrhoeae, Haemophilus ducreyi, Mycoplasma hominis, and Ureaplasma urealyticum

The in vitro activity of lomefloxacin, a new difluorinated quinolone antimicrobial was compared to comparative agents against organisms causing sexually transmitted diseases. Against Chlamydia trachomatis, Mycoplasma hominis, Ureaplasma urealyticum, Neisseria gonorrhoeae, and Haemophilus ducreyi, lomefloxacin exhibited MIC90 of 2.0, 8.0, 8.0, less than or equal to 0.015, and 0.003 micrograms/ml, respectively. Overall, the lomefloxacin activity was very similar to ciprofloxacin.

[Serologic detection of sexually transmitted diseases caused by Chlamydia trachomatis]

163 patients were examined for the presence of C. trachomatis by cultivation and concurrently sera were examined by the ELISA method for the presence of antibodies against C. trachomatis. Significant titres of antibodies were detected in less than half the patients with infection proved by cultivation. Antibodies were found more frequently in patients with a complicated course of the disease. In approximately 3% of the patients, where the agent was not detected by cultivation, antibodies were found in high titres. The author evaluated also the possibility to use the complement fixation reaction with ornithose antigen for the diagnosis of sexually transmitted infections caused by C. trachomatis. According to the author's results this method cannot be used. Serological evidence of Chlamydia infection is not a method of first choice for the diagnosis of sexually transmitted infections caused by C. trachomatis, but is an important supplementary method for the diagnosis, mainly of complicated infections.

Pelvic inflammatory disease: education for maintaining fertility

PID is a serious health problem that affects the reproductive potential of women. Education regarding risk factors and prevention of PID are primary prevention strategies that can minimize loss of future fertility potential. Acute episodes of PID can be successfully managed by clinicians using a high index of suspicion and initiating prompt, aggressive treatment for patients and partners. Ongoing follow-up and counseling can minimize repetitive threats to reproductive loss and circumvent the need for reparative fertility surgery.

Nursing management of the patient with Chlamydia trachomatis infection

Information on the recognition and management of clinical syndromes commonly caused by Chlamydia should be widely disseminated. Clinicians must be able to make risk assessments on their patients who may have asymptomatic disease. Because chlamydial infections are often undiagnosed, infected patients continue to spread the organisms to their sexual partners and to neonates. Sexual contacts of patients with Chlamydia or gonorrhea should receive treatment regimens effective against both organisms. Patients who are infected with gonorrhea should receive treatment regimens effective against both organisms. Chlamydia culture is the gold standard for detection of the organism. Antigen detection methods have been developed that offer a low-cost alternative to culture, but these tests are not ideal. Chlamydia tests are not a substitute for clinical experience and risk assessment by the nurse practitioner.