Value and feasibility of screening women attending STD clinics for cervical chlamydial infections

Rapid diagnosis of Chlamydia trachomatis infection in patients attending an ophthalmic casualty department

Direct immunofluorescence (DIF) techniques were compared with conventional cell culture for the diagnosis of ocular infections with Chlamydia trachomatis. The DIF test was found to have a sensitivity of 100% and a specificity of 97.5%. Of 178 patients studied, 19 patients (11%) were positive by DIF and 15 (8.4%) by conventional cell culture technique. Four patients who had previous treatment with chloramphenicol eye drops were negative by cell culture but positive by the DIF test. The DIF test is considered to be a rapid, accurate test with a number of advantages over culture techniques for the detection of C. trachomatis. The importance of appropriate referral of positive patients to prevent more serious sequelae due to C. trachomatis infection is discussed.

Evaluation of a genus reactive monoclonal antibody in rapid identification of Chlamydia trachomatis by direct immunofluorescence

This study compared the direct visualisation of elementary bodies in urogenital smears by the direct immunofluorescence test with the isolation of Chlamydia trachomatis in McCoy cell cultures treated with cytochalasin B. C trachomatis was isolated from 41 (16.4%) of 250 unselected specimens in McCoy cell cultures treated with cytochalasin B. Of the 41 culture positive specimens 37 (90%) were diagnosed by direct visualisation of elementary bodies in the smears using the direct immunofluorescence test. Four specimens were positive by isolation only and a further seven were positive by the direct immunofluorescence test only. Overall the direct immunofluorescence test had a sensitivity of 90% and a specificity of 97%. The presence of red blood cells or mucus or the use of barrier creams did not appear to interfere with the normal visualisation of elementary bodies using the direct immunofluorescence test.

A plea for rape victims

A woman was seen in the office several days after emergency department treatment for sexual assault. A cervical swab taken in the office grew Chlamydia trachomatis. No cultures for this organism had been taken in the emergency department, and the patient had not been given prophylactic antibiotics against Chlamydia. Physicians dealing with rape victims should culture for and cover with appropriate antibiotics for Chlamydia trachomatis, which is capable of causing pelvic inflammatory disease and eventual infertility or ectopic pregnancy.

Chlamydial infection: a common sexually transmitted disease

Chlamydia trachomatis infection is more prevalent than gonorrhea and causes a similar clinical picture. It is the prime cause of non-gonococcal urethritis in men and pelvic inflammatory disease in women. Its sequelae in women are ectopic pregnancy and infertility. It can be transmitted from an infected mother to her newborn child, leading to inclusion conjunctivitis and pneumonia. Tetracycline and erythromycin are effective in eradicating chlamydial infections, but the penicillins are not. Screening of high risk groups and special diagnostic facilities would help control this common sexually transmitted disease.

Chlamydia trachomatis infections in women with urogenital symptoms

Chlamydia trachomatis was isolated from 30 to 100 women attending a family physician's office with dysuria, frequency or vaginal discharge, compared with 2 of 30 asymptomatic women. Multiple infections were common: C. trachomatis coexisted with Gardnerella vaginalis, Candida albicans, Trichomonas vaginalis or a bacterial cause of urinary tract infection in 15 patients. C. trachomatis was isolated alone from 15 symptomatic women. The source of the positive culture was not always the site of symptoms. C. trachomatis was isolated from both the cervix and the urine of 9 patients, either simultaneously or sequentially. The probability of finding a chlamydial infection was 30% in young women with vaginal discharge alone, 33% in those with dysuria and frequency alone and 53% in those with abdominal or pelvic pain in addition to lower urogenital tract symptoms.

Chlamydial screening of pregnant women in a sexually transmitted diseases clinic

Fifty-three consecutive pregnant women seen over six months were screened for chlamydial infection, syphilis, gonorrhoea, trichomoniasis, and candidosis. Chlamydia trachomatis was isolated in 20 (37.7%) patients, of whom six were sexual partners of known cases of non-gonococcal urethritis (NGU) (two had associated gonorrhoea or candidosis) and six had gonorrhoea (three had associated trichomoniasis and candidosis). If treatment is given to contacts of NGU 14 patients with other presenting conditions would not have been treated unless chlamydial cultures had been performed. This may lead to potentially serious complications of chlamydial infection in both mothers and neonates.

Provision of a chlamydial culture service to a sexually transmitted diseases clinic

Urethral specimens from 215 men were inoculated on to McCoy cell cultures, both at the local laboratory and at a central reference laboratory, Chlamydia trachomatis was isolated from 58 (28%) patients; 12 of these isolates were, however, obtained only at the local laboratory. The results show the feasibility and convenience of a central laboratory supplying a peripheral laboratory with uninoculated prepared cell cultures. Such a service is not only more cost effective but obviates the problems of transporting specimens to a central laboratory.

The presentation and incidence of paratrachoma in adults

Thirteen definite and 3 probable cases of chlamydial eye infection were diagnosed in young adults attending the Bristol Eye Hospital between June 1978 and May 1980, and incidence of about 1 case per 44000 per year in the 15 to 44-year-old community served by this hospital, and 1 per 100000 in the total population of this community. These patients presented with a sub-acute follicular conjunctivitis or kerato-conjunctivitis, which had usually been present for several weeks and had often failed to respond to topical chloramphenicol treatment before presentation. Sera obtained from 14 patients, all had chlamydial antibody titres of 64 or more. Over the same period of time, an estimated 2500 patients per year from the same community attended the Venereology Department at the Bristol Royal Infirmary with genital chlamydial infections. These figures suggest that chlamydial infection of the eye complicates no more than 1 in 300 chlamydial infections of the genital tract in adults.

Cultural method for large-scale screening for Chlamydia trachomatis genital infection

Idoxuridine-treated McCoy cells grown as monolayers in 96 well microplates provide a convenient method for the isolation of Chlamydia trachomatis. Staining of infected monolayers with periodic acid-Schiff reagent (PAS) allows easy recognition of C trachomatis inclusions without the need for dark-ground microscopy. By this method 384 clinical specimens can be examined concurrently. It is sufficiently sensitive to form the basis of a chlamydial culture service for patients attending Sexually Transmitted Diseases (STD) Clinics.

Epidemiological and clinical correlates of chlamydial infection of the cervix

Of 474 women studied to identify epidemiological and clinical correlates of chlamydial infection of the cervix, Chlamydia trachomatis was isolated from 158 (33.3%) of all women, from 48.3% of those infected with Neisseria gonorrhoeae, from 43% of the sexual consorts of men with nongonococcal urethritis, and from 74% of those whose consorts were also infected with C trachomatis. C trachomatis was the sole pathogen found in 58 women. Age, marital state, occupation, past history of gonorrhoea, menstrual state, and symptoms had no predictive value. The isolation of C trachomatis was significantly associated with N gonorrhoeae, the use of oral contraceptives, cervical ectopy, cervicitis, and last sexual exposure more than one week previously. Except for three patients, none of the criteria alone or in combination was reliable enough to predict with acceptable accuracy that the 30 chlamydia-positive women among the 191 who were not infected with N gonorrhoeae and whose consorts were not known to have urethritis harboured chlamydia.

Chlamydial infection in homosexual men. Frequency of isolation of Chlamydia trachomatis from the urethra, ano-rectum, and pharynx

Urethral, rectal, and pharyngeal material from 150 men who had had exclusively homosexual contact and who consecutively attended a sexually transmitted diseases clinic was cultured for Chlamydia trachomatis. The organism was isolated from at least one site in 15 (105) patients. The isolation rates from the urethra, rectum, and pharynx were 6 . 7%, 4%, and 1 . 3% respectively.