Chlamydia

Test Description

Chlamydia trachomatis is the most common cause of sexually transmitted disease
in the United States. It is also responsible for trachoma, a serious eye infection.
Chlamydia can cause cervicitis, urethritis, epididymitis, and proctitis. Mode of
transmission for this bacterium includes direct contact through sexual activity or
direct contact of the infant with the mother’s cervix during birth. Although prevalent,
the disease is often unrecognized. Many women with chlamydial infections are
asymptomatic. However, the consequences of untreated chlamydial infection in
women include the development of pelvic inflammatory disease, resulting in possible
infertility. Thus, testing for the organism is very important. This is accomplished
through either a culture of the cervix or eye, or through detection of the antigen by
enzyme-linked immunosorbent assay (ELISA) technique. DNA testing using polymerase
chain reaction (PCR) methodology is the newest method of testing for
Chlamydia. This is done on female endocervical swabs, male urethral swabs, or on
urine specimens.
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THE EVIDENCE FOR PRACTICE


The Centers for Disease Control recommend testing in the following cases:
• All sexually active females under 20 years of age (test at least annually).
• Women ages 20 and older who have one or more risk factors (test annually).
            • Risk factors include having new or multiple sex partners, having sex with someone
            who has other partners, and not using barrier contraceptives, such as condoms.
• All women with an infection of the cervix.
• All pregnant women.
• Men with painful and frequent urination (dysuria), penile discharge, infection of the
  prostate (prostatitis), or inflammation involving the anus and rectum (proctitis).
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Normal Values         Culture: Negative
                                Antibody testing: Negative
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Possible Meanings of Abnormal Values

Positive
Chlamydia infection
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Contributing Factors to Abnormal Values

• Drugs which may cause false-negative results: antibiotics, immunosuppressive
  drugs.
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Interventions/Implications

Pretest

• Explain to the patient the purpose of the test and the need for a specimen to be collected.
• No fasting is required prior to the test.

Procedure
For antibody testing
• A 7-mL blood sample is drawn in a red-top collection tube.
• Gloves are worn for this procedure.

  For eye culture
• Cleanse any mucus from the eye with a dry cotton swab.
• Use a sterile swab to swab the inner canthus or lower conjunctiva.
• Place the swab in the medium required by the reference laboratory.
• Gloves are worn for this procedure.

For cervical culture
• The female patient is assisted into the lithotomy position, draped, and encouraged to
relax through deep breathing techniques.
• A vaginal speculum lubricated with warm water is inserted.
• Cervical mucus is removed using a large cotton swab.
• A dry, sterile cotton swab is then inserted into the endocervical canal and rotated from
side to side.
• Place the swab in the medium required by the reference laboratory.
• Gloves are worn throughout this procedure.

For a urethral culture
• The male patient is assisted into a supine position. This position is recommended to avoid
    falling if vasovagal syncope occurs during the procedure. Such a reaction would be characterized
    by profound hypotension, bradycardia, pallor, and diaphoresis.
• The urethral meatus is cleansed with sterile gauze.
• A calcium alginate swab or a sterile bacteriologic wire loop is inserted 2 to 3 cm into the
urethra and rotated from side to side.
For urine testing
• Instruct the patient not to urinate for 1 hour prior to collection.
• The patient should collect the first 15 to 50 mL of voided urine (the first part of the
stream) in a plastic, preservative-free, sterile urine collection cup.
• Gloves are worn when handling urine specimen.

Posttest

• Apply pressure at venipuncture site. Apply dressing, periodically assessing for continued
  bleeding.
• Refrigerate any urine specimen immediately at 2 to 8°C.
• Label any specimen and transport it to the laboratory as soon as possible.
• Report abnormal findings to the primary care provider.
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Clinical Alerts                    
• Patients with positive test results should have their sexual partners examined.
• Remind female patients that use of oral contraceptives do not protect against
sexually transmitted diseases.