Type of test Blood; microscopic examination

 Normal findings

 Negative culture Antibodies:

 Chlamydophila pneumoniae IgG: < 1:64 ,  IgM: < 1:10

Chlamydophila psittaci IgG: < 1:64  , IgM: < 1:10

Chlamydia trachomatis IgG: < 1:64  , IgM: < 1:10

Nucleic acid detection: negative

Test explanation and related physiology

There are many Chlamydia species that cause various diseases within the human body. Chlamydophila psittaci causes respiratory tract infections, headache, altered mentation, and hepatosplenomegaly. It occurs as a result of close contact with infected birds. Chlamydophila pneumoniae, another species, causes pneumonia. Chlamydophila trachomatis infection is probably the most frequently occurring sexually transmitted disease in developed countries. Infections of the genitalia, pelvic inflammatory disease, urethritis, cervicitis, salpingitis, and endometritis are most common. C. trachomatis may also infect the conjunctiva, pharynx, urethra, and rectum and cause lymphogranuloma venereum. The second serotype of C. trachomatis causes the eye disease trachoma, which is the most common form of preventable blindness. A third serotype produces genital and urethral infections different from lymphogranuloma. Most women colonized with Chlamydia are asymptomatic.

Tests can be performed on the blood of infected patients or swabs from the conjunctiva, nasopharynx, urethra, rectum, vagina, or cervix. Urine, seminal fluid, or pelvic washing can be used in culture and in direct identification of Chlamydia. Early identification of infection enables sexual partners to seek testing and/or treatment as soon as possible and reduces the risk of disease spread. Prompt treatment reduces the risk of infertility in women .

Interfering factors

• Women presently having routine menses

• Patients undergoing antibiotic therapy

Procedure and patient care

Before

* Explain the procedure to the patient.

During

• For Chlamydia antibody testing, collect venous blood in a red-top tube. Acute and convalescent serum should be drawn 2 to 3 weeks apart.

 • Sputum cultures  are used to check for C. psittaci respiratory infections.

• Chlamydia can be tested by direct nucleic acid identification or culture. A conjunctival smear is obtained by swabbing the eye lesion with a cotton-tipped applicator or scraping with a sterile ophthalmic spatula and smearing on a clean glass slide.

 • Note the following procedural steps for cervical culture:

1. The patient should refrain from douching and bathing in a tub before the cervical culture is performed.

2. The patient is placed in the lithotomy position.

 3. A nonlubricated vaginal speculum is inserted to expose the cervix.

4. Excess mucus is removed using a cleaning swab.

5. A second sterile, cotton-tipped swab is inserted into the endocervical canal and moved from side to side for 30 seconds to obtain the culture.

 6. The swab is then placed into an appropriate transport tube for testing.

• Note the following procedural steps for urethral culture:

 1. The urethral specimen should be obtained from the man before voiding within the previous hour.

2. A culture is taken by inserting a thin sterile swab with rotating movement about 3 to 4 cm into the urethra.

 • Note the following procedural steps for a urine specimen:

 1. The patient should not have urinated for at least 1 hour before specimen collection.

2. The patient should collect the first portion (first part of stream) of a random voided urine into a sterile, plastic, preservative-free container.

3. Transfer 2 mL of urine into the urine specimen collection tube using the disposable pipette provided. (The correct volume of urine has been added when the fluid level is between the black fill lines on the urine tube.)

• Note that these tests are performed by a physician, nurse, or other health-care provider in several minutes. Tell the patient that these procedures cause minimal discomfort.

After

 • Treat patients who have positive smears with antibiotics. Tell affected patients to have their sexual partners examined.

Abnormal findings

 Chlamydia infection