Fast Five Quiz: Common STDs

Michael Stuart Bronze, MD

Disclosures

January 17, 2019

Chlamydial infection is one of the leading causes of infertility in women. It is also a leading cause of PID. PID is a serious disease that often requires hospitalization for inpatient care, including intravenous (IV) antibiotics, testing to rule out tubo-ovarian abscess, and intensive counseling on the complications of recurrent infections. The risk for ectopic pregnancy in women who have had PID is 7-10 times greater than that for women without a history of PID. In 15% of women who have contracted PID, chronic abdominal pain is a long-term manifestation that most likely is related to pelvic adhesions in the ovaries and fallopian tubes.

According to the CDC, in 2017, the rate of chlamydia cases was 687.4 per 100,000 women. The rate was 363.1 chlamydia cases per 100,000 men. The US Preventive Services Task Force has made the following recommendations with regard to screening women for chlamydial infection:

  • Screen for chlamydial infection in all sexually active nonpregnant young women aged 24 years or younger and in older nonpregnant women who are at increased risk.

  • Screen for chlamydial infection in all pregnant women aged 24 years or younger and in older pregnant women who are at increased risk.

  • Do not routinely screen for chlamydial infection in women aged 25 years or older, regardless of whether they are pregnant, if they are not at increased risk.

Endocervical, urethral, rectal, or oropharyngeal specimens should be obtained and assayed for Chlamydia trachomatis infection in both males and females on the basis of the patient's sexual practices, obtained by history. A voided urine sample, whether midstream or first void, effectively captures the chlamydial organism for NAAT. NAATs are the most sensitive tests for these specimens and are therefore recommended for detecting C trachomatis infection.

Cytology is used mainly for diagnosing infant inclusion conjunctivitis and ocular trachoma through the demonstration of intracytoplasmic C trachomatis inclusions in HeLa cells (a continuously cultured carcinoma cell line used for tissue cultures). Cytologic diagnosis also is used to evaluate endocervical scrapings, but interpretation is difficult, and sensitivity and specificity have been low.

Cultures are difficult to obtain; many false-negative results are returned. They are also expensive to perform, because of the expertise and laboratory resources required. In addition, they are unsuitable for large numbers of patients (eg, in the emergency department). Nevertheless, in certain clinical situations, cultures are mandatory.

Because of its high specificity (100%) and sensitivity, cell culture is the only test that should be used to establish the presence or absence of infections in cases with legal implications, such as those involving rape or sexual abuse. Cell culture is also preferred for rectal specimens because nonculture test results are difficult to interpret in the presence of stool organisms.

For more on chlamydia, read here.

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