The need for a chlamydial culture service

Abstract

In a prospective study of unselected, female patients attending a sexually transmitted disease clinic one in eight patients would have been errouneously declared free of infection in the absence of a chlamydial culture service. Chlamydia trachomatis is now accepted as a causative organism of non-specific urethritis and post-gonococcal urethritis in men and non-specific genital infection in women. Thus, facilities for isolation of C. trachomatis should be an essential aid in the management of women attending STD clinics. Male patients would also benefit if such facilities were readily available.

PIP: The potential sequelae of Chlamydia trachomatis--nonspecific urethritis and post gonococcal urethritis in men and nonspecific genital infection in women--suggest a need for a chlamydial diagnostic service in clinics that treat sexually transmitted diseases. In this prospective study, over 2000 endocervical samples were obtained over an 18-month period from women presenting to a sexually transmitted diseases clinic. The isolation rate for chlamydia averaged 23.6%/month. There was no significant difference in presenting symptoms such as vaginal discharge, dysuria, pruritus, and abdominal pain between patients with chlamydial infection alone, those with gonorrhea alone, and women with no sexually transmitted disease. 178 (31%) of patients with chlamydia were sexual contacts of patients with nonspecific urethritis and 122 (22%) were contacts of men with gonorrhea. In the absence of a chlamydial service laboratory, only contacts of patients with nonspecific urethritis are likely to receive treatment, leaving 2/3 of chlamydia-positive women untreated. In 1976, an estimated 18,300 women were seen in British clinics with undiagnosed, untreated chlamydial infection. Given the magnitude and severity of this problem, a chlamydial diagnostic service should become a mandatory clinic component.