Chlamydia trachomatis Culture

CPT: 87110; 87140
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Test Details

Synonyms

  • Chlamydia (Isolation) Culture
  • Culture, Chlamydia
  • Lymphogranuloma Venereum Culture
  • Nongonococcal Urethritis Culture
  • Trachoma Inclusion Conjunctivitis

Test Includes

Cell culture and subsequent detection of Chlamydia trachomatis by fluorescent antibody staining. CPT coding for microbiology and virology procedures often cannot be determined before the culture is performed. Requests with only a written order and no test number indicated will be processed according to Default Testing for Virology.

Use

Aid in the diagnosis of infections, including medical/legal cases caused by Chlamydia trachomatis (eg, cervicitis, trachoma, conjunctivitis, PID, pneumonia, urethritis, nongonococcal urethritis, pneumonitis, and sexually-transmitted diseases)

Limitations

Culture may be negative in the presence of Chlamydia infection. Although culture is the legal standard, it is not the gold standard for the detection of C trachomatis. The sensitivity of culture is only 70% to 90% because C trachomatis may not survive transit to the laboratory, inadequate sampling, or low numbers of organisms in asymptomatic infection.1Chlamydia pneumoniae is not detected/isolated in this culture.

Methodology

Cell culture and subsequent detection of Chlamydia by fluorescent antibody

Additional Information

This organism infects the endocervical columnar epithelial cells and will not be found in the inflammatory cells. In obtaining the specimen, clean the area of inflammatory cells and then attempt to use another swab to scrape epithelial cells for culturing. Stamm et al noted that Chlamydia trachomatis was recovered from approximately 50% of female patients with anterior urethral syndrome and “sterile” bladder urine.2 The results of cytological diagnosis of chlamydial infection of the female genital tract have been disappointing. Papanicolaou-stained cervical smears are not reliable enough to help establish or exclude the presence of Chlamydia. Dorman et al have noted that in patients with vaginal discharge or other genital tract symptomatology of unknown etiology, cervical cytology can be useful in identifying patients who should be cultured for Chlamydia.3 Direct immunofluorescence techniques and nucleic acid amplification assays are available to detect Chlamydia in clinical specimens. These methods usually provide reliable results in high- and low-prevalence populations and detect both viable and nonviable organisms.4 Urine culture for Chlamydia is not a sensitive procedure and generally should not be done. The incidence of cervical infection with Chlamydia trachomatis is two to three times that of gonorrhea: 4% to 9% in private office settings, 6% to 23% in family planning clinics, and 20% to 30% in sexually-transmitted diseases clinics.4

Culture should be the test-of-choice in cases of child abuse, rectal and throat infections, and when a test for cure is desired.

Chlamydia is a single genus and consists of the following:

C trachomatis (serotypes A-K): inclusion conjunctivitis, trachoma, and genital infections

C trachomatis (serotypes L1-L3): lymphogranuloma venereum

C psittaci: psittacosis

C pneumoniae (TWAR): respiratory infections

Serology to detect antibodies to all three species of Chlamydia is available.

Specimen Requirements

Specimen

Chlamydia is an intracellular pathogen. Obtain swab specimens containing epithelial cells of conjunctiva, cervix, posterior nasopharynx, throat, rectum, or urethra.

Container

Viral, Chlamydia, or Mycoplasma culture transport provided by LabCorp, or other appropriate transport medium

Collection

Conjunctiva: Remove mucus and exudate. Use a swab and firm pressure to scrape away epithelial cells from upper and lower lids.

Cervix: Remove mucus/pus with a swab, discard, and use firm and rotating pressure to obtain specimen with another swab. May be combined with a urethral swab into same transport medium. This combination of cervical and urethral method is highly recommended.

Posterior nasopharynx or throat: Collect epithelial cells by using a swab.

Rectum: Sample anal crypts with a swab. Avoid contamination with fecal material.

Urethra: Patient should not urinate within one hour prior to specimen collection. The swab should be inserted 2 cm into the urethra. Use firm pressure to scrape cells from the mucosal surface. If possible repeat with second swab.

Storage Instructions

Transport and store at room temperature for up to 24 hours after specimen is placed into UTM-RT medium, or refrigerate.

Causes for Rejection

Bacterial swab specimen; specimen received in grossly leaking transport container; dry specimen; specimen submitted in fixative or additive; specimen received in expired transport medium or incorrect transport device; inappropriate specimen transport conditions; specimen received after prolonged delay in transport (usually more than 72 hours); specimen stored or transported at room temperature for more than 24 hours; wooden shaft swab in transport device; unlabeled specimen or name discrepancy between specimen and request label

Clinical Information

Special Instructions

Submit one specimen per test requested. Specify the exact specimen source/origin (eg, genital lesion). Indicate a specific test number on the request form. Check expiration date of transport; do not use expired devices. Do not use swabs with a wooden shaft.

Footnotes

1. Harper M, Johnson R. The predictive value of culture for the diagnosis of gonorrhea and Chlamydia infections. Clin Microbiol Newslet. 1990; 12:54-56.
2. Stamm WE, Wagner KF, Amsel R, et al. Causes of the acute urethral syndrome in women. N Engl J Med. 1980 Aug 21; 303(8):409-415. 6993946
3. Dorman SA, Danos LM, Wilson DJ, et al. Detection of chlamydial cervicitis by Papanicolaou stained smear and culture. Am J Clin Pathol. 1983 Apr; 79(4):421-425. 6837510
4. Phillips RS, Aronson MD, Taylor WC, Safran C. Should tests for Chlamydia trachomatis cervical Infection be done during routine gynecologic visits? An analysis of the costs of alternative strategies. Ann Intern Med. 1987 Aug; 107(2):188-194. 3300458

References

Barnes RC. Laboratory diagnosis of human chlamydial infections. Clin Microbiol Rev. 1989 Apr; 2(2):119-136. 2650858
Chirgwin K, Roblin PM, Gelling M, Hammerschlag MR, Schachter J. Infection with Chlamydia pneumoniae in Brooklyn. J Infect Dis. 1991 Apr; 163(4):757-761. 2010629
Fraiz J, Jones RB. Chlamydial infections. Annu Rev Med. 1988; 39:357-370. 3285782
Le Scolea LJ Jr. The value of nonculture chlamydial diagnostic tests. Clin Microbiol Newslet. 1991; 13(3):21-24.
Lombardo JM, Gadol CL. Chlamydia trachomatis: A perfect test? Clin Microbiol Newslet. 1990; 12(13):100-102.
Schachter J. Laboratory aspects of chlamydial infections. Adv Exp Med Biol. 1987; 224:73-77. 3329814

LOINC® Map

Order Code Order Code Name Order Loinc Result Code Result Code Name UofM Result LOINC
008565 Chlamydia trachomatis Culture 6349-5 008565 Chlamydia trachomatis Culture 6349-5

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