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Chlamydia trachomatis Culture
- Chlamydia (Isolation) Culture
- Culture, Chlamydia
- Lymphogranuloma Venereum Culture
- Nongonococcal Urethritis Culture
- Trachoma Inclusion Conjunctivitis
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.
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)
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.
Cell culture and subsequent detection of Chlamydia by fluorescent antibody
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.
Chlamydia is an intracellular pathogen. Obtain swab specimens containing epithelial cells of conjunctiva, cervix, posterior nasopharynx, throat, rectum, or urethra.
Viral, Chlamydia, or Mycoplasma culture transport provided by LabCorp, or other appropriate transport medium
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.
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
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.
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