Identification of chlamydia in cervical smears by immunofluorescence: technic, sensitivity, and specificity.

Immunofluorescent staining was compared to cell culture for the diagnosis of Chlamydia trachomatis infections in the female genital tract. By culture, the incidence in the 496 patients in the study was 12.3%. Immunofluorescence demonstrated organisms in 90% of the culture-positive cases, with a specificity of 99.3%. This method appears to be a successful replacement for culture for general screening.

Comparison of scrape, swab, and cytobrush samples for the diagnosis of cervical chlamydial infection by immunofluorescence.

An endocervical swab, cytologic scraper, and endocervical cytobrush were used to prepare simultaneous full-slide smears for immunofluorescence for the diagnosis of cervical chlamydial infection. The cytobrush produced the best sample, with significantly higher numbers of organisms. Most of the false negative results were obtained with the cytologic scraper. The optimum technique appears to be to use a cytobrush sample; however, a swab should be used with pregnant patients.

Clinical characteristics of women with chlamydial cervicitis.

Four hundred ninety-three women were examined, had a cervical culture done for Chlamydia trachomatis and completed a questionnaire. Sixty-one, or 12.4%, were positive for Chlamydia on culture. Infected women were more likely to be younger, to be unmarried, to have had more sexual partners, to have had past abnormal cytology, to have spotting or postcoital bleeding, to have a mucoid or purulent cervical discharge and to have signs of cervical inflammation, especially friability. No characteristic finding in the past history, symptoms or physical examination combined sufficient sensitivity and specificity to serve by itself as a basis for selective testing for C trachomatis. It appears that multiple characteristics--including history, symptoms, physical examination and cytologic results--must be utilized to select patients for testing.

The cytologic features of chlamydial cervicitis.

Chlamydial cervicitis is a common and important infection. Diagnostic cytologic criteria have been proposed, but not generally accepted. To better evaluate the cytologic changes, cervical cultures for Chlamydia trachomatis and duplicate cervical smears for Papanicolaou staining and immunofluorescence staining for chlamydial organisms were taken from 496 patients. A total of 61 (12.3%) of the patients had a positive culture for C. trachomatis. By immunofluorescence, the organisms were present as very small extracellular elementary bodies in mucus or as similar bodies in leukocytes; inclusions within epithelial cells were seen in only two cases. The organisms did not stain with the Papanicolaou stain. Chlamydial infection correlated with the degree of inflammation, with the presence of histiocytes and lymphocytes, especially large "transformed" lymphocytes, and with the presence of unidentified short bacteria, which stained red with the Papanicolaou stain. These features predict which patients should be tested more definitively for the presence of chlamydial organisms. However, we found no cytologic criteria that can reliably permit its diagnosis.