Do not order the Chlamydia trachomatis culture as a test-of-cure. The appropriate order for C. trachomatis test-of -cure is the Chlamydia trachomatis amplified probe (6744/87491.0). Test-of-cure should be performed no earlier than 3 weeks after treatment. Culture is very rarely used for other indications.

Copan UTM-RT transport (purple cap)

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.

Copan UTM-RT transport (purple-cap)

Refrigerated (preferred)

Ambient - 24 hours

• 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

Cell culture and subsequent detection of Chlamydia by fluorescent antibody

Negative

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).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. 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 othergenital tract symptomatology of unknown etiology, cervical cytology can be useful in identifying patients who should be cultured for Chlamydia. 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. 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. 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.