Chlamydia in Emergency Medicine Workup

  • Author: Debra E Houry, MD, MPH; Chief Editor: Rick Kulkarni, MD   more...
 
Updated: Mar 27, 2012
 

Laboratory Studies

  • Cell culture
    • Used to isolate and culture the organism
    • Fifty to 90% sensitivity; 99% specificity
    • Expensive because of the expertise and lab requirements
    • Unsuitable for large numbers of patients (eg, in the emergency department)
    • Difficult to culture the organism; many false-negative results
  • Direct fluorescent antibody
    • Laboratory assay test for C trachomatis
    • Fifty to 80% sensitivity; 99% specificity
    • Labor intensive; requires skilled personnel
    • Method of choice for confirmation of other assays
  • Nucleic acid amplification techniques
    • Detection of chlamydial DNA using specific probes
    • Eighty to 92% sensitivity; 99% specificity (No difference in urine specimen vs genital specimen for men; urine tests may be less sensitive than genital swab for women)
    • Expensive compared to enzyme immunoassays, but urine test is now becoming more cost effective
  • Enzyme immunoassay
    • Laboratory assay for C trachomatis
    • Forty to 60% sensitivity; 99% specificity
    • Inexpensive
    • Automatable
    • Suitable for large numbers because it is automatable and cost-effective
    • Most commonly used test for chlamydia in the emergency department and outpatient clinics
  • Tests to identify other STDs
  • Pregnancy test: Test patients at risk for STDs for pregnancy as well.
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Imaging Studies

  • An ultrasound may be performed to look for tubo-ovarian abscess.
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Other Tests

  • Complete blood count can be performed for suspected PID.
  • Consider HIV testing, as co-infection is not uncommon.
  • Consider performing a Pap smear on women, as risk of cervical cancer is increased 6.5 fold.
  • Consider testing partners for chlamydia.
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Procedures

  • Collect specimens from urethra, endocervix, rectum, or conjunctivae.
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Proceed to Treatment & Management
 
 
Contributor Information and Disclosures
Author

Debra E Houry, MD, MPH  Director, Center for Injury Control, Associate Professor of Emergency Medicine, Department of Emergency Medicine, Emory University

Debra E Houry, MD, MPH is a member of the following medical societies: American College of Emergency Physicians, American Medical Association, American Public Health Association, and Society for Academic Emergency Medicine

Disclosure: Nothing to disclose.

Specialty Editor Board

Richard Lavely, MD, JD, MS, MPH  Lecturer in Health Policy and Administration, Department of Public Health, Yale University School of Medicine

Richard Lavely, MD, JD, MS, MPH is a member of the following medical societies: American College of Emergency Physicians, American College of Legal Medicine, and American Medical Association

Disclosure: Nothing to disclose.

Francisco Talavera, PharmD, PhD  Adjunct Assistant Professor, University of Nebraska Medical Center College of Pharmacy; Editor-in-Chief, Medscape Drug Reference

Disclosure: Medscape Salary Employment

Jonathan A Handler, MD  HSG Chief Deployment Architect, Microsoft Corporation, Adjunct Associate Professor, Department of Emergency Medicine, Northwestern University, Feinberg School of Medine

Jonathan A Handler, MD is a member of the following medical societies: Alpha Omega Alpha, American College of Emergency Physicians, American Medical Informatics Association, Phi Beta Kappa, and Society for Academic Emergency Medicine

Disclosure: Nothing to disclose.

John D Halamka, MD, MS  Associate Professor of Medicine, Harvard Medical School, Beth Israel Deaconess Medical Center; Chief Information Officer, CareGroup Healthcare System and Harvard Medical School; Attending Physician, Division of Emergency Medicine, Beth Israel Deaconess Medical Center

John D Halamka, MD, MS is a member of the following medical societies: American College of Emergency Physicians, American Medical Informatics Association, Phi Beta Kappa, and Society for Academic Emergency Medicine

Disclosure: Nothing to disclose.

Chief Editor

Rick Kulkarni, MD  Attending Physician, Department of Emergency Medicine, Cambridge Health Alliance, Division of Emergency Medicine, Harvard Medical School

Rick Kulkarni, MD is a member of the following medical societies: Alpha Omega Alpha, American Academy of Emergency Medicine, American College of Emergency Physicians, American Medical Association, American Medical Informatics Association, Phi Beta Kappa, and Society for Academic Emergency Medicine

Disclosure: WebMD Salary Employment

References

  1. U.S. Preventive Services Task Force. Screening for chlamydial infection: U.S. Preventive Services Task Force recommendation statement. Ann Intern Med. Jul 17 2007;147(2):128-34. [Medline]. [Full Text].

  2. Screening for chlamydial infection: recommendation statement. National Guideline Clearinghouse. Available at http://guideline.gov/summary/summary.aspx?doc_id=10408. Accessed March 23, 2009.

  3. Centers for Disease Control and Prevention. Chlamydia screening among sexually active young female enrollees of health plans--United States, 2000-2007. MMWR Morb Mortal Wkly Rep. Apr 17 2009;58(14):362-5. [Medline]. [Full Text].

  4. (1) Diseases characterized by urethritis and cervicitis. Sexually transmitted diseases treatment guidelines 2006. (2) Update to CDC's sexually transmitted diseases treatment guidelines, 2006: fluoroquinolones no longer recommended for treatment of gonococcal infections. National Guideline Clearinghouse. Available at http://guideline.gov/summary/summary.aspx?doc_id=10769. Accessed March 23, 2009.

  5. Anttila T, Saikku P, Koskela P, et al. Serotypes of Chlamydia trachomatis and risk for development of cervical squamous cell carcinoma. JAMA. Jan 3 2001;285(1):47-51. [Medline].

  6. CDC. Sexually transmitted diseases treatment guidelines 2010. Centers for Disease Control and Prevention. MMWR Recomm Rep. Dec 17 2010;59(RR12):1-110.

  7. Darville T. Chlamydia trachomatis infections in neonates and young children. Semin Pediatr Infect Dis. Oct 2005;16(4):235-44. [Medline].

  8. Datta SD, Sternberg M, Johnson RE, Berman S, Papp JR, McQuillan G. Gonorrhea and chlamydia in the United States among persons 14 to 39 years of age, 1999 to 2002. Ann Intern Med. Jul 17 2007;147(2):89-96. [Medline].

  9. Jensen JS, Bjornelius E, Dohn B, Lidbrink P. Comparison of first void urine and urogenital swab specimens for detection of Mycoplasma genitalium and Chlamydia trachomatis by polymerase chain reaction in patients attending a sexually transmitted disease clinic. Sex Transm Dis. Aug 2004;31(8):499-507. [Medline].

  10. Kelly JJ, Dalsey WC, McComb J, Njuki F. Follow-up program for emergency department patients with gonorrhea or chlamydia. Acad Emerg Med. Dec 2000;7(12):1437-9. [Medline].

  11. Magid D, Douglas JM Jr, Schwartz JS. Doxycycline compared with azithromycin for treating women with genital Chlamydia trachomatis infections: an incremental cost-effectiveness analysis. Ann Intern Med. Feb 15 1996;124(4):389-99. [Medline].

  12. Miller WC, Ford CA, Morris M, et al. Prevalence of chlamydial and gonococcal infections among young adults in the United States. JAMA. May 12 2004;291(18):2229-36. [Medline].

  13. Stewart DP. Historical, physical, and laboratory characteristics of female ED patients with positive chlamydia and gonorrhea cultures. Am J Emerg Med. May 1996;14(3):336-7. [Medline].

 
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CT scan of an adolescent with chlamydial Fitz-Hugh-Curtis syndrome demonstrating a perihepatic fluid collection anterior to the liver.
CT scan of an adolescent with chlamydial Fitz-Hugh-Curtis syndrome demonstrating free peritoneal fluid.
 
 
 
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