Chlamydia infection laboratory findings: Difference between revisions

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VisualWikitext

Latest revision as of 05:54, 24 August 2021

Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]; Aysha Anwar, M.B.B.S [2]

Overview

Laboratory findings consistent with the diagnosis of Chlamydial infection and its complications include:^[1]^[2]^[3]^[4]

Laboratory Findings

Laboratory findings consistent with the diagnosis of Chlamydial infection and its complications include:^[1]^[5]^[3]

Type of Chlamydia	Tests	Findings
Neonatal conjuctivitis	CBC	Normal
Neonatal conjuctivitis	ESR	Normal
Neonatal pneumonia^[6]^[7]	CBC	Absolute increase in eosinophil count (>400cells/mm3)^[8]
	ESR	Increased
	CRP	Increased
	ABGS	Mild to moderate hypoxemia
Genital infection^[1]^[9]^[3]	CBC	Increased leukocyte count
	Urinalysis	>5 WBCS per high power field
	ESR	Normal or increased
	CRP	Normal or increased
Atypical pneumonia^[10]	CBC	Increased or normal leukocyte count (lymphocytes)
Fitz Hugh Curtis Syndrome^[1]	CBC	Increased leukocytes
	LFTS	Normal
	ESR	Normal or increased
	D Dimer	Normal or increased

Other diagnostic tests

Other diagnostic tests that may be used to diagnose chlamydia infection include the following:

Culture

Gold standard for diagnosing chlamydial infection^[11]^[12]
Test of choice in cases of sexual abuse in boys^[8]
Used for urogenital specimens (from males) and extragenital sites such as rectum and pharynx (males and female)^[8]
Highly specific
Limitations include long incubation period, live cell culture requirement, specific transport methods

Direct Cytological test

Used for diagnosing acute inclusion conjuctivitis in neonates^[13]
Detects typical intracytoplasmic inclusions using giemsa stain
Insensitive for diagnosing adult conjuctival and genital infection

Antigen detection tests

Tests based on antigen detection tests include the following:

Nucleic acid amplification tests (NAATS)^[4]^[13]^[14]^[15]^[16]

These include PCR, ligase chain reaction, and transcription-mediated amplification of RNA
FDA-approved for vaginal and urinary specimens^[8]
Not FDA-approved for usage on extragenital sites and urogenital specimen in boys.
Higher sensitivity and specificity than culture
Test of choice: use vaginal or cervical swabs or first-void urine in women. In men, use urethral swab or first-void urine. Female patients can collect their swab as it has the same sensitivity in comparison to a clinician collecting it.^[17]
Most sensitive tests: vaginal swabs for women, first-void urine for men.^[17]
Rectal and oropharyngeal swabs can also be performed.^[17]

Less accurate antigen detection tests

Nucleic acid hybridization tests
Enzyme immunoassay
Direct fluorescent antibody assay

FDA-cleared for conjuctival and nasopharyngeal specimen testing^[8]
Highest sensitivity and specificity for neonatal conjuctivitis

Antibody detection tests

Serological tests that may help in diagnosis of chlamydial infection include:^[11]

Microimmunofluorescence (mif) assay

Detect species-specific antibodies
Gold standard for chlamydia serology

Complement fixation tests

Used for diagnosing chlamydial respiratory infection
Replaced by microimmunofluorescence (mif)

References

↑ ^1.0 ^1.1 ^1.2 ^1.3 Yang HW, Jung SH, Han HY, Kim A, Lee YJ, Cha SW; et al. (2008). "[Clinical feature of Fitz-Hugh-Curtis syndrome: analysis of 25 cases]". Korean J Hepatol. 14 (2): 178–84. doi:10.3350/kjhep.2008.14.2.178. PMID 18617765.
↑ Peipert, Jeffrey F., et al. "Laboratory evaluation of acute upper genital tract infection." Obstetrics & Gynecology 87.5 (1996): 730-736.
↑ ^3.0 ^3.1 ^3.2 Stamm WE, Cole B (1986). "Asymptomatic Chlamydia trachomatis urethritis in men". Sex Transm Dis. 13 (3): 163–5. PMID 3764626.
↑ ^4.0 ^4.1 Centers for Disease Control and Prevention (2014). "Recommendations for the laboratory-based detection of Chlamydia trachomatis and Neisseria gonorrhoeae--2014". MMWR Recomm Rep. 63 (RR-02): 1–19. PMC 4047970. PMID 24622331.
↑ Peipert, Jeffrey F., et al. "Laboratory evaluation of acute upper genital tract infection." Obstetrics & Gynecology 87.5 (1996): 730-736.
↑ Tsai MH, Huang YC, Chen CJ, Lin PY, Chang LY, Chiu CH; et al. (2005). "Chlamydial pneumonia in children requiring hospitalization: effect of mixed infection on clinical outcome". J Microbiol Immunol Infect. 38 (2): 117–22. PMID 15843856.
↑ Mishra KN, Bhardwaj P, Mishra A, Kaushik A (2011). "Acute Chlamydia trachomatis respiratory infection in infants". J Glob Infect Dis. 3 (3): 216–20. doi:10.4103/0974-777X.83525. PMC 3162806. PMID 21887051.
↑ ^8.0 ^8.1 ^8.2 ^8.3 ^8.4 http://www.cdc.gov/std/tg2015/chlamydia.htm Accessed on September 14,2016
↑ Peipert, Jeffrey F., et al. "Laboratory evaluation of acute upper genital tract infection." Obstetrics & Gynecology 87.5 (1996): 730-736.
↑ Hayashi Y, Asano T, Ito G, Yamada Y, Matsuura T, Adachi S; et al. (1993). "[Study of cell populations of bronchoalveolar lavage fluid in patients with pneumonia due to Chlamydia psittaci and Mycoplasma pneumoniae]". Nihon Kyobu Shikkan Gakkai Zasshi. 31 (5): 569–74. PMID 8331841.
↑ ^11.0 ^11.1 Hattis D, Wasson JM, Page GS, Stern B, Franklin CA (1987). "Acid particles and the tracheobronchial region of the respiratory system--an "irritation-signaling" model for possible health effects". JAPCA. 37 (9): 1060–6. PMID 3327923.
↑ Gaydos CA, Roblin PM, Hammerschlag MR, Hyman CL, Eiden JJ, Schachter J, Quinn TC (1994). "Diagnostic utility of PCR-enzyme immunoassay, culture, and serology for detection of Chlamydia pneumoniae in symptomatic and asymptomatic patients". J. Clin. Microbiol. 32 (4): 903–5. PMC 263160. PMID 8027341.
↑ ^13.0 ^13.1 Chernesky MA (2005). "The laboratory diagnosis of Chlamydia trachomatis infections". Can J Infect Dis Med Microbiol. 16 (1): 39–44. PMC 2095010. PMID 18159527.
↑ Johnson RE, Newhall WJ, Papp JR, Knapp JS, Black CM, Gift TL; et al. (2002). "Screening tests to detect Chlamydia trachomatis and Neisseria gonorrhoeae infections--2002". MMWR Recomm Rep. 51 (RR-15): 1–38, quiz CE1-4. PMID 12418541.
↑ Peipert JF (2003). "Clinical practice. Genital chlamydial infections". N Engl J Med. 349 (25): 2424–30. doi:10.1056/NEJMcp030542. PMID 14681509.
↑ http://www.cdc.gov/mmwr/preview/mmwrhtml/rr6302a1.htm Accessed on September 12, 2016
↑ ^17.0 ^17.1 ^17.2 Workowski KA, Bachmann LH, Chan PA, Johnston CM, Muzny CA, Park I; et al. (2021). "Sexually Transmitted Infections Treatment Guidelines, 2021". MMWR Recomm Rep. 70 (4): 1–187. doi:10.15585/mmwr.rr7004a1. PMC 8344968 Check |pmc= value (help). PMID 34292926 Check |pmid= value (help).

Template:WikiDoc Sources

[pmid18617765-1] 1.0 ^1.1 ^1.2 ^1.3 Yang HW, Jung SH, Han HY, Kim A, Lee YJ, Cha SW; et al. (2008). "[Clinical feature of Fitz-Hugh-Curtis syndrome: analysis of 25 cases]". Korean J Hepatol. 14 (2): 178–84. doi:10.3350/kjhep.2008.14.2.178. PMID 18617765.

[2] Peipert, Jeffrey F., et al. "Laboratory evaluation of acute upper genital tract infection." Obstetrics & Gynecology 87.5 (1996): 730-736.

[pmid3764626-3] 3.0 ^3.1 ^3.2 Stamm WE, Cole B (1986). "Asymptomatic Chlamydia trachomatis urethritis in men". Sex Transm Dis. 13 (3): 163–5. PMID 3764626.

[pmid24622331-4] 4.0 ^4.1 Centers for Disease Control and Prevention (2014). "Recommendations for the laboratory-based detection of Chlamydia trachomatis and Neisseria gonorrhoeae--2014". MMWR Recomm Rep. 63 (RR-02): 1–19. PMC 4047970. PMID 24622331.

[5] Peipert, Jeffrey F., et al. "Laboratory evaluation of acute upper genital tract infection." Obstetrics & Gynecology 87.5 (1996): 730-736.

[pmid15843856-6] Tsai MH, Huang YC, Chen CJ, Lin PY, Chang LY, Chiu CH; et al. (2005). "Chlamydial pneumonia in children requiring hospitalization: effect of mixed infection on clinical outcome". J Microbiol Immunol Infect. 38 (2): 117–22. PMID 15843856.

[pmid21887051-7] Mishra KN, Bhardwaj P, Mishra A, Kaushik A (2011). "Acute Chlamydia trachomatis respiratory infection in infants". J Glob Infect Dis. 3 (3): 216–20. doi:10.4103/0974-777X.83525. PMC 3162806. PMID 21887051.

[NC-8] 8.0 ^8.1 ^8.2 ^8.3 ^8.4 http://www.cdc.gov/std/tg2015/chlamydia.htm Accessed on September 14,2016

[9] Peipert, Jeffrey F., et al. "Laboratory evaluation of acute upper genital tract infection." Obstetrics & Gynecology 87.5 (1996): 730-736.

[pmid8331841-10] Hayashi Y, Asano T, Ito G, Yamada Y, Matsuura T, Adachi S; et al. (1993). "[Study of cell populations of bronchoalveolar lavage fluid in patients with pneumonia due to Chlamydia psittaci and Mycoplasma pneumoniae]". Nihon Kyobu Shikkan Gakkai Zasshi. 31 (5): 569–74. PMID 8331841.

[pmid3327923-11] 11.0 ^11.1 Hattis D, Wasson JM, Page GS, Stern B, Franklin CA (1987). "Acid particles and the tracheobronchial region of the respiratory system--an "irritation-signaling" model for possible health effects". JAPCA. 37 (9): 1060–6. PMID 3327923.

[pmid8027341-12] Gaydos CA, Roblin PM, Hammerschlag MR, Hyman CL, Eiden JJ, Schachter J, Quinn TC (1994). "Diagnostic utility of PCR-enzyme immunoassay, culture, and serology for detection of Chlamydia pneumoniae in symptomatic and asymptomatic patients". J. Clin. Microbiol. 32 (4): 903–5. PMC 263160. PMID 8027341.

[pmid18159527-13] 13.0 ^13.1 Chernesky MA (2005). "The laboratory diagnosis of Chlamydia trachomatis infections". Can J Infect Dis Med Microbiol. 16 (1): 39–44. PMC 2095010. PMID 18159527.

[pmid12418541-14] Johnson RE, Newhall WJ, Papp JR, Knapp JS, Black CM, Gift TL; et al. (2002). "Screening tests to detect Chlamydia trachomatis and Neisseria gonorrhoeae infections--2002". MMWR Recomm Rep. 51 (RR-15): 1–38, quiz CE1-4. PMID 12418541.

[pmid14681509-15] Peipert JF (2003). "Clinical practice. Genital chlamydial infections". N Engl J Med. 349 (25): 2424–30. doi:10.1056/NEJMcp030542. PMID 14681509.

[abcd-16] ttp://www.cdc.gov/mmwr/preview/mmwrhtml/rr6302a1.htm Accessed on September 12, 2016

[pmid34292926-17] 17.0 ^17.1 ^17.2 Workowski KA, Bachmann LH, Chan PA, Johnston CM, Muzny CA, Park I; et al. (2021). "Sexually Transmitted Infections Treatment Guidelines, 2021". MMWR Recomm Rep. 70 (4): 1–187. doi:10.15585/mmwr.rr7004a1. PMC 8344968 Check |pmc= value (help). PMID 34292926 Check |pmid= value (help).

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@@ Line 7: / Line 7: @@
 ==Laboratory Findings==
-Laboratory findings consistent with the diagnosis of ''Chlamydial infection'' and its complications include:<ref name="pmid18617765">{{cite journal| author=Yang HW, Jung SH, Han HY, Kim A, Lee YJ, Cha SW et al.| title=[Clinical feature of Fitz-Hugh-Curtis syndrome: analysis of 25 cases]. | journal=Korean J Hepatol | year= 2008 | volume= 14 | issue= 2 | pages= 178-84 | pmid=18617765 | doi=10.3350/kjhep.2008.14.2.178 | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=18617765  }} </ref><ref>Peipert, Jeffrey F., et al. "Laboratory evaluation of acute upper genital tract infection." Obstetrics & Gynecology 87.5 (1996): 730-736.</ref><ref name="pmid3764626">{{cite journal| author=Stamm WE, Cole B| title=Asymptomatic Chlamydia trachomatis urethritis in men. | journal=Sex Transm Dis | year= 1986 | volume= 13 | issue= 3 | pages= 163-5 | pmid=3764626 | doi= | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=3764626  }} </ref>
+Laboratory findings consistent with the diagnosis of ''[[Chlamydial infection]]'' and its complications include:<ref name="pmid18617765">{{cite journal| author=Yang HW, Jung SH, Han HY, Kim A, Lee YJ, Cha SW et al.| title=[Clinical feature of Fitz-Hugh-Curtis syndrome: analysis of 25 cases]. | journal=Korean J Hepatol | year= 2008 | volume= 14 | issue= 2 | pages= 178-84 | pmid=18617765 | doi=10.3350/kjhep.2008.14.2.178 | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=18617765  }} </ref><ref>Peipert, Jeffrey F., et al. "Laboratory evaluation of acute upper [[UTI|genital tract infection]]." Obstetrics & Gynecology 87.5 (1996): 730-736.</ref><ref name="pmid3764626">{{cite journal| author=Stamm WE, Cole B| title=Asymptomatic Chlamydia trachomatis urethritis in men. | journal=Sex Transm Dis | year= 1986 | volume= 13 | issue= 3 | pages= 163-5 | pmid=3764626 | doi= | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=3764626  }} </ref>
 {|style="border: 0px; font-size: 90%; margin: 3px;" align=center
@@ Line 14: / Line 14: @@
 !style="background: #4479BA; padding: 5px 5px;"| {{fontcolor|#FFFFFF|Findings}}
 |-
-!rowspan="2" style="padding: 5px 5px; background: #DCDCDC; font-weight: bold;"| Neonatal conjuctivitis
+!rowspan="2" style="padding: 5px 5px; background: #DCDCDC; font-weight: bold;"| [[Neonatal conjuctivitis]]
-|style="padding: 5px 5px; background: #F5F5F5;"| CBC
+|style="padding: 5px 5px; background: #F5F5F5;"| [[CBC]]
 |style="padding: 5px 5px; background: #F5F5F5;"| Normal
 |-
-|style="padding: 5px 5px; background: #F5F5F5;"| ESR
+|style="padding: 5px 5px; background: #F5F5F5;"| [[ESR]]
 |style="padding: 5px 5px; background: #F5F5F5;"| Normal
 |-
 ! rowspan="4" style="padding: 5px 5px; background: #DCDCDC; font-weight: bold;"| Neonatal pneumonia<ref name="pmid15843856">{{cite journal| author=Tsai MH, Huang YC, Chen CJ, Lin PY, Chang LY, Chiu CH et al.| title=Chlamydial pneumonia in children requiring hospitalization: effect of mixed infection on clinical outcome. | journal=J Microbiol Immunol Infect | year= 2005 | volume= 38 | issue= 2 | pages= 117-22 | pmid=15843856 | doi= | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=15843856  }} </ref><ref name="pmid21887051">{{cite journal| author=Mishra KN, Bhardwaj P, Mishra A, Kaushik A| title=Acute Chlamydia trachomatis respiratory infection in infants. | journal=J Glob Infect Dis | year= 2011 | volume= 3 | issue= 3 | pages= 216-20 | pmid=21887051 | doi=10.4103/0974-777X.83525 | pmc=3162806 | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=21887051  }} </ref>
-|style="padding: 5px 5px; background: #F5F5F5;"| CBC
+|style="padding: 5px 5px; background: #F5F5F5;"| [[CBC]]
-|style="padding: 5px 5px; background: #F5F5F5;"| Absolute increase in eosinophil count (>400cells/mm3)<ref name= NC>http://www.cdc.gov/std/tg2015/chlamydia.htm Accessed on September 14,2016</ref>
+|style="padding: 5px 5px; background: #F5F5F5;"| Absolute increase in [[eosinophil]] count (>400cells/mm3)<ref name= NC>http://www.cdc.gov/std/tg2015/chlamydia.htm Accessed on September 14,2016</ref>
 |-
-|style="padding: 5px 5px; background: #F5F5F5;" | ESR
+|style="padding: 5px 5px; background: #F5F5F5;" | [[ESR]]
 |style="padding: 5px 5px; background: #F5F5F5;" | Increased
 |-
-|style="padding: 5px 5px; background: #F5F5F5;" | CRP
+|style="padding: 5px 5px; background: #F5F5F5;" | [[CRP]]
 |style="padding: 5px 5px; background: #F5F5F5;" | Increased
 |-
-|style="padding: 5px 5px; background: #F5F5F5;" | ABGS
+|style="padding: 5px 5px; background: #F5F5F5;" | [[Arterial blood gas|ABGS]]
 |style="padding: 5px 5px; background: #F5F5F5;" | Mild to moderate hypoxemia
 |-
 ! rowspan="4" style="padding: 5px 5px; background: #DCDCDC; font-weight: bold;"| Genital infection<ref name="pmid18617765">{{cite journal| author=Yang HW, Jung SH, Han HY, Kim A, Lee YJ, Cha SW et al.| title=[Clinical feature of Fitz-Hugh-Curtis syndrome: analysis of 25 cases]. | journal=Korean J Hepatol | year= 2008 | volume= 14 | issue= 2 | pages= 178-84 | pmid=18617765 | doi=10.3350/kjhep.2008.14.2.178 | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=18617765  }} </ref><ref>Peipert, Jeffrey F., et al. "Laboratory evaluation of acute upper genital tract infection." Obstetrics & Gynecology 87.5 (1996): 730-736.</ref><ref name="pmid3764626">{{cite journal| author=Stamm WE, Cole B| title=Asymptomatic Chlamydia trachomatis urethritis in men. | journal=Sex Transm Dis | year= 1986 | volume= 13 | issue= 3 | pages= 163-5 | pmid=3764626 | doi= | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=3764626  }} </ref>
-|style="padding: 5px 5px; background: #F5F5F5;"| CBC
+|style="padding: 5px 5px; background: #F5F5F5;"| [[CBC]]
-|style="padding: 5px 5px; background: #F5F5F5;"| Increased leukocyte count
+|style="padding: 5px 5px; background: #F5F5F5;"| Increased [[leukocyte]] count
 |-
-|style="padding: 5px 5px; background: #F5F5F5;"| Urinalysis
+|style="padding: 5px 5px; background: #F5F5F5;"| [[Urinalysis]]
 |style="padding: 5px 5px; background: #F5F5F5;"| >5 WBCS per high power field
 |-
-|style="padding: 5px 5px; background: #F5F5F5;"| ESR
+|style="padding: 5px 5px; background: #F5F5F5;"| [[ESR]]
 |style="padding: 5px 5px; background: #F5F5F5;"| Normal or increased
 |-
-|style="padding: 5px 5px; background: #F5F5F5;"| CRP
+|style="padding: 5px 5px; background: #F5F5F5;"| [[CRP]]
 |style="padding: 5px 5px; background: #F5F5F5;"| Normal or increased
 |-
 !style="padding: 5px 5px; background: #DCDCDC; font-weight: bold;"| Atypical [[pneumonia]]<ref name="pmid8331841">{{cite journal| author=Hayashi Y, Asano T, Ito G, Yamada Y, Matsuura T, Adachi S et al.| title=[Study of cell populations of bronchoalveolar lavage fluid in patients with pneumonia due to Chlamydia psittaci and Mycoplasma pneumoniae]. | journal=Nihon Kyobu Shikkan Gakkai Zasshi | year= 1993 | volume= 31 | issue= 5 | pages= 569-74 | pmid=8331841 | doi= | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=8331841  }} </ref>
-|style="padding: 5px 5px; background: #F5F5F5;"| CBC
+|style="padding: 5px 5px; background: #F5F5F5;"| [[CBC]]
-|style="padding: 5px 5px; background: #F5F5F5;"| Increased or normal leukocyte count( lymphocytes)
+|style="padding: 5px 5px; background: #F5F5F5;"| Increased or normal [[leukocyte]] count (lymphocytes)
 |-
 ! rowspan="4" style="padding: 5px 5px; background: #DCDCDC; font-weight: bold;"| Fitz Hugh Curtis Syndrome<ref name="pmid18617765">{{cite journal| author=Yang HW, Jung SH, Han HY, Kim A, Lee YJ, Cha SW et al.| title=[Clinical feature of Fitz-Hugh-Curtis syndrome: analysis of 25 cases]. | journal=Korean J Hepatol | year= 2008 | volume= 14 | issue= 2 | pages= 178-84 | pmid=18617765 | doi=10.3350/kjhep.2008.14.2.178 | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=18617765  }} </ref>
-|style="padding: 5px 5px; background: #F5F5F5;"| CBC
+|style="padding: 5px 5px; background: #F5F5F5;"| [[CBC]]
-|style="padding: 5px 5px; background: #F5F5F5;"| Increased leukocytes
+|style="padding: 5px 5px; background: #F5F5F5;"| Increased [[leukocytes]]
 |-
-|style="padding: 5px 5px; background: #F5F5F5;"| LFTS
+|style="padding: 5px 5px; background: #F5F5F5;"| [[PFTs|LFTS]]
 |style="padding: 5px 5px; background: #F5F5F5;"| Normal
 |-
-|style="padding: 5px 5px; background: #F5F5F5;"| ESR
+|style="padding: 5px 5px; background: #F5F5F5;"| [[ESR]]
 |style="padding: 5px 5px; background: #F5F5F5;"| Normal or increased
 |-
-|style="padding: 5px 5px; background: #F5F5F5;"| D Dimer
+|style="padding: 5px 5px; background: #F5F5F5;"| [[D-dimer|D Dimer]]
 |style="padding: 5px 5px; background: #F5F5F5;"| Normal or increased
 |}
 ==Other diagnostic tests==
-Other diagnostic tests which may be used to diagnose chlamydia infection include the following:
+Other diagnostic tests that may be used to diagnose chlamydia infection include the following:
 ===Culture===
-*Gold standard for diagnosing chlamydial infection<ref name="pmid3327923">{{cite journal| author=Hattis D, Wasson JM, Page GS, Stern B, Franklin CA| title=Acid particles and the tracheobronchial region of the respiratory system--an "irritation-signaling" model for possible health effects. | journal=JAPCA | year= 1987 | volume= 37 | issue= 9 | pages= 1060-6 | pmid=3327923 | doi= | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=3327923  }} </ref><ref name="pmid:     8027341">{{cite journal| author=Gaydos CA, Roblin PM, Hammerschlag MR, Hyman CL, Eiden JJ, Schachter J et al.| title=Diagnostic utility of PCR-enzyme immunoassay, culture, and serology for detection of Chlamydia pneumoniae in symptomatic and asymptomatic patients. | journal=J Clin Microbiol | year= 1994 | volume= 32 | issue= 4 | pages= 903-5 | pmid=:     8027341 | doi= | pmc=263160 | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=8027341  }} </ref>
+*Gold standard for diagnosing [[chlamydial infection]]<ref name="pmid3327923">{{cite journal| author=Hattis D, Wasson JM, Page GS, Stern B, Franklin CA| title=Acid particles and the tracheobronchial region of the respiratory system--an "irritation-signaling" model for possible health effects. | journal=JAPCA | year= 1987 | volume= 37 | issue= 9 | pages= 1060-6 | pmid=3327923 | doi= | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=3327923  }} </ref><ref name="pmid8027341">{{cite journal |vauthors=Gaydos CA, Roblin PM, Hammerschlag MR, Hyman CL, Eiden JJ, Schachter J, Quinn TC |title=Diagnostic utility of PCR-enzyme immunoassay, culture, and serology for detection of Chlamydia pneumoniae in symptomatic and asymptomatic patients |journal=J. Clin. Microbiol. |volume=32 |issue=4 |pages=903–5 |year=1994 |pmid=8027341 |pmc=263160 |doi= |url=}}</ref>
-*Test of choice in sexual abuse in boys <ref name= NC>http://www.cdc.gov/std/tg2015/chlamydia.htm Accessed on September 14,2016</ref>
+*Test of choice in cases of sexual abuse in boys<ref name= NC>http://www.cdc.gov/std/tg2015/chlamydia.htm Accessed on September 14,2016</ref>
-*Used for urogenital specimens (boys) and extragenital sites such as rectum and pharynx (males and female)<ref name= NC>http://www.cdc.gov/std/tg2015/chlamydia.htm Accessed on September 14,2016</ref>
+*Used for urogenital specimens (from males) and extragenital sites such as [[rectum]] and [[pharynx]] (males and female)<ref name= NC>http://www.cdc.gov/std/tg2015/chlamydia.htm Accessed on September 14,2016</ref>
 *Highly specific
 *Limitations include long incubation period, live cell culture requirement, specific transport methods
@@ Line 82: / Line 82: @@
 Tests based on antigen detection tests include the following:
-'''Nucleic acid amplification tests(NAATS)'''<ref name="pmid24622331">{{cite journal| author=Centers for Disease Control and Prevention| title=Recommendations for the laboratory-based detection of Chlamydia trachomatis and Neisseria gonorrhoeae--2014. | journal=MMWR Recomm Rep | year= 2014 | volume= 63 | issue= RR-02 | pages= 1-19 | pmid=24622331 | doi= | pmc=4047970 | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=24622331  }} </ref><ref name="pmid18159527">{{cite journal| author=Chernesky MA| title=The laboratory diagnosis of Chlamydia trachomatis infections. | journal=Can J Infect Dis Med Microbiol | year= 2005 | volume= 16 | issue= 1 | pages= 39-44 | pmid=18159527 | doi= | pmc=2095010 | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=18159527  }} </ref><ref name="pmid12418541">{{cite journal| author=Johnson RE, Newhall WJ, Papp JR, Knapp JS, Black CM, Gift TL et al.| title=Screening tests to detect Chlamydia trachomatis and Neisseria gonorrhoeae infections--2002. | journal=MMWR Recomm Rep | year= 2002 | volume= 51 | issue= RR-15 | pages= 1-38; quiz CE1-4 | pmid=12418541 | doi= | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=12418541  }} </ref><ref name="pmid14681509">{{cite journal| author=Peipert JF| title=Clinical practice. Genital chlamydial infections. | journal=N Engl J Med | year= 2003 | volume= 349 | issue= 25 | pages= 2424-30 | pmid=14681509 | doi=10.1056/NEJMcp030542 | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=14681509  }} </ref><ref name=abcd>http://www.cdc.gov/mmwr/preview/mmwrhtml/rr6302a1.htm Accessed on September 12, 2016</ref>
+'''Nucleic acid amplification tests (NAATS)'''<ref name="pmid24622331">{{cite journal| author=Centers for Disease Control and Prevention| title=Recommendations for the laboratory-based detection of Chlamydia trachomatis and Neisseria gonorrhoeae--2014. | journal=MMWR Recomm Rep | year= 2014 | volume= 63 | issue= RR-02 | pages= 1-19 | pmid=24622331 | doi= | pmc=4047970 | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=24622331  }} </ref><ref name="pmid18159527">{{cite journal| author=Chernesky MA| title=The laboratory diagnosis of Chlamydia trachomatis infections. | journal=Can J Infect Dis Med Microbiol | year= 2005 | volume= 16 | issue= 1 | pages= 39-44 | pmid=18159527 | doi= | pmc=2095010 | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=18159527  }} </ref><ref name="pmid12418541">{{cite journal| author=Johnson RE, Newhall WJ, Papp JR, Knapp JS, Black CM, Gift TL et al.| title=Screening tests to detect Chlamydia trachomatis and Neisseria gonorrhoeae infections--2002. | journal=MMWR Recomm Rep | year= 2002 | volume= 51 | issue= RR-15 | pages= 1-38; quiz CE1-4 | pmid=12418541 | doi= | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=12418541  }} </ref><ref name="pmid14681509">{{cite journal| author=Peipert JF| title=Clinical practice. Genital chlamydial infections. | journal=N Engl J Med | year= 2003 | volume= 349 | issue= 25 | pages= 2424-30 | pmid=14681509 | doi=10.1056/NEJMcp030542 | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=14681509  }} </ref><ref name=abcd>http://www.cdc.gov/mmwr/preview/mmwrhtml/rr6302a1.htm Accessed on September 12, 2016</ref>
 *These include [[PCR]], [[ligase chain reaction]], and transcription-mediated amplification of RNA
-*FDA approved for vaginal and urinary specimens<ref name= NC>http://www.cdc.gov/std/tg2015/chlamydia.htm Accessed on September 14,2016</ref>
+*FDA-approved for vaginal and urinary specimens<ref name= NC>http://www.cdc.gov/std/tg2015/chlamydia.htm Accessed on September 14,2016</ref>
-*Not FDA approved for usage on extragenital sites and urogenital specimen in boys
+*Not FDA-approved for usage on extragenital sites and urogenital specimen in boys.
 *Higher sensitivity and specificity than culture
+*Test of choice: use [[vaginal]] or [[cervical]] [[swabs]] or [[first-void urine]] in women. In men, use [[urethral]] [[swab]] or [[first-void urine]]. Female patients can collect their swab as it has the same sensitivity in comparison to a clinician collecting it.<ref name="pmid34292926">{{cite journal| author=Workowski KA, Bachmann LH, Chan PA, Johnston CM, Muzny CA, Park I | display-authors=etal| title=Sexually Transmitted Infections Treatment Guidelines, 2021. | journal=MMWR Recomm Rep | year= 2021 | volume= 70 | issue= 4 | pages= 1-187 | pmid=34292926 | doi=10.15585/mmwr.rr7004a1 | pmc=8344968 | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=34292926  }} </ref>
+*Most sensitive tests: [[vaginal]] [[swabs]] for women, [[first-void urine]] for men.<ref name="pmid34292926">{{cite journal| author=Workowski KA, Bachmann LH, Chan PA, Johnston CM, Muzny CA, Park I | display-authors=etal| title=Sexually Transmitted Infections Treatment Guidelines, 2021. | journal=MMWR Recomm Rep | year= 2021 | volume= 70 | issue= 4 | pages= 1-187 | pmid=34292926 | doi=10.15585/mmwr.rr7004a1 | pmc=8344968 | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=34292926  }} </ref>
+*[[Rectal]] and [[oropharyngeal]] [[swabs]] can also be performed.<ref name="pmid34292926">{{cite journal| author=Workowski KA, Bachmann LH, Chan PA, Johnston CM, Muzny CA, Park I | display-authors=etal| title=Sexually Transmitted Infections Treatment Guidelines, 2021. | journal=MMWR Recomm Rep | year= 2021 | volume= 70 | issue= 4 | pages= 1-187 | pmid=34292926 | doi=10.15585/mmwr.rr7004a1 | pmc=8344968 | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=34292926  }} </ref>
 '''Less accurate antigen detection tests'''
@@ Line 92: / Line 95: @@
 *[[Enzyme immunoassay]]
 *[[Direct fluorescent antibody]] assay
-::*FDA cleared for conjuctival and nasopharyngeal specimen testing <ref name= NC>http://www.cdc.gov/std/tg2015/chlamydia.htm Accessed on September 14,2016</ref>
+::*FDA-cleared for conjuctival and nasopharyngeal specimen testing<ref name= NC>http://www.cdc.gov/std/tg2015/chlamydia.htm Accessed on September 14,2016</ref>
 ::*Highest sensitivity and specificity for neonatal conjuctivitis
 ===Antibody detection tests===
-Serological tests which may help in diagnosis of chlamydial infection include:<ref name="pmid3327923">{{cite journal| author=Hattis D, Wasson JM, Page GS, Stern B, Franklin CA| title=Acid particles and the tracheobronchial region of the respiratory system--an "irritation-signaling" model for possible health effects. | journal=JAPCA | year= 1987 | volume= 37 | issue= 9 | pages= 1060-6 | pmid=3327923 | doi= | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=3327923  }} </ref>
+Serological tests that may help in diagnosis of chlamydial infection include:<ref name="pmid3327923">{{cite journal| author=Hattis D, Wasson JM, Page GS, Stern B, Franklin CA| title=Acid particles and the tracheobronchial region of the respiratory system--an "irritation-signaling" model for possible health effects. | journal=JAPCA | year= 1987 | volume= 37 | issue= 9 | pages= 1060-6 | pmid=3327923 | doi= | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=3327923  }} </ref>
 '''Microimmunofluorescence (mif) assay'''
-*Detect species-specific antibodies
+*Detect species-specific [[antibodies]]
-*Gold standard for chlamydia serology
+*Gold standard for chlamydia [[serology]]
 '''Complement fixation tests'''
-*Used for diagnosing chlamydial respiratory infection
+*Used for diagnosing chlamydial [[respiratory infection]]
-*Replaced by mif
+*Replaced by microimmunofluorescence (mif)
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