Chlamydia is an STI caused by a genus of bacteria (Chlamydia spp.) that requires living cells for growth and is classified as obligate cell parasites. Recognized species include Chlamydia psittaci, Chlamydia pneumoniae, and Chlamydia trachomatis. C. psittaci causes psittacosis in birds and humans, and C. pneumoniae is responsible for approximately 10% of cases of community-acquired pneumonia. C. trachomatis is grouped into three serotypes. One group causes lymphogranuloma venereum (LGV), an STI. Another group causes trachoma, an eye disease. The third group causes genital tract infections different from LGV. Culture of the organism is definitive for chlamydiae. C. trachomatis infection is the most common reportable STI in the United States, and reporting has been required in all 50 states and the District of Columbia since 2000.
Screening for chlamydia is particularly important because it is such a common STI that is often with no symptoms but can cause serious complications if left untreated. Annual screening for chlamydia is recommended for all sexually active women younger than 25 years, women older than 25 years if they have new or multiple sex partners or a sex partner with a diagnosed STI, men who have sex with men (MSM), and persons with HIV who are sexually active. Pregnant women who are at risk should also be screened for chlamydia early in pregnancy.
Although methods such as culture, DFA stain, and DNA probe are available to test for chlamydia, the nucleic acid amplification test (NAAT) (which detects the genetic material of C. trachomatis), is recommended because it is more sensitive and specific and can be done without a pelvic examination for women.
For females:
Use a collection swab with a plastic or wire shaft and rayon, Dacron, or cytobrush tip to swab the vagina.
Use a sucrose phosphate glutamate buffer or M4 media to store and transport the specimen to the laboratory at ≤4 °C within 24 hours. If the sample cannot be transported to the laboratory within 24 hours, store at −70 °C.
For males:
Obtain a first morning urine sample.
Place specimen in a biohazard bag for transport to the laboratory.
The NAAT test detects the presence of chlamydia DNA but does not measure whether antibiotic treatment is effective. In those cases, bacterial culture using antibody testing is needed to determine the correct antibiotic therapy.
Pretest Patient Care
Assess patient knowledge regarding the test and explain purpose and procedure. Elicit history regarding possible exposure to organism.
Follow guidelines in Chapter 1 for safe, effective, informed pretest care.
Posttest Patient Care
Review test results; report and record findings. Modify the nursing care plan as needed.
Follow guidelines in Chapter 1 for safe, effective, informed posttest care.