[Investigation of Chlamydia trachomatis positivity in women with and without gynecologic complaints by cytologic and direct immunofluorescence methods].

The asymptomatic nature of the majority of Chlamydia trachomatis infections leads to persistent infections and serious complications as well as continuous transmission of bacteria in the populations. The aim of this study was to investigate the presence of C. trachomatis in non-pregnant women with and without gynecologic signs and symptoms, and to detect the rate of asymptomatic carriage. Cervical specimens collected from 200 nonpregnant women (age range: 20-81 yrs; mean age: 40.2+/-10.4 yrs) who were admitted to Gynecology and Obstetrics Clinics of Hacettepe University Hospital were included to the study. Of them 68 had clinical complaints such as vaginal discharge, itching/irritation, inflammation and inguinal pain, while 132 had not any clinical complaints. All the samples were examined by direct immunofluorescence (DFA) method (Fluorotect Chlamydia, Omega Diagnostics, UK) with fluorescein isothiocyanate labeled monoclonal antibodies against C. trachomatis serotype specific major outer membrane proteins, and the samples were simultaneously screened cytologically by Papanicolaou staining method. As a result, C. trachomatis antigen positivity was found in 49 (24.5%) of the samples by DFA method, and chlamydial inclusion bodies were detected in 19 (9.5%) of women by cytologic method. Twelve (24.5%) of the 49 DFA positive samples, and 7 (4.6%) of the 151 DFA negative samples yielded positive results cytologically. The observed proportion of overall agreement (P) was estimated as 78% between the results of methods. C. trachomatis antigen positivity was detected in 16.2% (11/68) and 28.8% (38/132) of women with and without clinical symptoms, respectively. There was no statistically significant difference between C. trachomatis positivity and neither the presence of clinical signs and symptoms nor the characteristics of the signs and symptoms (p>0.05). In conclusion, the high asymptomatic carriage rate detected in our study population indicated that, for the prevention of bacterial transmission in the populations, the women who were admitted to gynecology and obstetrics clinics should be screened for C. trachomatis positivity even if they had no clinical complaints. The use of DFA method together with the widely used, practical and economical cytologic examination method, would increase the sensitivity and specificity of C. trachomatis diagnosis.