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II. Confirmation of Chlamydia trachomatis Infection by Direct Immunofluorescence Using Monoclonal Antibodies

Nancy B. Kiviat, MD; Marcia Peterson, CT(ASCP); Elaine Kinney-Thomas, PhD; Milton Tam, PhD; Walter E. Stamm, MD; King K. Holmes, MD, PhD

JAMA. 1985;253(7):997-1000.

Abstract
We found inflammatory patterns of transparent lymphocytes on increased numbers of histiocytes suggestive of chlamydial infection in 68 (56%) of 121 cervical cytologic smears. Chlamydia trachomatis was isolated from 36 (53%) of those with and only two (4%) of those without such inflammatory patterns. Direct stain with fluorescein-conjugated monoclonal antibodies demonstrated elementary bodies of C trachomatis in 30 (79%) of the 38 culture-positive patients, including 29 of the culture-positive patients who had an inflammatory cytologic pattern suggestive of C trachomatis infection. Thus, Papanicolaou smears can be screened for inflammatory pattern, and separate endocervical smears from patients with a pattern suggestive of chlamydial infection can then be stained by immunofluorescence to confirm the presence of C trachomatis infection. This two-step approach detected 29 of 38 infections confirmed by culture in the present study, giving a sensitivity of 76%, a specificity of 100%, and a positive predictive value of 100% in a population having a 31% prevalence of C trachomatis infection.

(JAMA 1985;253:997-1000)

Author Affiliations
From the Departments of Pathology (Dr Kiviat and Ms Peterson) and Medicine (Drs Stamm and Holmes), University of Washington, Harborview Medical Center, and Genetic Systems Corporation (Drs Kinney-Thomas and Tam), Seattle.

Footnotes
Reprint requests to Harborview Medical Center ZA-51, 325 Ninth Ave, Seattle, WA 98104 (Dr Kiviat).

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