The diagnosis of chlamydia is commonly presumptive but should be confirmed using laboratory tests. Direct detection using commercially available immunofluorescence or ELISA monoclonal antibody techniques permits rapid diagnosis. False positive and negative results occur; false positive results can be a problem, particularly in patients who deny risk of sexually transmitted infection. Results must be interpreted having regard to the clinical context
Chlamydiae are obligate intracellular parasites; isolation requires tissue culture techniques and takes 3 or 4 days. Direct tests are not as sensitive as culture but are reliable and much less expensive. Culture is only available from a few laboratories.
Serology is of limited value. Complement fixation tests for antibody are not very specific and have largely been superseded. ELISA and immunofluorescence techniques detect chlamydial group antibodies. Microimmunofluorescence tests can detect type specific antibodies. Seroconversion or a 4-fold increase in titre in serum samples collected 2 weeks apart indicates acute infection. A high titre of IgG antibodies and the presence of IgM antibodies probably indicate current infection. Negative serology may be of value in excluding chlamydial infectioa
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