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Journal of Clinical Microbiology, May 2007, p. 1395-1402, Vol. 45, No. 5
0095-1137/07/$08.00+0     doi:10.1128/JCM.00100-07
Copyright © 2007, American Society for Microbiology. All Rights Reserved.

Chlamydia trachomatis Load at Matched Anatomic Sites: Implications for Screening Strategies

Claude-Edouard C. Michel,¹ Christopher Sonnex,² Christopher A. Carne,² John A. White,³ Jose Paolo V. Magbanua,¹ Elpidio Cesar B. Nadala Jr.,^1, and Helen H. Lee^1*

Department of Haematology, University of Cambridge, Cambridge CB2 2PT, United Kingdom,¹ Department of Genitourinary Medicine, Clinic 1A, Addenbrooke's Hospital, Cambridge CB2 2QQ, United Kingdom,² Department of Genitourinary Medicine, St. Thomas' Hospital, London SE1 7EH, United Kingdom³

Received 15 January 2007/ Returned for modification 28 February 2007/ Accepted 12 March 2007

Urethral and endocervical swabs and self-collected vaginal swabs (SCVSs) and urine specimens are all used as samples for diagnosis of urogenital infection with Chlamydia trachomatis. We have now determined chlamydial organism load in matched specimens from different anatomic sites and examined its relation to clinical signs and symptoms in men and women. Organism load was measured with assays based on the ligase chain reaction or real-time PCR analysis. The mean organism loads in 58 infected men were 1,200 and 821 elementary bodies (EBs) per 100 µl of sample for first-void urine (FVU) and urethral swabs, respectively (P > 0.05). Organism load in FVU samples or urethral swabs was positively associated with symptoms (P < 0.01) and clinical signs (P < 0.01) in men. The mean organism loads in 73 infected women were 2,231, 773, 162, and 47 EBs/100 µl for endocervical swabs, SCVSs, urethral swabs, and FVU samples, respectively (P < 0.001 for each comparison). Only the presence of multiple symptoms or clinical signs was associated with organism load in women. These results show that FVU is a suitable noninvasive sample type for men, given the fact that its chlamydial load did not differ significantly from that of urethral swabs. Given their higher organism load compared with FVU, SCVSs are the preferred noninvasive sample type for women.

Published ahead of print on 21 March 2007.

Present address: Diagnostics for the Real World, 840 Del Rey Avenue, Sunnyvale, CA 94085.

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