EVALUATION OF 4 DIFFERENT SEROLOGICAL ASS AYS IN GYNECOLOGICAL CHLAMYDIAL DIAGNOSTICS

Genital chlamydial infections persist for years in both women and men. Because of low numbers of organisms found in the urogenital tract dir ect detection of Chlamydia trachomatis may be difficult. In these case s serology serves as a useful diagnostic supplement in clinically susp ected infection or tubal factor sterility. A total of 178 sterility pa tients (63 with pelviscopically proven occluded, 115 with open fallopi an tubes), 103 women with positive cervical swabs, 100 obstetric patie nts (6% with positive cervical swabs), and 100 blood donors were serol ogically tested. The following tests were used: 1. microimmunofluoresc ence test (MIF, Graystone), 2. a commercial test using lipopolysacchar ide (LPS) extracted elementary bodies as antigen, 3. a commercial ''wh ole inclusion'' test, 4. a commercial recombinant chlamydial LPS test. The positive predictive values of these tests were 71%, 65%, 66%, 52% for tubal occlusion and 40%, 40%, 21%, 13% for a positive cervical sw ab (obstetric patients), respectively. Principally, only the Chlamydia trachomatis species-specific tests (MIF test and LPS extracted elemen tary body test) were suited for gynaecological chlamydial diagnostics. Due to its cross-reactivity with Chlamydia pneumoniae the ''whole inc lusion'' test should be restricted to high prevalence groups such as s terility patients. The genus-specific LPS test proved to be of no help for the gynaecologist. No serological test allowed any differentiatio n between past and present infection with Chlamydia trachomatis.