The present guidelines aim to provide comprehensive information regarding the laboratory diagnosis of infections caused by Chlamydia trachomatis in East European countries. These recommendations contain important information for laboratory staff working with sexually transmitted infections (STIs) and/or STI?related issues. Individual East European countries may be required to make minor national adjustments to these guidelines as a result of lack of accessibility to some reagents or equipment, or laws in a specific country.
The present guidelines aim to provide comprehensive information regarding chlamydial sexually transmitted infection (STI) and the corresponding laboratory diagnosis for East European countries. In many East European countries, commercial kits, that are frequently available in the west, are often not affordable and often the tests used have not been validated against internationally accepted standards. These guidelines are primarily intended for professionals testing specimens from patients at a sexual health care clinic but may also be helpful for community based screening programmes. The guidelines represent the first attempt to introduce an evidence?based approach to the diagnosis of chlamydial infections in Eastern Europe It is recognized that, for different East European countries, minor national adjustments to these guidelines may be needed to meet local laws, health strategies and the availability of kits and reagents. The present guidelines were elaborated as a consensus document of the Eastern European Sexual and Reproductive Health Network1 and comprise one element of a series of guidelines aimed at optimization, standardization, and quality assurance of the laboratory diagnosis of the reproductive tract infections.2-4
Chlamydia trachomatis is a major cause of genital tract infections among sexually active adolescents and young persons.5 It has been reported that pelvic inflammatory disease may occur in ? 40% of women with untreated C. trachomatis genital tract infection 6, 7 with a significant but uncertain number developing tubal factor infertility, ectopic pregnancy or chronic pelvic pain.8 Untreated C. trachomatis infection during pregnancy may lead to conjunctivitis or pneumonia in the newborn. In men, the sequel of protracted untreated C. trachomatis infection is epididymitis. Genital tract infection with C. trachomatis in either sex may also lead to reactive arthritis, while oro?genital contact may lead to pharyngitis and insertive anal contact, to proctitis. Accidental inoculation of the eye with genital discharge material may lead to adult inclusion conjunctivitis. The costs to national health services of treating the sequelae of chlamydial STI are clearly substantial. Cost?benefit studies in developed countries show that the best strategy is to diagnose and treat the initial uncomplicated infection. 9 However, the majority of chlamydial infections, particularly those in women, are asymptomatic. This has two implications. First, since the diagnosis of chlamydial genital tract infections based on signs and symptoms is unreliable, the use of effective laboratory tests to detect chlamydial infection is essential. Second, as infected persons often do not seek medical attention, screening strategies based on local criteria are required to ensure that chlamydial infections are not missed in high-risk population groups. 10
Infections caused by the more invasive LGV biovars of C. trachomatis manifest as classical lymphogranuloma venereum and proctitis or proctocolitis in women and men who have sex with men (MSM). Recent outbreaks in Europe and North America have been particularly associated with MSM.11, 12
Data on morbidity due to genital chlamydial infections in Eastern European countries are scarce and their reliability is doubtful owing to the comparatively low number of tests performed, 13 the low quality of the tests used and the methods chosen. 14-16
The classification of infections caused by C. trachomatis is presented in Table 1.