The laboratory components of a Chlamydia trachomatis disease control programme for a developing country are reviewed. Early diagnosis of chlamydial infections is the most cost effective means of preventing the long term sequelae of trachoma, pelvic inflammatory disease, ectopic pregnancy and infertility, which are now a major public health burden to the health care system in developing countries. Public health strategies are required to establish both a co-ordinated limited system of laboratory services, and to promote the diagnosis and treatment of disease syndromes in the absence of laboratory support. Laboratory tests for the specific diagnoses of chlamydial infections requiring different levels of expertise and equipment can be instituted within settings appropriate to the resources and technical expertise available. Emphasis is given to appropriate cost effective utilization of laboratory testing.
PIP: Current methods used for the laboratory diagnosis of a Chlamydia trachomatis disease control program for a developing country are reviewed to guide clinical microbiology laboratories to develop criteria for testing. Human chlamydia infections are a major public health problem in both developed and developing countries. Worldwide an estimated 360 million persons are infected by the ocular serovars of Chlamydia trachomatis and 6.4 million are blind from the scarring, sequelae. The genital strains of Chlamydia trachomatis cause cervical, endometrial or tubal infections in women, resulting in pelvic inflammatory disease (PID) or ectopic pregnancy, and infertility. Over 50% of chlamydia infections in women are asymptomatic and progress to silent PID and infertility. In industrialized countries chlamydia infections are the major cause of sexually transmitted disease-related infertility. Infants born to infected mothers are at risk for chlamydia pneumonia and ophthalmia neonatorum. More tentative associations of chlamydia infections exist with Reiter's Syndrome. Early diagnosis of chlamydia infections is the most cost effective means of preventing the longterm sequelae of trachoma, pelvic inflammatory disease, ectopic pregnancy and infertility, which are a major public health liability in developing countries. In many developed and developing countries, public health decision maker are not aware of the extent of chlamydia infections in the community. One of the priorities of the disease control program is to provide accurate epidemiologic data through seroprevalence studies. This includes estimates of persons infected, the severity of complications and sequelae. Public health strategies are required to establish laboratory services and to diagnose and treat the disease. The diagnostic methods for C. trachomatis include specimen collection, cytologic methods, serologic methods, cell culture method, antigen detection methods, and nucleic acid hybridization tests that should be available at the national reference laboratory.