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PubMed1994

Evaluation of five immunoassays for detection of Chlamydia psittaci in cloacal and conjunctival specimens from turkeys.

Five commercially available immunoassays were evaluated for the detection of Chlamydia psittaci in cloacal and conjunctival swabs from industrially raised turkeys: IMAGEN (DAKO Diagnostics, Ely, Cambridgeshire, United Kingdom), Chlamydia CEL-VET IF (Cellabs, Brookvale, Australia), IDEIA (DAKO Diagnostics), CELISA (Cellabs), and CLEARVIEW (Unipath, Bedford, United Kingdom). Results were compared with isolation in Buffalo Green Monkey cells as a reference method. For the conjunctival samples, the sensitivities of the IMAGEN test, the Chlamydia CEL-VET IF test, the IDEIA, the CELISA, and the CLEARVIEW test were found to be 100, 66, 0, 0, and 0%, respectively, as compared to the reference test. Also for the conjunctival samples, the specificities of the IMAGEN test, the Chlamydia CEL-VET IF test, and the IDEIA were found to be 100, 11, and 92.8%, respectively. For the cloacal specimens, the sensitivities of the IMAGEN test, the Chlamydia CEL-VET IF test, the IDEIA, the CELISA, and the CLEARVIEW test were found to be 100, 93.3, 26.6, 0, and 53.3%, respectively. Also for the cloacal specimens, the specificities of the IMAGEN test, the Chlamydia CEL-VET IF test, the IDEIA, and the CLEARVIEW test were found to be 92, 12, 100, and 88%, respectively. The IMAGEN test was the most sensitive and specific direct chlamydia antigen detection test for cloacal and conjunctival samples from turkeys.

Animals↗
PubMed2004

Prevalence of Chlamydia trachomatis infection among women in a Middle Eastern community.

BACKGROUND: Common vaginal infections that manifest in women are usually easily diagnosed. However, Chlamydia infection is often asymptomatic, leading to infertility before it is detected. If it occurs in pregnancy, it could lead to significant neonatal morbidity. It may also play a role with other viral infections for e.g. Human Papilloma Virus in the development of cervical cancer. The objective of this study was to determine the prevalence of Chlamydia infection in women undergoing screening for cervical abnormalities as a part of a research project in primary and secondary care institutions in the United Arab Emirates. METHODS: In this cross sectional study married women attending primary and secondary care participating in a large nationwide cervical abnormalities screening survey were offered Chlamydia testing using a commercially available test kit. This kit uses a rapid immunoassay for the direct detection of Chlamydia trachomatis antigen in endocervical swab specimens. As this study was performed in a traditional Islamic country, unmarried women were excluded from testing, as the management of any positive cases would create legal and social problems. All married women consenting to take part in the study were included irrespective of age. RESULTS: Of 1039 women approached over a period of eight months 919 (88.5%) agreed to participate. The number of women in the 16 to 19 years was small (0.01%) and 30% were aged over 40 years. The prevalence of Chlamydia infection in this study was 2.6% (95% confidence interval 1.2-3.3%), which was marginally higher in women screened in secondary care (p = 0.05). CONCLUSION: This is one of the few reports on the prevalence of Chlamydia infection in women from the Middle East. Due to cultural and social constraints this study excluded a large proportion of women aged less than 19 years of age. Hence no direct comparisons on prevalence could be made with studies from the West, which all included younger women at high risk of Chlamydia. However this study emphasizes the importance of cultural factors while interpreting results of studies from different cultures and communities.

Journal Article↗
PubMed2000

[Impact of Chlamydia pneumoniae infections on asthma].

VIRUSES AND BACTERIA: The fact that the airways are exposed to a large number of infectious agents could explain the frequency of respiratory infections and their causal effect in bronchial inflammation. Viruses are most often the causal agent, but the frequency of bacterial infections make them potential candidates in certain respiratory diseases. Chlamydia are particularly important due to their capacity to provoke immune dysfunction and chronic inflammation. EFFECT ON ASTHMA: It is not surprising to find biological evidence of Chlamydia pneumoniae infection in a large number of subjects who experience major degradation of their asthma because asthmatic subjects are particularly susceptible to respiratory infections and Chlamydia pneumoniae is a frequent cause of such infections. PATHOGENIC EFFECT: Finding Chlamydia pneumoniae as the causal agent in asthma is however much more surprising, with a much different consequence. There are however many epidemiological and clinical findings and case observations (Chlamydia pneumoniae asthma associations, prolonged favorable course in certain obstructive bronchial diseases after a short antibiotic regimen) as well as provocative pathophysiological data favoring this particular form of "infectious asthma". FURTHER INFORMATION: Large-scale studies with rigorous methodology remain to be performed. The would be needed to determine the exact relationship between Chlamydia pneumoniae infections and certain types of asthma, particularly when wheezing occurs after a respiratory infection and when chronic obstruction develops. The could also determine the role of anti-Chlamydia pneumoniae antibiotics in case of obstructive respiratory failure and also determine their efficacy on long-term outcome.

Adult↗
PubMedDate not supplied

Chlamydia pneumoniae infection and nonspecific aortoarteritis: search for a link with a nonatherosclerotic inflammatory arterial disease.

BACKGROUND: The association between Chlamydia pneumoniae infection and atherosclerosis has gained recognition. However, the nature of this association is controversial. The infective link may not be specific for atherosclerosis and may also exist in other nonatherosclerotic arterial diseases. We investigated patients with nonspecific aortoarteritis for serological evidence of prior Chlamydia pneumoniae infection. METHODS AND RESULTS: Fifty patients each of nonspecific aortoarteritis and coronary artery disease with angiographic evidence of significant (>70%) coronary artery lesions were tested for the presence of IgG antibodies against Chlamydia pneumoniae by micro-immunofluorescence assay and compared with 50 age- and sex-matched normal healthy controls. The number of patients with nonspecific aortoarteritis who tested positive for Chlamydia pneumoniae antibodies (IgG) was not significantly different from controls (8 v. 7, p=ns). The mean titer amongst positive subjects in the two groups was also similar (1:40+/-40 v. 1:50+/-25; p=ns). Patients with coronary artery disease were significantly older than patients with nonspecific aortoarteritis and controls (53.2+/-5.8 v. 21.2+/-9.9 years and 24.5+/-5.2 years, p<0.01 for both) and showed a higher seroprevalence of prior Chlamydia pneumoniae infection (18 v. 8 and 7, p < 0.05 for both). The mean IgG titers of patients with coronary artery disease who tested positive were also significantly higher than the other two groups (1:98+/-34 v. 1:40+/-40, p<0.001 and 1:98+/-34 v. 1:50+/-25, p<0.01, respectively). CONCLUSIONS: In patients with nonspecific aortoarteritis, the seroprevalence of prior Chlamydia pneumnoniae infection is not more than that in healthy individuals of the same age group, but is significantly lesser than that in patients with coronary artery disease. Thus Chlamydia pneumoniae infection may not be associated with all forms of chronic inflammatory arterial lesions.

Adolescent↗
PubMed1993

[The occurrence of Chlamydia psittaci infections in raptors from wildlife preserves].

152 free-living raptors found in the area around Munich, Germany, were investigated for possible Chlamydia psittaci infections. Chlamydia psittaci was detected in 13.2% of these birds of prey (Strigiformes, Falconiformes and Accipitriformes) by examination of cloacal swabs with an antigen ELISA (IDEIA Chlamydia test kit). Chlamydia psittaci antibodies could be demonstrated in 85.1% of 121 birds by a Chlamydia antibody ELISA (Chlamydia-psittaci-AK-EIA). 29.7% of the samples investigated were positive, 55.4% showed strong positive reactions. The birds showed neither clinical nor pathological signs of chlamydial infections. The specificity and sensitivity of the Chlamydia antibody ELISA, as determined using positive sera and epidemiological criteria are discussed. Antigen ELISA and the cell culture method showed a consistency of 94%. The results and their consequences for diagnostic procedures and state regulations are discussed.

Animals↗
PubMed2000

Screening for chlamydia in adolescents and young women.

OBJECTIVE: To measure the proportion of sexually active females aged 15 to 25 years who received a screening test for Chlamydia trachomatis infection during the previous year. DESIGN: Administrative data were used to identify females in the target age range who were likely to be sexually active. Medical record data were reviewed for a sample to determine whether the administrative algorithm was acceptable. Laboratory claims data and medical record data were used to identify females who had had a screening test for chlamydia. SETTING: Four geographically dispersed US managed health care plans. PATIENTS: We studied 19,214 sexually active females aged 15 to 25 years continuously enrolled for calendar year 1997 in 1 of 4 major US health plans who had a visit to their health care provider during that year. Sexual activity was determined using an algorithm designed for use with administrative data. MAIN OUTCOME MEASURE: Rates of chlamydia screening among sexually active females aged 15 to 25 years. RESULTS: The proportion of females aged 15 to 25 years identified as sexually active by the administrative data algorithm in the 4 health plans was similar (43%-54%; P =.79). However, substantial variation was found in rates of chlamydia screening for eligible females in these 4 health plans (2%-42%; P<. 001). Plans varied considerably in the types of visits (eg, sexually transmitted disease screening or pregnancy) that determined eligibility for the measure. CONCLUSIONS: A measure of health plan performance on screening for chlamydia in young females using administrative data is feasible and provides useful results despite some flaws in estimation. There is room for improvement in rates of chlamydia screening in sexually active females aged 15 to 25 years.

Adolescent↗
PubMed1995

Alteration of Chlamydia trachomatis biologic behavior in synovial membranes. Suppression of surface antigen production in reactive arthritis and Reiter's syndrome.

OBJECTIVE: To investigate the biologic state of Chlamydia and its surface antigen expression in the synovial membranes of patients with Chlamydia-associated reactive arthritis/Reiter's syndrome (ReA/RS). METHODS: Expression of chlamydial lipopolysaccharide (LPS), major outer membrane protein (MOMP), and elementary body (EB) antigens was studied by gold labeling immunoelectron microscopy on 6 synovial membrane and 2 synovial fluid (SF) pellet samples from 6 patients with Chlamydia-associated arthritis. The study findings were compared with 24-hour cultures of HeLa cells infected with Chlamydia trachomatis EB. RESULTS: Persistent C trachomatis infection was found in all 6 synovial membrane samples from patients who had either early or chronic arthritis. The infection persisted despite antibiotic treatment, including a 1-month course of doxycycline therapy. Most persistent organisms were atypical reticulate bodies (RBs) found in both fibroblasts and macrophages. Specific, but weak, immunogold staining for all 3 antibodies was found on both intracellular RBs and extracellular EBs. In the SF samples, Chlamydia surface antigens were detected only in phagosomes containing degraded electron-dense materials. CONCLUSION: The synovial membrane biopsies conducted in this study of Chlamydia-associated ReA/RS revealed atypical RBs with diminished MOMP and LPS expression. Such altered organisms may escape immune surveillance and contribute to disease chronicity; moreover, these organisms may be difficult to detect and treat in some ReA/RS patients.

Adult↗
PubMed1994

Cervicovaginal cytology and the diagnosis of Chlamydia trachomatis: a comparison with immunofluorescent results.

To evaluate the accuracy of a Chlamydia diagnosis in our laboratory, cytologic Chlamydia diagnoses for the years 1990 and 1991 were compared with immunofluorescent studies for Chlamydia for the same period. Only one of 22 cases diagnosed cytologically as suggestive of Chlamydia had a positive immunofluorescent result. On rescreen of 110 cervicovaginal smears taken within 1 mo of a positive fluorescent antibody test, 11 cases were found to contain criteria suggestive of Chlamydia. These correlations represent a 4.5% specificity and 10% sensitivity rate, suggesting that our current efforts in cytology are not effective in determining the presence of Chlamydia.

Chlamydia Infections↗
PubMed2002

Mannose-receptor positive and negative mouse macrophages differ in their susceptibility to infection by Chlamydia species.

It has been shown that N-linked high mannose type oligosaccharides competitively inhibits attachment to and infectivity of chlamydiae in HeLa cells. To further study whether mannose moieties are involved in the infectivity of chlamydiae, the susceptibility of mannose-receptor negative J774A and positive J774E mouse macrophages to Chlamydia trachomatis, Chlamydia psittaci and Chlamydia pneumoniae was evaluated. C. trachomatis infected mannose-receptor positive cells better than mannose-receptor negative cells. C. psittaci infected both mannose-receptor negative and positive cells equally well, while C. pneumoniae infected mannose-receptor negative cells better than mannose-receptor positive cells. Further studies using this system may provide insight into the role of mannose-receptor in attachment, entry and survival of chlamydiae in macrophages.

Animals↗
PubMed1998

Demonstration of Chlamydia trachomatis in Papanicolaou-stained gynecological smears.

A fluorescent antibody staining method was developed to detect Chlamydia trachomatis elementary bodies in Papanicolaou-stained cervical smears. Twenty-five known chlamydia-positive and 12 chlamydia-negative smears were correctly identified using this method. Smears from individuals with culture-positive chlamydia infections showed a high density of elementary bodies. Among 64 routine cervical smears, 27% (6/22) of smears that showed inflammatory changes were positive by fluorescent antibody staining for chlamydia, compared to 2.4% (1/42) of smears that were negative for inflammatory changes. This method should facilitate detection of chlamydia infections in populations undergoing cytological screening.

Cervix Uteri↗
PubMed1989

Prevalence of Chlamydia trachomatis infection in a population of asymptomatic women in a screening program for cervical cancer.

The prevalence of Chlamydia trachomatis infection in a population of women with no symptoms of sexually transmitted disease was investigated. These women, aged 35-55 years, participated in a screening program for cervical cancer. With the use of a direct immunofluorescence method, 109 out of 2,470 smears tested were positive for Chlamydia trachomatis, indicating an overall prevalence of 4.4%. No changes in prevalence were found when five-year cohorts of this group were analyzed, indicating that age-dependent changes or epidemiological factors do not result in a different (decreased) prevalence over the ages 35 to 55 years. The prevalence of Trichomonas vaginalis and fungi, as detected by cytological screening, was lower than that observed for Chlamydia trachomatis: 3.1 and 2.1%, respectively. Of the 109 smears positive for Chlamydia trachomatis, 90 showed cervical cells with reactive changes (out of 1,490 smears with PAP II), whereas no cytological changes were found in 15 cases (out of 884 smears with PAP I). Changes suggestive of mild or moderate dysplasia were found in only four cases (out of 93 smears with PAP III). The results indicate that Chlamydia trachomatis is associated with reactive changes of endocervical cells and raise serious questions about whether prevention of possible secondary effects such as infertility and pelvic inflammatory disease can be achieved by a combined screening program for cervical cancer and Chlamydia trachomatis.

Adult↗
PubMed2003

Improved sensitivity of the Chlamydia trachomatis Cobas Amplicor assay using an optimized procedure for preparation of specimens.

The aim of this study was to evaluate the performance of an improved sample preparation procedure that enhances the sensitivity of the Chlamydia trachomatis Cobas Amplicor assay (Roche, Switzerland). This procedure was developed after it was observed that, in some cases, endocervical swabs positive for Chlamydia trachomatis in a direct immunofluorescence assay were negative in the Chlamydia trachomatis Cobas Amplicor. For this procedure, the initial sample volume was increased over that recommended by the manufacturer, the sample was concentrated by centrifugation, and the yield of the extraction was increased by an additional enzymatic lysis. Five hundred sixteen endocervical swabs from women visiting a family planning clinic were tested in parallel by the Chlamydia trachomatis Cobas Amplicor using the extraction procedure recommended by the manufacturer and the modified in-house sample preparation procedure. Eight samples were positive with both procedures. Seven additional samples were positive with the in-house method only. The results show that the in-house sample preparation procedure markedly improves the test sensitivity of the Chlamydia trachomatis Cobas Amplicor assay. Consequently, the use of this improved screening protocol will facilitate the detection of even low-level infections with Chlamydia trachomatis, which in turn will lead to the introduction of earlier therapeutic interventions.

Adult↗
PubMedDate not supplied

Chlamydia trachomatis in andrologic patients--direct and indirect detection.

BACKGROUND: Chlamydia trachomatis is considered to be the most common sexually transmitted disease in Germany. It is currently unclear whether chlamydial infection causes pathological conditions of the male accessory glands with consequences for male infertility. PATIENTS AND METHODS: Within the framework of several prospective studies the association between sperm quality, male accessory gland function and infection with C. trachomatis was investigated in men of couples with unexplained infertility. Chlamydial infection was determined by serologic methods and by proof of Chlamydia-specific DNA. As a marker of infection the direct determination of granulocytes in the ejaculate or the measurement of the polymorphonuclear (PMN) elastase concentration was used. The male accessory gland function was evaluated using the markers fructose, citric acid and alpha-glucosidase in the seminal plasma. RESULTS: Chlamydia-specific DNA in the ejaculate was present in between 3-5% of the subjects, which corresponds to its prevalence in the normal population. Chlamydia IgA antibodies were demonstrated with a frequency of 38% in seminal plasma (n = 834) using a genus-specific test (rELISA). Using other species-specific tests (MIF, SeroCT, IgA pELISA and ImmunoComb), Chlamydia IgA antibodies were found at frequencies of between 8 and 22%. CONCLUSION: Only in a few individual cases was it possible to show a connection between reduced sperm quality, disturbed male accessory gland function and indication of infection with Chlamydia, bacteria or Ureaplasma.

Adult↗
PubMed1989

Serum IgG and IgA antibodies to Chlamydia in ectopic pregnancies.

The possible association of Chlamydia trachomatis with ectopic pregnancies was evaluated in a case-control study, comprising 35 women with ectopic pregnancy and 294 apparently healthy women who served as controls. Chlamydia-specific IgG and IgA antibodies were determined by single serovar (L2) inclusion immunoperoxidase assay (IPA). Socio-demographic characteristics, gynecological history and contraceptive methods were also evaluated. An inverse relationship was found between the educational levels and the prevalence of IgG and IgA antibodies to chlamydia. The prevalence rate of elevated IPA IgG (titer greater than or equal to 128) and IPA IgA (titer greater than or equal to 16) specific to chlamydia was significantly higher in women with ectopic pregnancy versus controls (32% vs 8%, respectively, for IgG: odds ratio = 4.9; and 26% vs 4% for IgA: odds ratio = 7.5). Chlamydia trachomatis was not isolated in cell cultures in 10 specimens available from fallopian tubes of women with ectopic pregnancy. Only 9% of the women recall having pelvic inflammatory disease (PID) indicating that most of the infections were asymptomatic. Women who did not use IUD had a higher proportion of chlamydia-specific IgG and IgA seropositives, though not statistically significant, as compared to IUD users. This study further supports the hypothesis that subclinical infection of the tube with C. trachomatis may underlie ectopic pregnancies.

Adolescent↗
PubMed2005

Performance of urine leukocyte esterase in asymptomatic male youth: another look with nucleic acid amplification testing as the gold standard for Chlamydia detection.

PURPOSE: To re-evaluate the sensitivity and specificity of leukocyte esterase (LE) for screening adolescent and young adult males for Chlamydia trachomatis using a nucleic acid amplification test (NAAT) as the gold standard. METHODS: This study was conducted at two Massachusetts Department of Youth Services sites and one Job Corps site. Recently admitted asymptomatic sexually active male youth aged 14 to 25 years (mean 16.6 years) were recruited between January 2001 and July 2003 (N = 1008). Participants provided first part voided urine specimens for testing with LE and Chlamydia NAAT. The sensitivity, specificity, and positive and negative predictive value of urine LE for identification of Chlamydia infection were determined using NAAT as the gold standard. RESULTS: Fifty-seven (5.7%) participants were infected with Chlamydia as defined by a positive NAAT. Defining trace + as the LE cut point resulted in sensitivity and specificity of 57.9% and 78.3%, respectively. Defining 1+ as the cut point resulted in sensitivity and specificity of 47.4% and 96.1%, respectively. CONCLUSIONS: Urine leukocyte esterase is a moderately sensitive method to screen for Chlamydia. Nevertheless, a substantial proportion of infections are not detected with LE screening. When feasible, urine NAAT provides a much more sensitive and equally noninvasive method of detecting Chlamydia. However, if LE is used as an initial screen followed by NAAT confirmation of LE positive samples, we recommend using trace LE as the cut point for positive results.

Adolescent↗
PubMed2005

Prevalence of chlamydiae in boars and semen used for artificial insemination.

Although there are indications for venereal transmission of chlamydiae in pigs, direct diagnostic evidence on the presence of these bacteria in boars and boar semen in particular is still incomplete. We investigated boars from two studs (A, B) in semen (A: n = 174; B: n = 100) and faeces (A: n = 174; B: n = 24) for chlamydiae using ompA-PCR and partial ompA gene sequencing. Additionally, blood serum was examined for chlamydial antibodies using an indirect ELISA (A: n = 171; B: n = 62). Chlamydiae were found in 9 (5.2%) and 24 (24.0%) semen specimens, and in 71 (40.1%) and 2 (8.3%) faecal samples from boars of stud A and B, respectively. Regarding individual chlamydial species, Chlamydophila psittaci and Chlamydia suis were identified most frequently, with the former predominating in semen (in 23 out of 33 positive samples) and the latter in faeces (68/73). In contrast, Chlamydophila pecorum was found only sporadically. Chlamydial antibodies were detected in 80 (46.8%) and 6 (9.7%) boars of stud A and B, respectively. No correlation was observed between the data from serology and PCR of semen or faeces in either of the studs. In conclusion, detection of chlamydiae in semen of boars suggests a potential for venereal transmission. Whether the high overall prevalence of chlamydial infections reflects a general situation in boars needs to be investigated. Serological testing failed to identify boars shedding chlamydiae in their semen.

Animals↗
PubMed2005

Comparison of intranasal and transcutaneous immunization for induction of protective immunity against Chlamydia muridarum respiratory tract infection.

Chlamydia pneumoniae causes a range of respiratory infections including bronchitis, pharyngitis and pneumonia. Infection has also been implicated in exacerbation/initiation of asthma and chronic obstructive pulmonary disease (COPD) and may play a role in atherosclerosis and Alzheimer's disease. We have used a mouse model of Chlamydia respiratory infection to determine the effectiveness of intranasal (IN) and transcutaneous immunization (TCI) to prevent Chlamydia lung infection. Female BALB/c mice were immunized with chlamydial major outer membrane protein (MOMP) mixed with cholera toxin and CpG oligodeoxynucleotide adjuvants by either the IN or TCI routes. Serum and bronchoalveolar lavage (BAL) were collected for antibody analysis. Mononuclear cells from lung-draining lymph nodes were stimulated in vitro with MOMP and cytokine mRNA production determined by real time PCR. Animals were challenged with live Chlamydia and weighed daily following challenge. At day 10 (the peak of infection) animals were sacrificed and the numbers of recoverable Chlamydia in lungs determined by real time PCR. MOMP-specific antibody-secreting cells in lung tissues were also determined at day 10 post-infection. Both IN and TCI protected animals against weight loss compared to non-immunized controls with both immunized groups gaining weight by day 10-post challenge while controls had lost 6% of body weight. Both immunization protocols induced MOMP-specific IgG in serum and BAL while only IN immunization induced MOMP-specific IgA in BAL. Both immunization routes resulted in high numbers of MOMP-specific antibody-secreting cells in lung tissues (IN>TCI). Following in vitro re-stimulation of lung-draining lymph node cells with MOMP; IFNgamma mRNA increased 20-fold in cells from IN immunized animals (compared to non-immunized controls) while IFNgamma levels increased 6- to 7-fold in TCI animals. Ten days post challenge non-immunized animals had >7,000 IFU in their lungs, IN immunized animals <50 IFU and TCI immunized animals <1,500 IFU. Thus, both intranasal and transcutaneous immunization protected mice against respiratory challenge with Chlamydia. The best protection was obtained following IN immunization and correlated with IFNgamma production by mononuclear cells in lung-draining LN and MOMP-specific IgA in BAL.

Administration, Intranasal↗
PubMed2006

A randomized trial of strategies to increase chlamydia screening in young women.

OBJECTIVE: Despite the recommendations of numerous clinical practice guidelines, testing of at-risk women for Chlamydia trachomatis infection remains low. We evaluated an intervention to increase guideline-recommended chlamydia screening. METHOD: In a two-by-two factorial design randomized trial conducted in 2001-2002, 23 primary care clinics at Group Health Cooperative in Washington State were randomized to either control (standard) or intervention (enhanced) guideline implementation arms. Clinic-level intervention strategies included use of clinic-based opinion leaders, individual measurement and feedback, and exam room reminders. A second patient-level intervention, a chart prompt to screen for chlamydia, was delivered in a random sample of 3509 women. The outcome measure was post-intervention chlamydia testing rates among sexually active women ages 14-25. RESULTS: The clinic-level intervention did not significantly affect overall chlamydia testing (odds ratio (OR) = 1.08, 95% confidence interval (CI) 0.92-1.26, P = 0.31). However, testing rates increased significantly among women making preventive care visits (OR, Pap test visit = 1.23, 95% CI, 1.01-1.51, P = 0.04; OR, physical exam visit = 1.22, 95% CI 1.06-1.42, P = 0.009, intervention vs. control clinics). The chart prompt intervention had no significant effect (OR = 1.08, 95% CI 0.94-1.23, P = 0.27). CONCLUSIONS: Interventions to improve guideline-recommended chlamydia testing increased testing among women making preventive care visits. Additional organizational change and/or patient activation strategies may improve plan-wide testing, particularly among asymptomatic women.

Adolescent↗