Role of The Papanicolaou Smear in Diagnosis of Chlamydial Infections

Effect of endocervical specimen quality on detection of Chlamydia trachomatis and on the incidence of false-positive results with the Chlamydiazyme method

“…The results of the current study indicating increased Chlamydiazyme detection of C. trachomatis associated with the presence of RBCs and PMNs in the specimens are similar to results of previous studies in which cell cultures were used (1,3,13,15,19,23,(30)(31)(32)36). The presence of RBCs may indicate either the bleeding often associated with a C. trachomatis infection (13) or the fact that there was vigorous rubbing of the endocervical area in an attempt to obtain an adequate specimen.…”

“…No attempt was made during this evaluation to detect intracellular inclusion bodies of C. trachomatis in Pap-stained smears from infected patients, because such a microscopic analysis has been previously shown to be insensitive (1, 10-12, 23, 25, 31). Failure to observe intracellular inclusions may be due either to the poor quality of many specimens or to too few well-preserved cells in the sample (1,(10)(11)(12). Epithelial cells containing intact inclusions are very fragile and are rarely well preserved (25).…”

Significance of a Diagnosis of Microorganisms on Pap Smear

“…Shiina's important contribution was the description of the nebular body, or nebular inclusion, which was classified as types II to V according to the size of the inclusions, the presence of a membranous structure around the inclusions, and the release of particles into the extracellular space [21]. Some authors have argued that the finding of these nebular inclusions is the most reliable indicator of Chlamydia infection on Pap smear [22].…”

“…Measures of sensitivity ranged from 0% to 63%, with most studies falling in the range of 10% to 20% [21,22], an abysmal value for a screening test. Measures of specificity over a series of studies range from 20% to 93% [22] and averaged 79% over a series of studies according to Bernal et al [23].…”

“…Measures of sensitivity ranged from 0% to 63%, with most studies falling in the range of 10% to 20% [21,22], an abysmal value for a screening test. Measures of specificity over a series of studies range from 20% to 93% [22] and averaged 79% over a series of studies according to Bernal et al [23]. Findings such as these have lead many authors to conclude that the Pap smear is not a reliable method of diagnosing C. trachomatis infection and that ancillary studies should be used in these cases [18Y20, 22Y28].…”