Infections caused by Chlamydia trachomatis are probably the most common sexually transmitted diseases in the United States. Commonly unrecognized and often inadequately treated, chlamydial infections can ascend the reproductive tract and cause pelvic inflammatory disease, which often results in the devastating consequences of infertility, ectopic pregnancy, or chronic pelvic pain. C. trachomatis infections are also known to increase the risk for human immunodeficiency virus infection. The obligate intracellular life cycle of C. trachomatis has traditionally required laboratory diagnostic tests that are technically demanding, labor-intensive, expensive, and difficult to access. In spite of these historical challenges, however, laboratory diagnosis of C. trachomatis has been a rapidly advancing area in which there is presently a wide array of commercial diagnostic technologies, costs, manufacturers. This review describes and compares the diagnostic methods for C. trachomatis infection that are currently approved for use in the United States, including the newest DNA amplification technologies which are yet to be licensed for commercial use. Issues to consider in selecting a test for purposes of screening versus diagnosis based on prevalence, performance, legal, social, and cost issues are also discussed.

Current methods of laboratory diagnosis of Chlamydia trachomatis infections.

Chlamydia trachomatis is the most common cause of curable bacterial sexually transmitted infection (STI) worldwide. It manifests primarily as urethritis in males and endocervicitis in females. Untreated chlamydial infection in man can cause epididymitis and proctitis. Though most women with Chlamydia infection are asymptomatic or have minimal symptoms, some develop salpingitis, endometritis, pelvic inflammatory disease (PID), ectopic pregnancy and tubal factor infertility. It is associated with an increased risk for the transmission or acquisition of HIV and is also attributed to be a risk factor for the development of cervical carcinoma. Early diagnosis and treatment of infected individuals is required to prevent the spread of the disease and severe sequelae. Traditionally, tissue culture was considered the gold standard for the diagnosis. However, with the availability of newer diagnostic techniques particularly molecular methods which are not only highly sensitive and specific but are cost-effective also, the diagnosis has became fast and easy. The purpose of this review is to study the various aspects of genital C. trachomatis infection. Also the advances related to the clinical picture, various diagnostic modalities, prevention, treatment, drug resistance and control measures will be dealt with.

Genital Chlamydia trachomatis: an update.

Current Methods of Laboratory Diagnosis of Chlamydia Trachomatis Infections

When Roland Summit published his paper on child sexual abuse accommoda, tion (Summit, 1983), the notion that sexually abused children disclose abuse only reluctantly and ambivalently was thought "so basic that it contributed nothing new to the literature" (Summit, 1992, p. 155). Summit's paper was neither original research nor a systematic review of research, and he empha' sized that his conclusions were largelybased on his work as a clinical consult, ant and "endorsements" from professionals, victims, and their families (Summit, 1983, p. 180). Summit's reliance on clinical observations left him open to the subsequent criticism that scientific support for child sexual abuse accommodation is lack, ing (Bradley & Wood, 1996; Kovera & Borgida, 1997; Mason, 1995). AI, though the courts are friendly to expert testimony supporting accommodation (Lyon, 2002), they have also become accepting of expert testimony attacking accommodation's scientific foundation (Bruck, 1999; United States v. Rouse, 2004). Indeed, one federal court, persuaded by a prominent experimental psy, chologist that accommodation is no longer accepted in the scientific commu, nity, held that defense lawyers confronted with expert testimony supporting accommodation have a constitutional duty to consult with experts capable of disputing such claims (Gersten v. Senkowski, 2004). Summit's emphasis on the clinical basis for accommodation was unfortunate. Subsequent critics have overlooked research cited by Summit

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False Denials: Overcoming Methodological Biases in Abuse Disclosure Research

Vaginal introital diameter in the evaluation of sexual abuse

• This study was performed to determine if gonorrheal infections in children aged 1 to 12 years were frequently associated with sexual contacts. In our study all 14 children who had gonorrhea and who were over 4 years of age and 35% (six) of the 17 children who had gonorrhea and who were between 1 and 4 years old were found to have had sexual contact with older males who were almost always in the extended family. Our study supports the concept that gonorrhea in children over 4 years old is almost always associated with sexual contact. In children between 1 and 4 years old, a history of sexual contact is more difficult to obtain but may be elicited in more than a third of the cases. Hospitalization of the children and identification of extended family members with gonorrhea, followed by additional interviews, were useful procedures in determining who had had sexual contact with the children. ( Am J Dis Child 1982;136:994-996)

Michael F. Durfee

Papers

Sexual Contact in Children With Gonorrhea

Vaginal Chlamydia trachomatis infection in children with sexual contact.