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A study of 371 women (261 asymptomatic and 110 symptomatic subjects with clinical PID) was performed to detect the presence of Chlamydia trachomatis (C.t.) and to correlate the serological markers against this microrganism, such as antibody to chlamydial hsp60 (Ab-Chsp60) and different levels of IgG, IgM and IgA, with epidemiology, pathology, sexual habits, age, diagnostic methods in the groups of women with and without pelvic inflammatory disease (PID). We found a statistically significant difference between the asymptomatic and symptomatic women regarding the presence of C.t. (3.4% versus 20%; p<0.0001). This presence was affected by the age of women (more in the group < or =25 years old), by having sex with new partners mainly if they did not undergo an antibiotic treatment. The association of antibody Chsp60 with the presence of clinical PID was quite striking. We also found a strict correlation between the detection of Ab-Chsp60 and previous chlamydial infection as well as between Ab-Chsp60 and elevated serum chlamydial IgG or IgA levels. Due to these findings, we can say that the use of serological markers for C.t. in clinical practice may be an important tool for an early screening and diagnosis of women at high risk of chlamydial infection.

Five hundred and forty-four immigrant women, admitted from 1983 to 1993 to the 2nd Institute of Obstetrics and Gynaecology of Rome University, were enrolled in the study. Africa and East Europe were the most common places of birth. Seventy-five per cent of women gave birth spontaneously, and a caesarean section was performed in 22.2%. The frequency of spontaneous delivery and caesarean section was about the same among Italian and immigrant women.

Sensitivity and specificity of three commercial latex agglutination tests, i.e. Streptex, Wellcogen (Wellcome Diagnostics, Dartford, England) and Directigen (Becton Dickinson, Baltimore, USA) were evaluated on 233 vaginal swabs and 208 urine specimens after 4h culture in comparison with traditional cultural and identification methods. On vaginal swabs sensitivity of Wellcogen and Streptex was shown to be comparable (43% and 37% respectively), but both tests gave several false positive results; Directigen test showed higher (100%) specificity, but its sensitivity was very low. On urine cultures all the tests were shown to be unsatisfactory in comparison with traditional methods, sensitivity and specificity being demonstrated to be poor.