A 24-year-old woman comes to the office for an annual examination. Two weeks ago, the patient was evaluated at an urgent care center for lower abdominal pain and vaginal discharge. Pelvic examination at that time showed mucopurulent cervical discharge and cervical friability. Nucleic acid amplification testing (NAAT) was positive for Chlamydia trachomatis. Testing for gonorrheal infection was negative. The patient was treated with doxycycline orally twice daily for 7 days. Her partner also tested positive for Chlamydia infection and received doxycycline therapy. The patient's symptoms resolved after 7 days of treatment.
The patient has had no sexual activity since her last visit and is currently asymptomatic. As part of her annual examination, a Pap test and NAAT for both Chlamydia trachomatis and Neisseria gonorrhoeae are performed. The Pap test is normal and the NAAT is positive for Chlamydia trachomatis.
Which of the following is the most likely explanation for this patient's positive test result?

Question

A 24-year-old woman comes to the office for an annual examination.  Two weeks ago, the patient was evaluated at an urgent care center for lower abdominal pain and vaginal discharge.  Pelvic examination at that time showed mucopurulent cervical discharge and cervical friability.  Nucleic acid amplification testing (NAAT) was positive for Chlamydia trachomatis.  Testing for gonorrheal infection was negative.  The patient was treated with doxycycline orally twice daily for 7 days.  Her partner also tested positive for Chlamydia infection and received doxycycline therapy.  The patient's symptoms resolved after 7 days of treatment.
The patient has had no sexual activity since her last visit and is currently asymptomatic.  As part of her annual examination, a Pap test and NAAT for both Chlamydia trachomatis and Neisseria gonorrhoeae are performed.  The Pap test is normal and the NAAT is positive for Chlamydia trachomatis.
Which of the following is the most likely explanation for this patient's positive test result?

Quizplus · Accepted Answer

11ec193a_97d8_adb7_853d_416869509068_MD0002_00 This patient and her partner were appropriately treated for chlamydial cervicitis; however, repeat nucleic acid amplification (NAAT) testing was positive for Chlamydia trachomatis 2 weeks after treatment. NAAT is more sensitive and specific than culture methods and is the preferred diagnostic test for chlamydial infection in both symptomatic and asymptomatic patients. However, because NAAT testing can detect both living and dead organisms, false-positive test results are common within 3 weeks of initial treatment. In general, routine "test of cure" is not indicated if the chlamydial infection is treated with first-line antibiotics such as azithromycin or doxycycline as resistance to these antibiotics appears to be very low (Choices B and D). Test of cure is indicated for patients who are pregnant or have persistent symptoms; however, it should be performed ≥3 weeks after treatment completion. Despite adequate initial treatment, Chlamydia trachomatis reinfection is common and is typically the result of resumption of unprotected intercourse with an untreated partner. Therefore, for all patients with NAAT- or culture-proven chlamydial infection, retesting is performed 3-6 months after treatment completion to evaluate for possible reinfection. (Choice C) This patient has had no recent sexual activity, and it is unlikely that she would develop an infection from a new sexual partner within 2 weeks of receiving effective treatment. (Choice E) Tubo-ovarian abscess usually presents with acute lower abdominal pain, fever, and chills. Purulent cervical discharge may also be present. This patient's clinical improvement and asymptomatic presentation make this diagnosis unlikely. Educational objective: Nucleic acid amplification testing is the most sensitive and specific test for the diagnosis of Chlamydia trachomatis infection. Retesting within 3 weeks of treatment is not recommended due to a high rate of false-positive results. __________ References: Female genital Chlamydia trachomatis infection: where are we heading? (http://www.ncbi.nlm.nih.gov/pubmed/22350326) Chlamydia trachomatis genital infections. (http://www.ncbi.nlm.nih.gov/pubmed/28357377)

A 24-Year-Old Woman Comes to the Office for an Annual