Narrative Review of Chlamydia trachomatis Culture, Viability Testing, and Sequencing Methods

Area of Science:

• Microbiology
• Infectious Diseases
• Antimicrobial Resistance

Background:

• Chlamydia trachomatis (CT) is a prevalent bacterial STI in the US, typically detected by NAATs.
• CT's intracellular nature complicates culture, viability determination, and antimicrobial susceptibility testing (AST).
• Culture remains vital for strain typing, test-of-cure, sexual assault cases, and resistance surveillance.

Purpose of the Study:

• To systematically review advancements in CT culture methods.
• To assess progress in viability determination and antimicrobial resistance detection for CT.
• To identify gaps in current technologies and guide future research.

Main Methods:

• A systematic literature search was performed across 5 electronic databases.
• Keywords focused on CT culture, viability assays, and antimicrobial resistance detection methods.
• Twenty-nine relevant manuscripts were identified and synthesized narratively.

Main Results:

• Limited progress in CT culture techniques observed over the last decade.
• Promising viability and resistance detection methods lack standardization and widespread use.
• Phenotypic AST is limited to specialized labs; validated genotypic assays are scarce, impeding resistance trend assessment.

Conclusions:

• CT culture's clinical role is decreasing but remains important for research and surveillance.
• Key technological gaps include distinguishing viable from non-viable CT and standardized AST protocols.
• Future research should focus on clinical viability assays, consensus AST methods, and integrated genomic approaches.