Chlamydia trachomatis in routine cervical smears. A microscopic and ultrastructural analysis

This study examined cervical smears for cytologic evidence of Chlamydia trachomatis in 380 women seen for routine gynecologic examination or follow-up for an abnormal cervical smear. Cervical smears and Chlamydiazyme samples were obtained. Fifteen patients tested Chlamydiazyme positive and were considered to be Chlamydia positive. Cellular samples meeting the screening criteria were examined carefully for evidence of Chlamydia, including type II (central target inclusions) and type III (granular inclusions or nebular inclusions). Electron microscopy was performed on representative inclusions from both Chlamydia-positive and -negative patients. Inclusions were identified in 6 of the Chlamydia-positive and 31 of the -negative patients. Electron microscopy of type II and III inclusions, from both positive and negative patients, revealed chlamydial organisms to be present only in nebular inclusions. Intracytoplasmic inclusions, other than nebular inclusions, result from inflammatory changes and, as such, may be induced by a chlamydial infection but are not specific to Chlamydia.