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Lack of specificity of chlamydiazyme® for detection of vaginal chlamydial infection in prepubertal girls

A 1-year prospective study was undertaken of 65 prepubertal girls referred for evaluation of sexual abuse or vulvovaginitis to compare Chlamydiazyme®, an enzyme immunoassay (EIA), with culture for the detection of Chlamydia trachomatis in vaginal specimens. Five (8%) of 65 patients were initially EIA-positive. On repeat sampling without intervening antibiotic treatment, 4 girls who were initially positive became negative and 1 remained persistently positive. Chlamydial cultures were negative in all patients. The patient with the persistently positive EIA also had Group A streptococcal vaginitis. We were able to demonstrate that some strains of Group A Streptococcus can cause a positive reaction with the EIA. Cross-reactions with other bacterial species are also known to occur. We therefore conclude that Chlamydiazyme® is not specific for the detection of chlamydial infection in the vagina of prepubertal girls and, for medicolegal reasons, should not be used for evaluation of sexual abuse.