Is it appropriate to test for gonorrhea/chlamydia using a Gen-Probe assay in a patient who has had a total abdominal hysterectomy and has no cervix? The lab report always comes back stating “valid on endocervical specimens only.”—JOY HAMPTON, MS, PA-C, Moyock, N.C.
Since chlamydia infects the cells of the endocervix, women without a cervix do not need to be screened. However, chlamydia can also infect the urethra. Therefore, if a woman complains of dysuria and chlamydia infection is suspected as the cause, a nucleic acid amplification test, such as the Gen-Probe APTIMA assay, can be performed on urine. Urine testing is not recommended with the Gen-Probe Pace 2 test. Similarly, women without a cervix need not be evaluated for cervical gonorrhea, but Neisseria gonorrhoeae can also infect the urethra, rectum, and pharynx. Only in rare cases does it become disseminated.—JoAnn Deasy, PA-C, MPH (143-8)