What is the role of serology and cultures in the workup of reactive arthritis (ReA)?

Updated: Dec 24, 2020
  • Author: Carlos J Lozada, MD; Chief Editor: Herbert S Diamond, MD  more...
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Answer

Chlamydia should be sought in every case of ReA. Serology is useful in some cases; however, culture techniques may not be reliable, causative agents are only identified in only 58% of cases with genitourinary (GU) symptoms, and there is a high positive rate in control populations (people without ReA). [17]

If urethritis or cervicitis is present, cervical or urethral cultures should be obtained. Smears of urethral discharge may be sent for antichlamydial staining by direct fluorescent antibody (DFA) testing, enzyme immunoassay (EIA), culture, or nucleic acid probe. Polymerase chain reaction (PCR) assay may be considered. [83] A Giemsa stain or a Wright stain may reveal the classic gram-negative intracellular diplococci associated with gonorrhea. Many patients may experience simultaneous sexually transmitted diseases, particularly chlamydia and gonorrhea.

Results of routine urine cultures are negative. Stool cultures can be helpful for enteric pathogens (eg, Salmonella, Shigella, and Yersinia). Obtaining stool cultures even when bowel symptoms are inapparent or mild may help direct treatment; however, cultures are often negative by the time of presentation. [60]

The US Preventive Services Task Force (USPSTF) guidelines for screening for chlamydial infections and gonorrhea were updated in 2014. The USPSTF recommends screening in sexually active women age 24 years and younger and in older women who are at increased risk for infection. Evidence was insufficient to assess the balance of benefits and harms of screening for chlamydia and gonorrhea in men. [84]


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