女性生殖道沙眼衣原体持续感染的现状

生殖道沙眼衣原体感染在人群中的发生率高,特别在年轻女性人群中,容易导致持续性的生殖道感染,进而引起一系列严重并发症(如不孕不育).感染的严重程度取决于沙眼衣原体本身的致病力大小、环境因素及宿主易感因素.筛检沙眼衣原体持续性感染的最佳血清学指标是其IgG和C反应蛋白(两者同时阳性),而IgG只能作为其既往感染的血清学指标.     

Duration of untreated genital infections with chlamydia trachomatis: a review of the literature

BACKGROUND: Estimates of the duration of untreated genital infections with Chlamydia trachomatis vary. Accurately estimating the distribution of the duration of infection would be useful in the counseling patients, and is essential when modeling the burden of chlamydial disease and the potential impact of prevention programs. GOAL: The authors review the scientific literature to summarize what is known about the duration of genital chlamydial infection and the factors that affect it. STUDY DESIGN: Literature review of animal and human studies. RESULTS: Animal studies document a longer duration of infection in primates than in mice or guinea pigs. Although animals spontaneously become culture negative over time, numerous studies document persistent nonculture evidence of chlamydiae in the upper genital tract. Studies in which women have been serially cultured suggest that most untreated infections remain culture positive for more than 60 days. Small series report that some infections may persist for years. Most infections eventually become culture negative; however, non-culture evidence of chlamydiae often persist in women with negative cultures. The duration of chlamydial infection is reduced in animals previously exposed to chlamydiae and in older humans, suggesting that partial immunity may result from exposure. Data are inadequate to define the median duration of untreated infection or to derive a curve that describes the natural history of untreated genital chlamydial infections. CONCLUSION: Current data do not allow one to reliably estimate the duration of genital infections with C trachomatis. Systematic retesting could help to better define the duration of infection in patients who, against medical advice, delay treatment for genital chlamydial infections.     

Determinants of persistent and recurrent Chlamydia trachomatis infection in young women: results of a multicenter cohort study

BACKGROUND: Sequelae of genital Chlamydia trachomatis infection in women are more strongly linked to repeat infections than to initial ones, and persistent or subsequent infections foster continued transmission. OBJECTIVE: To identify factors associated with persistent and recurrent chlamydial infection in young women that might influence prevention strategies. METHODS: Teenage and young adult women with uncomplicated C trachomatis infection attending reproductive health, sexually transmitted disease, and adolescent medicine clinics in five US cities were recruited to a cohort study. Persistent or recurrent chlamydial infection was detected by ligase chain reaction (LCR) testing of urine 1 month and 4 months after treatment. RESULTS: Among 1,194 women treated for chlamydial infection, 792 (66.4%) returned for the first follow-up visit, 50 (6.3 %) of whom had positive LCR results. At that visit, women who resumed sex since treatment were more likely to have chlamydial infection (relative risk [RR], 2.0; 95% CI, 1.03-3.9), as were those who did not complete treatment (RR, 3.4; 95% CI, 1.6-7.3). Among women who tested negative for C trachomatis at the first follow-up visit, 36 (7.1%) of 505 had positive results by LCR at the second follow-up visit. Reinfection at this visit was not clearly associated with having a new sex partner or other sexual behavior risks; new infection was likely due to resumption of sex with untreated partners. Overall, 13.4% of women had persistent infection or became reinfected after a median of 4.3 months, a rate of 33 infections per 1,000 person months. CONCLUSIONS: Persistent or recurrent infection is very common in young women with chlamydial infection. Improved strategies are needed to assure treatment of women's male sex partners. Rescreening, or retesting of women for chlamydial infection a few months after treatment, also is recommended as a routine chlamydia prevention strategy.     

Prevalence of antichlamydial antibody in London blood donors.

The prevalence of type-specific antichlamydial antibody in a population of blood donors in London was studied using a microimmunofluorescence test. Twenty-six (17%) of 150 women and 38 (26%) of 150 men had antichlamydial antibody (IgG at greater than or equal to 1/16 or IgM greater than or equal to 1/8 or both). Of these, five (3%) women had one (0.75%) man had this antibody directed against Chlamydia trachomatis serotypes D-K, responsible for genital infections, and one man had antibody to Chlamydia psittaci agents. The remaining 57 men and women had antibody against an atypical chlamydial isolate designated Chlamydia IOL-207, which is iodine-negative and serologically distinct from both C trachomatis and C psittaci. The nature and location of infection by this agent are obscure. The results of this study suggest that the prevalence of sexually transmitted infection with C trachomatis serotypes D-K in a normal adult population in London is very low.     

Chlamydia infections

Chlamydia trachomatis represents one of the most common causative agents of sexually transmitted diseases. Clinically, genital chlamydial infections are similar to gonorrhoea. Although the clinical symptoms in chlamydial infections are usually milder than those in gonorrhoea, late complications are more common and more dangerous, because the carriers may easily escape notice. The knowledge of chlamydial infections has increased during the last few years. The present report deals with recent developments in this field.     

生殖道沙眼衣原体体外经不同浓度阿奇霉素作用后超微结构的变化

目的 初步探讨不同浓度阿奇霉素作用下沙眼衣原体的超微结构形态变化。方法 采用McCoy细胞培养方法,在沙眼衣原体实验菌株（D/UW-3/Cx）体外培养过程中添加含阿奇霉素质量浓度为0.0667、0.1340、0.1900、0.2680、0.3330 mg/L的培养液,不加阿奇霉素的培养液作为空白对照组。在透射电镜下观察McCoy细胞和沙眼衣原体超微结构的变化。结果 在接种D/UW-3/Cx时加入阿奇霉素培养48 h后,随阿奇霉素浓度的增加,透射电镜下可见包涵体内外囊泡增多;有异常增大的网状体,部分存在分裂异常,甚至网状体坏死崩解;原体数目减少,体积增大,外膜皱褶增多。阿奇霉素质量浓度为0.3330 mg/L时见不到包涵体。结论 阿奇霉素可引起沙眼衣原体外膜膨大,形成囊泡;网状体异常增大,甚至崩解;原体减少。     

Ciprofloxacin treatment of chlamydial infections of urogenital tracts of women.

Ciprofloxacin was evaluated in chlamydial infections of the urogenital tracts of women treated with a dosage regimen of 500 mg orally twice a day for seven days. Of the 40 women evaluated, 30 were infected with Chlamydia trachomatis only, two were infected with Neisseria gonorrhoeae only, and a further eight had combined gonococcal and chlamydial infections. Ten were found to be harbouring Chlamydia trachomatis in the urethra as well as the cervix. Neisseria gonorrhoeae was eradicated from all patients with or without concomitant chlamydial infection. The overall chlamydial reisolation rates were 14% (5/35) four weeks after treatment and 23% (6/26) 11 weeks after treatment. The organism was not reisolated from the urethra of any of the patients after treatment. Ciprofloxacin was effective against Mycoplasma hominis, but almost completely ineffective against Ureaplasma urealyticum.     

Chlamydial genital infection in Ibadan, Nigeria. A seroepidemiological survey.

Sera from patients attending a sexually transmitted diseases (STD) clinic, a family planning clinic, and an antenatal clinic in Ibadan, Nigeria, as well as from male blood donors from the same area were tested for the presence of type specific antichlamydial antibodies using a modified micro-immunofluorescence test. Among men and women attending the STD clinic the exposure rates to Chlamydia trachomatis serotypes D to K (genital pathogens) were 18.7% and 26.7% respectively. Antibody titres suggesting active disease in these men and women were found in 11.8% and 22.7% respectively. The highest rate of exposure (35%) was among women attending the family planning clinic; of these women 25% had antibody suggesting active disease. Titres of IgG antibody in this study were similar to those found among men and women with chlamydial genital infections in the United Kingdom. Antibodies to serotypes D to K were also detected in 10.3% of women attending an antenatal clinic and in 9.9% of male blood donors. The prevalence of antibodies to C trachomatis serotypes A to C and lymphogranuloma venereum serotypes was low. These results suggest that the prevalence of chlamydial genital infections in Ibadan, both among STD patients and especially among those individuals not seeking treatment (family planning and antenatal clinic patients), is high. Since serious sequelae can follow chlamydial genital infections it is imperative to carry out further investigations in this area.     

Women at risk for gonorrhea: comparison of rosaramicin and ampicillin plus probenecid in the eradication of Neisseria gonorrhoeae, Chlamydia trachomatis and genital mycoplasmas

Rosaramicin is a macrolide antibiotic with activity against Neisseria gonorrhoeae, Chlamydia trachomatis, and the genital mycoplasmas Ureaplasma urealyticum and Mycoplasma hominis. Its efficacy in the treatment of genital infections was evaluated and compared with that of single-dose ampicillin plus probenecid in women with known, or suspected, uncomplicated gonococcal infection. Isolation rates for N. gonorrhoeae, C. trachomatis, U. urealyticum, and M. hominis were 72%, 44%, 95%, and 65%, respectively. Rosaramicin cured 24 (89%) of 27 gonococcal infections and 11 (92%) of 12 chlamydial infections. It transiently reduced the carriage of U. urealyticum but had little effect on carriage of M. hominis. Rosaramicin may be of value in the treatment of concurrent gonococcal and chlamydial infections when tetracycline is contraindicated.     

Genital Chlamydia infections

Chlamydia trachomatis represents an important infectious agent for sexually transmitted diseases. In the USA more than 3 million new cases are recorded per year. The clinical picture and late complications are similar to those of gonorrhea; however, infections from C. trachomatis have relatively mild symptoms. This group of diseases may therefore be overlooked, and complications and late sequelae due to C. trachomatis thus occur more frequently in comparison to N. gonorrhoeae. From the viewpoint of general health in a population, chlamydial infections seem to be more important than the classic venereal diseases. The number of infections may be underestimated as infected individuals may be asymptomatic and are therefore not diagnosed and the disease recorded. Knowledge about chlamydial infections has increased significantly, and C. trachomatis today can easily be diagnosed by routine laboratory methods; this report deals with current knowledge regarding the epidemiology, clinical symptoms, complications, diagnosis, and treatment of genital chlamydial infections.     

Test-of-cure for asymptomatic genital chlamydial infections in women. A cost-benefit analysis.

Asymptomatic genital infection caused by Chlamydia trachomatis is common, and one or more test-of-cure consultations in such cases is routine. The economic implications of two post-treatment strategies, either no test-of-cure, or one test-of-cure consultation with a single test for C. trachomatis, renewed treatment, and another test-of-cure of those still chlamydia-positive, and so on, have been compared. The costs of the test-of-cure strategy are twice those of the no-test regimen. Without test-of-cure, 79 more cases of pelvic inflammatory disease, 8 cases of infertility requiring treatment, and 2 cases of ectopic pregnancy would occur for every 10,000 patients. It is concluded that routine test-of-cure of asymptomatic genital chlamydial infections after treatment is not cost beneficial.     

The need for a chlamydial culture service.

In a prospective study of unselected, female patients attending a sexually transmitted disease clinic one in eight patients would have been errouneously declared free of infection in the absence of a chlamydial culture service. Chlamydia trachomatis is now accepted as a causative organism of non-specific urethritis and post-gonococcal urethritis in men and non-specific genital infection in women. Thus, facilities for isolation of C. trachomatis should be an essential aid in the management of women attending STD clinics. Male patients would also benefit if such facilities were readily available.     

The need for a chlamydial culture service.

In a prospective study of unselected, female patients attending a sexually transmitted disease clinic one in eight patients would have been errouneously declared free of infection in the absence of a chlamydial culture service. Chlamydia trachomatis is now accepted as a causative organism of non-specific urethritis and post-gonococcal urethritis in men and non-specific genital infection in women. Thus, facilities for isolation of C. trachomatis should be an essential aid in the management of women attending STD clinics. Male patients would also benefit if such facilities were readily available.     

Comparison of chlamydial culture with Chlamydiazyme assay during erythromycin PCE treatment of Chlamydia genital infections

We compared chlamydial culture with the chlamydial antigen detection enzyme immunoassay system (Chlamydiazyme, Abbott Diagnostic Products; Abbott Park, IL) during treatment of Chlamydia genital infections. Participants received 333 mg of erythromycin PCE (Abbott Laboratories; Abbott Park, IL) 3 times per day for 7 days. On days 0, 3, 7, and 14, chlamydial cultures were positive in 30/30 (100%), 5/29 (17.2%), 0/27, and 0/25 participants, respectively. Concurrent Chlamydiazyme assays were positive in 30/30 (100%), 11/30 (37%), 1/28 (4%), and 0/25 participants. Twenty-eight of 28 persons who received erythromycin PCE for at least 3 days had negative test results for both chlamydial culture and Chlamydiazyme at their last clinic visit. Chlamydiazyme assay tended to remain positive longer than chlamydial culture during treatment, but 7 days after therapy was completed, no Chlamydia trachomatis antigens were detectable by this assay. Erythromycin PCE was well tolerated and rapidly eliminated Chlamydia genital infections in 83% of persons showing negative cultures by the third day of therapy.     

Minimum inhibitory concentration and minimum bactericidal concentration of tetracycline and erythromycin in 35 recent Munich isolates of Chlamydia trachomatis

Thirty-five recent clinical isolates of Chlamydia trachomatis were subcultured and subjected to antimicrobial susceptibility testing with tetracycline and erythromycin. Detection of typical chlamydial inclusion bodies and elementary bodies was based on the use of fluorescence-labelled monoclonal antibodies. Minimum inhibitory concentration being defined as the lowest concentration suppressing all inclusion body formation and minimum bactericidal concentration as the lowest concentration preventing all detectable chlamydial growth, both these parameters were studied. With tetracycline the minimum inhibitory concentrations ranged from 0.03 to 0.08 microgram/ml, with erythromycin from 0.04 to 0.2 microgram/ml. The corresponding data for the minimum bactericidal concentrations were less than 0.2 to 1.0 and 0.2 to 2.0 respectively. Thus, at present, there still seems to be no major resistance problem with genital Chlamydia trachomatis isolates in the Federal Republic of Germany.     

Prevalence of Chlamydia trachomatis and Neisseria gonorrhoeae infections in Greenland. A seroepidemiological study.

In a sero-epidemiological study of the prevalence of chlamydial and gonococcal infections in Greenland three groups of subjects were studied--262 patients attending an outpatient department in the town of Nuuk (of whom 12% harboured Chlamydia trachomatis and 54% Neisseria gonorrhoeae), 63 controls from the same town, and the entire population of 150 in the settlement of Uvkusigsat. Using a microimmunofluorescence test evidence of exposure to C trachomatis was found in 79% of the female and 26% of the male patients, in 12% and 50% of the female and male controls respectively, and in 51% and 21% of the female and male populations of Uvkusigsat respectively. Using an indirect haemagglutination test antibodies to gonococcal pili were found in sera of 92% of the female and 70% of the male patients, in 30% of the male and 10% of the female controls, and in 41% of the women and 33% of the men in Uvkusigsat. The study indicates that genital chlamydial and gonococcal infections are serious public health problems in Greenland and that such infections are acquired early in both sexes and often occur concomitantly.     

Chlamydial genital infection in Addis Ababa, Ethiopia. A seroepidemiological survey.

A seroepidemiological survey was undertaken in Addis Ababa to assess the prevalence of chlamydial genital infections among patients attending a sexually transmitted diseases (STD) clinic and patients with no overt genital symptoms. In the STD clinic patients antibodies to Chlamydia trachomatis serotypes D to K (genital types) were detected in 68 of 210 (32.4%) men and in 72 of 159 (45.3%) women, a rate of exposure as high or higher than that found in Europe. Serological evidence of active chlamydial infection was present in 26.7% of men and 28.9% of women. Women were at risk of contracting STD, including chlamydial infections, at the age of 14 years or earlier. The titres of antichlamydial IgG were extremely high in some patients attending the STD clinic, with titres of between 1/512 and 1/8192 in 9.5% of men and 13.2% of women. This suggests that some patients had severe or disseminated chlamydial disease. The prevalence of exposure to chlamydial genital infections among 148 patients with no overt genital disease was 14.2%, which is significantly higher than that found in the United Kingdom. Among the total of 517 patients tested the prevalence of exposure to trachoma, lymphogranuloma venereum, and Chlamydia psittaci agents was very low.     

Prevalence of Chlamydia trachomatis and Neisseria gonorrhoeae infections in Greenland. A seroepidemiological study

In a sero-epidemiological study of the prevalence of chlamydial and gonococcal infections in Greenland three groups of subjects were studied--262 patients attending an outpatient department in the town of Nuuk (of whom 12% harboured Chlamydia trachomatis and 54% Neisseria gonorrhoeae), 63 controls from the same town, and the entire population of 150 in the settlement of Uvkusigsat. Using a microimmunofluorescence test evidence of exposure to C trachomatis was found in 79% of the female and 26% of the male patients, in 12% and 50% of the female and male controls respectively, and in 51% and 21% of the female and male populations of Uvkusigsat respectively. Using an indirect haemagglutination test antibodies to gonococcal pili were found in sera of 92% of the female and 70% of the male patients, in 30% of the male and 10% of the female controls, and in 41% of the women and 33% of the men in Uvkusigsat. The study indicates that genital chlamydial and gonococcal infections are serious public health problems in Greenland and that such infections are acquired early in both sexes and often occur concomitantly.     

Epidemiology of infection by serotypes D to K of chlamydia trachomatis.

Non-specific urethritis (NSU) is a sexually transmitted disease; 50% of cases are due to Chlamydia trachomatis, so that this is the commonest sexually transmitted infection in the developed world. Chlamydial infection is now readily diagnosable and the evidence increasingly suggests that it is underdiagnosed. Chlamydial conjunctivitis (in the newborn baby or the adult) in the developed world is a complication of sexually transmitted genital infection by C trachomatis and it indicates a large reservoir of such infections. Because of the association of sexually transmitted diseases, systemic treatment for such chlamydial conjunctivitis should not be given until full genital and serological investigators have been carried out. Chlamydial infection causes serious complications (that were formerly often thought to be gonococcal), such as epididymitis in young men and salpingitis on young women. It may cause local complications in the eye of the newborn baby and even pneumonia in babies and fatal endocarditis in adults. The diagnosis of NSU should lead to the correct treatment of the male patient and of his sexual partners. It is the promiscuous woman, who does not have a regular sexual partner to report back to her that he has NSU, who is at particular risk of undiagnosed chlamydial infection. Routine genital investigations for chlamydia are particularly indicated in her case. Following the parallel of gonorrhoea, it seems that the use of contact tracers may be an effective method for controlling chlamydial infection.     

The case for further treatment studies of uncomplicated genital Chlamydia trachomatis infection

Azithromycin 1 g immediately and doxycycline 100 mg twice daily have good antimicrobial activity against Chlamydia trachomatis and treatment studies have demonstrated a >95% microbiological cure at 2-5 weeks, with antimicrobial resistance being rarely reported. Recently an 8% (95%, CI 5% to 11%) failure rate was observed in 289 women, but not in men, who had been sexually inactive after treatment. At high multiplicities of infection (load) in vitro persistence can often be demonstrated to antimicrobials-heterotypic resistance. The subsequently recovered isolates do not possess antimicrobial resistance at low loads. It is known that genital chlamydia load varies in vivo and is probably greater in women than men. In mass treatment trials of trachoma, treatment failure is associated with high chlamydia loads. It is therefore possible that women with high chlamydia loads may be at increased risk of treatment failure. Given the imminent role out of the National Chlamydia Screening Programme and the consequences of persistent chlamydial infection in women this hypothesis urgently merits further investigation.