Seroprevalence of genital Chlamydia trachomatis infection in women of reproductive age

The genital chlamydial infection is the most common sexually transmitted diseases (STD) and major cause of infertility and ectopic pregnancy for millions of women in the world particularly in developing countries. This study was performed to find out the seroprevalence of Chlamydia trachomatis (CT) genital infection in women of reproductive age attending the Department of Obstetrics and Gynaecology, Mymensingh Medical College Hospital (MMCH) during the period from January 2009 to December 2009 through a cross sectional study. A total of 108 serum samples from symptomatic and asymptomatic pregnant and non-pregnant women were tested for CT specific IgG antibody by Enzyme Linked Immunosorbent Assay (ELISA). A total of 31(28.7%) patients were found to have antibody of which 44% (26/59) were from pregnant group and 10.2% (5/49) from non-pregnant group. The seropositivity was 21.6% (16/74) in symptomatic cases and 44.1% (15/34) in asymptomatic cases. The study shows high prevalence of Chlamydial antibody which is common in pregnant and non-pregnant, symptomatic and asymptomatic adult women in Bangladesh. So, screening for chlamydial infection should be done routinely by suitable tests in sexually active symptomatic and asymptomatic women including pregnant women to prevent serious complications.     

Non-culture diagnosis of Chlamydia trachomatis genital infection in sexually active women

Infections caused by Chlamydia trachomatis (CT) are one of the most prevalent of all sexually transmitted diseases (STD). This cross sectional study was carried out to diagnose genital CT infection on 108 (59 pregnant and 49 non-pregnant) women attending at Department of Gynaecology and Obstetrics, Mymensingh Medical College Hospital (MMCH) during the period from January 2009 to December 2009. This non- culture technique was based on detection of CT major outer membrane protein (MOMP) by Direct Fluorescence Antibody Test (DFAT) from endocervical swab. Chlamydial inclusion bodies (IB) were looked for using Iodine stain. CT antigens were detected in 45.3% (49/108) cases by DFAT; IBs were detected in 5.5% cases (06/108) by Iodine staining technique. Majority of CT positive cases (65%) were found in the younger age group (15 to 25 years). The CT infection was found 47.2 % (35/74) in symptomatic cases, 41.1% (14/34) in asymptomatic cases and 47.4% in pregnant group, 42.8% in non-pregnant group. Although high incidence of genital chlamydia infection is common both in pregnant, non-pregnant, symptomatic and asymptomatic women in Bangladesh an early and reliable diagnostic method for genital chlamydia infection in Bangladesh should be further explored.     

Prevalence of Chlamydia trachomatis in women seeking termination of pregnancy

Fifty consecutive unmarried women seeking termination of pregnancy in Toa Payoh Hospital were analysed to determine the prevalence of Chlamydia trachomatis infection as compared to gonococcal infection. Cases harbouring chlamydial infection were followed up to exclude postabortal pelvic infection. Incidence of positive cultures were also compared among the various ethnic groups in the population. Results from the data analysed showed that chlamydial infection was significantly more prevalent than gonorrhoea in our local women seeking therapeutic abortion. However, further research to define the exact size of the problem is indicated.     

长期应用口服避孕药妇女生殖道衣原体感染分析

目的了解和研究长期应用国产低剂量口服避孕药（OC）与使用者衣原体（CT）感染的关系。方法采用聚合酶链反应（PCR）检测服用避孕药或使用宫内节育器5年以上的妇女224人宫颈分泌物中CTDNA。结果三组研究对象的CT检出率为21．24％,三组中CT检出率1号片组最高,对照组最低,分别为1号片组24．69％、复方18甲组20．45％、对照组17．54％,服药组均高于对照组,CT检出率三组间的差别无显著性（P〉0．05）。服药组不同类型的避孕药使用者中CT感染的检出率也不相同,1号片组CT感染高于复方18-甲组,这可能与COC中雌孕激素的配伍不同有关,1号片中的雌孕激素均高于复方18-甲组。与雌孕激素的共同作用而导致CT感染率增加。口服避孕药者中CT的感染引起的宫颈异常高于对照组,但无显著差异,多数感染者并无临床体征。结论长期服用避孕药者CT感染略有升高。对有性生活。特别是长期使用口服避孕药的妇女提供相应的随访和检测服务,以提高避孕药使用者的生殖健康水平。     

Cost-effectiveness of screening women at moderate risk for genital infections caused by Chlamydia trachomatis

We evaluated the cost-effectiveness of screening women at moderate (prevalence, 7.9%) risk for urogenital infections with Chlamydia trachomatis. The characteristics of culture and direct antigen tests were based on published values. Those of serology were based on a comparative study in 434 college women. Three serological tests were evaluated: microimmunofluorescence, an indirect fluorescent antibody assay, and an enzyme-linked immunoassay. Their sensitivities and specificities were 97% and 64%, 87% and 64%, and 84% and 51%, respectively, compared with culture. Screening all patients with a direct antigen test costing less than $12 was more cost-effective than neither testing nor treating patients, although only 53% of patients with positive test results would actually be infected. The use of culture alone or as a confirmatory test was less cost-effective but had high positive predictive values. Seropositivity was not highly predictive of active infection. Chlamydial screening can be cost-effective in moderate-risk women.     

Chlamydia trachomatis infections in women with urogenital symptoms.

Chlamydia trachomatis was isolated from 30 to 100 women attending a family physician's office with dysuria, frequency or vaginal discharge, compared with 2 of 30 asymptomatic women. Multiple infections were common: C. trachomatis coexisted with Gardnerella vaginalis, Candida albicans, Trichomonas vaginalis or a bacterial cause of urinary tract infection in 15 patients. C. trachomatis was isolated alone from 15 symptomatic women. The source of the positive culture was not always the site of symptoms. C. trachomatis was isolated from both the cervix and the urine of 9 patients, either simultaneously or sequentially. The probability of finding a chlamydial infection was 30% in young women with vaginal discharge alone, 33% in those with dysuria and frequency alone and 53% in those with abdominal or pelvic pain in addition to lower urogenital tract symptoms.     

女性生殖道衣原体感染检测IL-2、IL-6的意义

目的 探讨女性生殖道沙眼衣原体感染患者宫颈分泌物及血清中IL-2、IL-6的水平及其意义. 方法 采用放射免疫法分别检测40例衣原体感染的女性患者(试验组1)和15例非衣原体感染正常女性(对照组)的宫颈分泌物IL-2、IL-6的水平;同时采用放射性免疫法分别检测15例衣原体感染女性(试验组2)和15例非衣原体感染正常女性(对照组)的血清IL-2、IL-6的水平. 结果 40例衣原体感染的女性患者宫颈分泌物中IL-2水平明显高于对照组(P<0.05),而两组宫颈分泌物的IL-6水平无明显差异(P＞0.05).15例衣原体感染的女性患者和15例非衣原体感染的女性血清中IL-2、IL-6水平无明显差异(均P＞0.05). 结论 生殖道局部细胞因子IL-2在沙眼衣原体感染的发病机制中可能起重要作用.IL-2、IL-6的血清学化验对了解生殖道衣原体感染可能无临床指导意义.     

A prospective single-blind trial of minocycline and doxycycline in the treatment of genital Chlamydia trachomatis infection in women

A total of 2124 women who attended the Richmond Family Planning Association Clinic in Melbourne consecutively were screened for the presence or absence of Chlamydia trachomatis. One hundred and three women were found to have Chl. trachomatis infection of the cervix and were invited to participate in a clinical trial of minocycline and doxycycline for the treatment of chlamydial infection. A 10-day course of either drug resulted in a negative result of a chlamydial culture for all patients at the follow-up assessment, which occurred between 11 days to 12 weeks after the therapy. Minocycline and doxycycline showed equal effectiveness in the eradication of mycoplasmas in over 80% of the treated patients. Minocycline appeared to have a slight advantage with respect to the resolution of the gynaecological symptoms that were associated with the chlamydial infection. The number of adverse events that were recorded during the trial was similar for both treatment regimens. Gynaecological symptoms were associated with chlamydial infection in approximately 50% of the women in the study. The lack of association between chlamydial infection and gynaecological symptoms has led to the instigation of routine testing for the presence of Chlamydia spp. in young women who have more than one sexual partner.     

Incidence of Chlamydia trachomatis infection related to selected signs and symptoms of lower genital tract infections in women

Chlamydia trachomatis infections of the female reproductive tract is associated with a spectrum of clinical syndromes from simple colonization to mucopurulent cervicitis, urethritis, proctitis, and pelvic inflammatory disease. Its natural history and tendency for progression is unclear. It is said these infections are the most common of all sexually transmitted diseases.     

Chlamydia trachomatis infection in women with ectopic pregnancy

Chlamydia trachomatis infection, presumably sexually transmitted, has been implicated in the spread of tubal infertility and ectopic pregnancy. In searching evidence of Chlamydia trachomatis infection as a possible cause of tubal ectopic pregnancy, we enrolled 40 consecutive pathologically proven tubal ectopic women and 37 normal early intrauterine pregnant women from our OPD and ward from Jan. 1989 to July 1989. All cases underwent a structured interview giving particular attention to past reproductive history, contraception history and past history of STD. The levels of serum antibody IgG to Chlamydia trachomatis in all cases were determined. Seven ectopic women with wearing IUD in situ (group A) and 33 ectopic women with no identical factor (group B) were compared with 37 normal early intrauterine pregnant women (control group). The result showed group B more often had IgG antibody to Chlamydia trachomatis than control group (P = 0.001). Group A had higher antibody to Chlamydia trachomatis than control group but the difference was not statistically significant (P greater than 0.05). We concluded that the above findings add to the evidence that Chlamydia trachomatis infection is a major cause of tubal ectopic pregnancy.     

女性不孕与生殖道沙眼衣原体感染的关系初探

为探讨女性不孕与其生殖道沙眼衣原体感染的关系，从１４７例不孕妇女输卵管及宫颈内取样，用聚合酶链反应（ＰＣＲ）检测，并以６０例正常妊娠妇女输卵管内取样作为对照组。结果显示：不孕组输卵管和宫颈的沙眼衣原体感率分别为１５．６６％和２２．４５％，对照组输卵管沙眼衣原体感染率仅为３．３３％，两组比较差异显著（ｐ〈０．０５）；同时显示年轻妇女与工人是感染的高危人群。由此表明不孕妇女生殖道沙衣原体感染是引起不孕     

Management of Chlamydia trachomatis genital infections: reported practices of primary care physicians.

OBJECTIVE: To determine the knowledge of primary care physicians about Chlamydia trachomatis genital infection and its management. DESIGN: Self-administered questionnaire comprising direct questions and hypothetical cases. PARTICIPANTS: All 108 general and family practitioners on the north shore of Vancouver were sent the questionnaire; 79 (73%) responded. RESULTS: There was a reasonable level of knowledge in many areas, particularly among the physicians who had graduated more recently than the others. Virtually all stated that they have access to chlamydial diagnostic testing, and most indicated that they test for chlamydial infection at least occasionally. However, many of the respondents failed to consider that youths in their practice may be sexually active, and only 28% knew that women 15 to 19 years of age have the highest reported rates of chlamydial infection. Many of the physicians were confused about syndromes that are or are not associated with C. trachomatis infection; this indicated the possibility of inappropriate testing and treatment decisions. If they had to test for C. trachomatis in a prepubescent girl 34% reported that they would obtain a specimen from the endocervix, a technique that is inappropriately invasive. When presented with a positive test result many of the respondents failed to consider the possibility of a false-positive result. Fortunately all of the physicians were well informed about correct treatment regimens for C. trachomatis infection, although many did not realize how effective they really are. In the case of a young man with suspected or proven gonorrhea or a young female outpatient with pelvic inflammatory disease, only 19% and 20% respectively stated that they would prescribe a regimen appropriate for both penicillinase-producing Neisseria gonorrhoeae and C. trachomatis. Many of the respondents had not heard of management guidelines, and fewer still reported that they consult them. CONCLUSIONS: Despite the availability of several sets of guidelines there appear to be important gaps in the knowledge and practice of many primary care physicians with respect to genital infections. Since the preparation of guidelines is time-consuming and expensive, further work should be done to evaluate their impact and to address their limitations.     

生殖道沙眼衣原体感染致不育的相关研究

目的探讨生殖道沙眼衣原体感染与不育症的关系。方法对84例不育夫妇的精液及宫颈黏液进行沙眼衣原体PCR检测，并对其及精液常规、免疫学检测等指标进行统计学处理，以探讨其与不育症的关系。结果生殖道沙眼衣原体检出率与不育、精子数、抗精子抗体阳性率呈正相关关系。结论衣原体感染性不育症可能是衣原体对精子发生与成熟的干扰或直接作用，也可能是抗精子抗体使精子不能激活的结果。     

Molecular diagnosis of genital Chlamydia trachomatis infection by polymerase chain reaction

The present study was carried to diagnose genital Chlamydia trachomatis infection among women of reproductive age, attending Mymensingh Medical College Hospital, during July 2009 to June 2010 by Polymerase chain reaction (PCR). A total of 70 females were investigated including 56 symptomatic and 14 asymptomatic cases. Endocervical swabs were collected and dipped in 500μl Tris buffer. Polymerase chain reaction (PCR) amplification was done for detection of endogenous plasmid-based nucleic acid. A total 17 out of 56 of the symptomatic cases (30.4%) were positive for C. trachomatis and none were found positive among the 14 asymptomatic cases. These findings suggest high prevalence of C. trachomatis infection among this group of population.     

连接酶链反应检测男性就诊者尿标本中的沙眼衣原体

OBJECTIVE: To determine the sensitivity and specificity of ligase chain reaction (LCR) for detection of Chlamydia trachomatis (C. trachomatis) in the urine of symptomatic and asymptomatic men. METHODS: C. trachomatis was detected by LCR in both first-void urine (FVU) and urethral swab cultures from 852 randomly selected male outpatients seeking medical attention for sexually transmitted diseases. In cases with discrepancy between the results yielded by the two methods, a second LCR directed against a gene fragment encoding the major outer membrane protein was performed. The results were evaluated on the basis of an expanded gold standard. RESULTS: The sensitivity and specificity was 98.6% and 99.4% with LCR, respectively, and was 77.4% and 99.5% with urethral swab culture. The sensitivity of LCR was much higher than that of urethral swab culture P<0.001 .The presence or absence of urethral symptoms did not show any influence on the results. CONCLUSION: LCR is sensitive and specific for detecting C. trachomatis infections, and FVU can be used for non-invading diagnosis and screening of the infection in men.