Genital Chlamydia trachomatis infections

Chlamydia trachomatis infections affect young, sexually active persons. Risk factors include multiple partners and failure to use condoms. The incidence of infection has increased in the past 10 years. Untreated C .  trachomatis infections are responsible for a large proportion of salpingitis, ectopic pregnancy, infertility and, to a lesser extent, epididymitis. Screening is a possible intervention to control the infection, which is often asymptomatic. The emergence of lymphogranuloma venereum proctitis in men who have sex with men, in Europe, and of a variant with a deletion in the cryptic plasmid, in Sweden, are new features of C .  trachomatis infections in the last years. A diagnosis is best made by using nucleic acid amplification tests, because they perform well and do not require invasive procedures for specimen collection. Single-dose therapy has been a significant development for treatment of an uncomplicated infection of the patient and his or her sexual partner.     

Chlamydia trachomatis infections in New Caledonia. Study of 1,023 patients over a 12-month period

A study of chlamydial infections was realized in New Caledonia during a period of one year. It concerned 1,023 patients: 775 adults and 248 children. It showed the high frequency of chlamydial urethritis in the male population, chlamydial cervicitis in gynecologic patients, chlamydial pneumonia and conjunctivitis in neonates and infants. The contamination between mother and infants was demonstrated several times. This preliminary study must be completed by an epidemiological exhaustive survey in order to determine the most exposed population and to take prophylactic appropriate actions.     

Simultaneous Chlamydia trachomatis and HPV infection in pregnant women

Pregnancy is associated with HPV infection and with Chlamydia trachomatis (CT) infection mostly due to the natural immunosuppression. In addition, pregnancy associated to CT infection can lead to adverse conditions to the woman and fetus, and CT is also believed to be a co‐factor in human immunodeficiency virus infection and HPV‐induced cervical cancer. The aim of this study was to establish the odds ratios (OR) of CT infection in to HPV‐infected pregnant women and vice versa of women stratified by age (<25 years) and marital status. This work is part of a national multicentric transversal study carried out in six Brazilian cities supported by the Ministry of Health of Federal Government of Brazil in 2003. Cervical scrapes of 371 pregnant women were sampled. We performed a hybrid capture‐2 technique to diagnose these samples on HPV and CT infection, and the women responded a questionnaire. Significant association was observed between nonstable marital status and hr‐HPV infection [OR = 2.61 (1.38–4.97) P = 0.003)], and age <25 years old [OR = 2.26 (1.09–4.71) P = 0.029]. Nonstable marital status was also associated with lr‐HPV infection [OR = 2.67 (1.59–4.50) P < 0.001), and age <25 years old [OR = 2.55 (1.51–4.32) P < 0.001). Fifty of the 371 pregnant women were infected with hr‐HPV (13.5%) and 111 (30.0%) were infected with lr‐HPV. The coinfections of HPV and CT were found in 31 women, that is, 8.36% of the pregnant women (P < 0.001). The high rate of simultaneous CT and HPV infection in pregnant women favors the recommendation to screen pregnant women for both CT and HPV. Diagn. Cytopathol. 2010. © 2009 Wiley‐Liss, Inc.     

两种方法检测分娩期孕妇解脲支原体、沙眼衣原体宫内感染的分析

目的了解分娩期孕妇解脲支原体(Uu)、沙眼衣原体(CT)感染的发病率及其对不良妊娠结局的影响.方法采用PCR方法检测宫颈分泌物、羊水配对标本Uu、CT-DNA,及蛋白芯片方法检测孕妇空腹血清、脐动脉血血清配对标本Uu、CT-IgG抗体.结果 116例分娩期孕妇宫颈分泌物Uu、CT的阳性率分别是37.93%,5.17%,而羊水中Uu、CT的检出率为0%.孕妇血清Uu、CT感染率分别是38.14%,14.66%,脐动脉血血清Uu、CT阳性率19.83%,6.90%,血行性宫内感染垂直传播率约为50%.Uu或CT阳性组孕妇胎膜早破、胎儿宫内窘迫、相对性脐带过短发生率显著高于Uu和CT阴性组孕妇(P＜0.05).结论分娩期孕妇Uu和CT感染与胎膜早破、胎儿宫内窘迫、脐带缠绕有关.Uu、CT蛋白芯片方法是一种检测Uu、CT感染的新方法,值得临床推广应用.     

Genital infections caused by Chlamydia trachomatis in French Guiana: current status and diagnostic importance

Several laboratory aspects of Chlamydia trachomatis genital pathology were studied in order to evaluate their importance in French Guiana. Urethritis, cervicitis and sterilities were characterized by both direct methods of diagnosis and a serological study.     

Chlamydia trachomatis genital infections in tahiti

The rate ofChlamydia trachomatis infection was determined in three populations in Tahiti by means of a direct immunofluorescence test performed in specimens, tissue culture and detection of chlamydial antibody in serum specimens using a single-serotype indirect immunofluorescence test.Chlamydia trachomatis was recovered in 53 % of 53 bar girls, 24 % of 75 women attending a public maternity clinic for routine care, and 37 % of 71 men attending a sexually transmitted disease clinic with acute or subacute urethritis. The presence of chlamydial antibody in a high proportion of the groups studied confirmed the high frequency of chlamydial infections (62.3 %, 66.6 % and 83.1 % respectively).Neisseria gonorrhoeae infection was often associated with chlamydial infection in both bar girls and men with urethritis (11.4 % and 18.3 % respectively). With regard to clinical manifestations, 58.3 % (7/12) of bar girls and 23.2 % (10/43) women at the maternity clinic without clinical complaints were found to beChlamydia trachomatis-positive. The presence ofChlamydia trachomatis in these asymptomatic persons highlights their important role in spread of this organism in Tahiti. The findings indicate that routine testing forChlamydia trachomatis is warranted in patients attending the sexually transmitted disease and public maternity clinics in Tahiti.     

孕妇解脲支原体、沙眼衣原体感染的诊断与药物干预

目的探讨妊娠期孕妇解脲支原体（UU）、沙眼衣原体（CT）感染的发病率及其对感染者的治疗效果。方法对108例妊娠妇女采用核酸杂交的方法检测宫颈分泌物,对标本UU、CT-DNA进行DNA扩增、核酸杂交检测。结果 108例妊娠早中期孕妇宫颈分泌物UU、CT的阳性率分别是33.33%,7.41%,口服阿奇霉素治疗后检测UU、CT阳性率分别是17.59%,1.85%。两组间有显著性差异（P=0.001或P=0.002）。结论解脲支原体、沙眼衣原体是妊娠期妇女感染的常见病原体,临床治疗效果显著值得推广应用。     

Screening for Chlamydia trachomatis in subfertile women

Chlamydia trachomatis is the most common sexually transmitted disease in the UK and Europe. The majority of female infections are asymptomatic and recognized sequelae include pelvic inflammatory disease, infertility, and ectopic pregnancy. Women with chlamydial infection who undergo uterine instrumentation are recognized to be at risk of ascending infection. Most patients attending for infertility investigations and treatment will undergo some form of uterine instrumentation. Published data regarding the prevalence of chlamydial infection in the subfertile are few and conflicting. In this study, more than 400 consecutive women presenting for infertility investigation and treatment at a single regional fertility centre were screened for Chlamydia: Half were screened using enzyme immunoassay (EIA) and half by ligase chain reaction (LCR). Prevalence by diagnostic test was 0% with EIA and 1.9% with LCR. Overall, the low prevalence was at least partly explained by older age. Until more evidence comes from studies testing consecutive subfertile patients both with EIA and a DNA amplification method such as LCR, centres using EIA should consider using prophylactic antibiotics prior to uterine instrumentation.     

Glycogen Assay for Diagnosis of Female Genital Chlamydia trachomatis Infection

Chlamydia trachomatis can synthesize glycogen at various stages in its developmental cycle. The glycogen content of female genital epithelial cells was detected by anthrone, and the results were compared with those from PCR. A total of 320 cervical samples were examined. Of 92 specimens that were positive by PCR, 78 were positive and 14 were negative by the glycogen assay. Of 228 specimens that were negative by PCR, 220 were negative and 8 were positive by the glycogen assay. The sensitivity and specificity of the glycogen assay obtained from these data were 84.8% (78 of 92) and 96.5% (220 of 228), respectively. Use of the glycogen assay to detect the glycogen content in genital epithelial cells may be helpful in the diagnosis of C. trachomatis infection. This is an easy, fast, and inexpensive assay and can be done in less-sophisticated labs.     

Diagnosis of Chlamydia trachomatis infections in asymptomatic men and women by PCR assay.

A PCR assay was evaluated for its ability to detect genital chlamydial infection in asymptomatic men and women. Urethral swab specimens were collected from 472 men for culture and PCR assay, and first-void urine (FVU) specimens were collected from 379 of these men for enzyme immunoassay (EIA) and PCR assay. Cervical swab specimens were collected from 242 women for culture, EIA, and PCR assay. Patients were considered infected if they were culture positive or positive by PCR with both plasmid- and major outer membrane protein-based primers. By using this extended "gold standard," the prevalence of infection in this population was 7.6% for men and 7.9% for women. For men, the sensitivities of urethral swab specimen culture and PCR and FVU specimen EIA and PCR were 61, 72, 55, and 91%, respectively. All assays had specificities of > or = 99.8%. The positive and negative predictive values for PCR testing of FVU specimens were 100 and 99.4%, respectively, compared with values of 96.3 and 97.8%, respectively, for PCR of urethral swab specimens. The sensitivities of cervical swab specimen culture and PCR testing were 42 and 90%, respectively, with corresponding specificities of 100 and 99.3%. All cervical swabs were negative by EIA. Molecular techniques such as PCR assays are valuable tools for the detection of symptomatic genital chlamydial infection. In particular, PCR assays of FVU specimens from men offer a highly sensitive, noninvasive screening tool that will likely improve patient compliance for diagnostic testing.     

Chlamydia trachomatis infections: a clinical update

Chlamydia trachomatis has emerged as the most common sexually transmitted pathogen in the United States and in many other countries. Because of its increasing importance, the authors present an update on chlamydial infections.     

Persistent Chlamydia trachomatis infections resist apoptotic stimuli

Microbial modulation of apoptosis has added a new dimension of understanding to the dynamic interaction between the human host and its microbial invaders. Persistent infection can be a by-product of inhibition of apoptosis and may significantly impact the pathogenesis of diseases caused by organisms such as Chlamydia trachomatis. We compared apoptotic responses among HeLa 229 cells acutely and persistently infected and mock infected with serovar A/HAR-13. Persistence was induced by gamma interferon at 0.2 and 2.0 ng/ml. Cells were treated with etoposide or staurosporine at 24-h intervals and assayed for apoptosis by cell count, DNA ladder formation, and cytochrome c translocation. From the 24- to 120-h time points, infected cultures were 87 and 90% viable for etoposide and staurosporine treatment, respectively, and produced no DNA ladder, and cytochrome c remained in the mitochondria. In contrast, mock-infected cells were 22 and 37% viable for etoposide (P = 0.0001) and staurosporine (P = 0.01), respectively, and displayed characteristic DNA ladders, and cytochrome c was translocated. We found that resistance to apoptotic stimuli was identical in acute and persistent infections. Since cytochrome c was not translocated from the mitochondrion, caspase-9 activity was likely not involved. The expression of chlamydial hsp60, a known stimulator of inflammation in vivo, was measured in both active and persistent infections by Western blot, with increased production in the latter with or without staurosporine treatment. Chlamydial disregulation of apoptosis and the ensuing persistence of organisms offer an alternative pathogenic mechanism for chlamydial scarring observed in trachoma and infertility populations via sustained inflammation induced by immunoreactive molecules such as hsp60.     

Predominance of Chlamydia trachomatis serovars associated with urogenital infections in females in New Delhi,India

Screening for Chlamydia trachomatis was done for 280 endocervical swab samples by PCR specific for endogenous plasmid. Age dependency was seen in symptomatic patients, with a high chlamydial prevalence rate (28%) found in younger women. Genotyping by restriction fragment length polymorphism analysis of omp1 PCR-positive samples showed serovars D, E, and F to be the most prevalent.     

Large-scale testing of women in Copenhagen has not reduced the prevalence of Chlamydia trachomatis infections

Objective  To examine the impact of a stable, large-scale enzyme immunoassay (EIA) Chlamydia trachomatis testing situation in Copenhagen, and to estimate the impact of introducing a genomic-based assay with higher sensitivity and specificity.
Methods  Over a five-year study period, 25 305–28 505 women screened for chlamydial infection each year, corresponding to 19.3% of the female population in Copenhagen, Denmark, were analyzed.
Results  The C. trachomatis age-specific examination percentage and age-specific positive percentage were unchanged during the study period. For EIA, the age-specific positive predictive value of a test decreased from 94% at age 17 to only 50% at age 34 years. Irrespective of the choice of diagnostic test, only about 30% of chlamydial infections would be diagnosed, given current strategies.
Conclusion  Although genomic detection assays will increase the positive and negative predictive values of the Chlamydia test result, new screening strategies for both men and women in younger age groups will be necessary if chlamydial infections are to be curtailed.