Recognition and treatment of chlamydial infections

The microbiology, laboratory diagnosis, clinical features, and treatment of infectious diseases caused by Chlamydia trachomatis and Chlamydia psittaci are reviewed. Chlamydial genital infection is the most common sexually transmitted disease in the United States. C. trachomatis plays an important role in nongonococcal urethritis, postgonococcal urethritis, cervicitis, pelvic inflammatory disease, and possibly proctitis. Proper treatment of genital infections caused by C. trachomatis is important to prevent severe sequelae such as epididymitis and pelvic inflammatory disease, both of which may lead to sterility. Infected pregnant women should be treated to prevent transmission of chlamydial infections to their infants. Chlamydial conjunctivitis is the most common eye infection in the first month of life. C. trachomatis also causes pneumonia in infants. Lymphogranuloma venereum and trachoma are important diseases in developing countries. C. psittaci, transmitted by birds, causes psittacosis in humans; this disease is rare in the United States. Diagnosis is a problem because chlamydial genital infection can be asymptomatic and because the organism is difficult to isolate. Culture remains the diagnostic method of choice, but recently marketed direct-detection assays provide qualitative results within hours after specimen collection. Tetracyclines and erythromycin are the drugs of choice for treating chlamydial infections in adults. An antimicrobial with activity against both C. trachomatis and Neisseria gonorrhoeae is preferred because both organisms are often present concurrently in patients with sexually transmitted disease. Chlamydial infections in pediatric patients often respond to systemic erythromycin therapy; tetracyclines are equally effective but are contraindicated for children less than nine years of age. Adequate diagnosis and treatment of sexually transmitted chlamydial infections in patients and their contacts is important to limit the spread of disease.     

Screening for sexually transmitted infections in substance abuse treatment programs

OBJECTIVES: We evaluated the prevalence of the sexually transmitted infections (STIs) chlamydia and gonorrhea in clients at a methadone maintenance program and a residential detoxification program. METHODS: We collected urine specimens for chlamydia and gonorrhea ligase chain reaction testing and assessed sexual, substance abuse and STI histories. RESULTS: Of 700 subject assessments, 490 occurred among detoxification clients and 210 in methadone maintenance. Chlamydia trachomatis was detected in 5/700 (0.9, 95% CI=0.1-1.8%) and Neisseria gonorrhoeae in none. All chlamydia infected subjects were recruited from the detoxification program. Subjects reported high risk sexual behavior: 17% reported commercial sex exchange, and 22% reported inconsistent condom use with multiple sexual partners during the prior 2 months. CONCLUSION: Based on prevalence in Boston, MA, universal screening for STI in substance abuse treatments programs is not warranted. However, routine screening for younger substance abusers and in communities with high prevalence should be considered.     

Chlamydia trachomatis infection at a family planning clinic

Endocervical samples were taken for the detection of Chlamydia trachomatis from 500 consecutive patients attending a family planning clinic. The Microtrak direct specimen immunofluorescence test was used. Swabs from 79 patients (15.8%) were positive for chlamydia. Seventy-one (95%) of these patients were symptom free, and 39.8% were under 20 years old. Twenty-one patients were pregnant, seven (33%) had chlamydia. Those positive for chlamydia had twice the frequency of abnormal smears and other sexually transmitted infections as those who were negative. Contraceptive use was similar except that intrauterine devices were used less frequently by patients with chlamydia infection. This report indicates the frequent occurrence of Chlamydia trachomatis infection in New Zealand and that newly developed methods of diagnosis enable us to identify and treat those with this infection. Characteristically these patients are under 20, have multiple partners and a high incidence of abnormal smears and other sexually transmitted infections.     

Infections with Chlamydia trachomatis

The gram-negative obligate intracellular bacterium Chlamydia trachomatis is the pathogen that is most often transmitted through sexual contact. C. trachomatis is responsible for a wide range of different diseases. Strains of serovars D to K primarily cause urogenital infections, which are often asymptomatic, but can also lead to uncomplicated and complicated genital diseases. Pelvic inflammatory diseases attributed to ascending genital infections can result in ectopic pregnancies and infertility in women. After perinatal transmission, infections in the newborn can also occur. Strains of serovars L1, L2 and L3 cause lymphogranuloma venereum, a common sexually transmitted disease in many tropical and subtropical regions. The illness is associated with various skin lesions and systemic symptoms such as fever and headache. Unlike other serovars, strains of serovar A, B and C are transmitted primarily by infectious eye discharge. They cause a chronic eye disease called trachoma that occurs under poor hygienic conditions. Infections with C. trachomatis should be treated with antibacterial drugs reaching high intracellular concentrations. The choice of antibiotics and duration of treatment depend on the indication. In general, intracellular acting agents such as doxycycline, macrolides like azithromycin and erythromycin and certain quinolones (i.e. levofloxacin and ofloxacin) are applied for specific therapy of C. trachomatis infections. During pregnancy, application of macrolides or aminopenicillins has been recommended for most indications. Because of the serious potential consequences of urogenital C. trachomatis infection in women, many industrialized countries offer a C. trachomatis screening. For the elimination of trachoma, which is envisaged by the World Health Organization for the year 2020, the so-called SAFE strategy is used. This strategy includes therapeutic and hygienic measures that may be suitable to eliminate one of the leading causes of blindness worldwide.     

Unsuspected Chlamydia trachomatis in females attending a sexually transmitted diseases clinic

One hundred and five women attending Auckland sexually transmitted diseases clinic were reviewed because of positive cervical cultures for Chlamydia trachomatis. Their average age was 19 years, 70% were European; 28% were Maori. In half the patients the positive culture was a chance finding and therefore treatment was delayed resulting in six patients (12%) developing pelvic inflammatory disease. Eight out of nine male contacts, subsequently traced, had asymptomatic urethritis, one having epididymitis. One patient had no evidence of urethritis but was chlamydia positive. Associated pathogens present in the women were Neisseria gonorrhoeae (26%), Trichomonas vaginalis (6%), Gardnerella vaginalis (46%) and Candida albicans (19%). These findings support a need for routine chlamydial testing in female patients attending sexually transmitted diseases clinics and epidemiological treatment of female contacts of men with non-specific urethritis.     

Emerging strategies in the diagnosis,prevention and treatment of chlamydial infections

Chlamydial infections cause a spectrum of diseases affecting millions of individuals worldwide. Chlamydia trachomatis is the most common sexually transmitted bacterium and the causative agent of trachoma, the leading cause of preventable infectious blindness in the world. The unique intracellular life-cycle and the chronic, persistent nature of chlamydial infections have hindered efforts to develop optimal diagnostic, preventive and treatment strategies for these pathogens. The reported association of C. pneumoniae with atherosclerosis and adult onset asthma suggests that these organisms may play an important role in the aetiology of chronic diseases. Treatment options involving new classes of antibiotics or new versions of existing antibiotics that may provide greater specificity and utility for long-term use against chlamydiae are much needed. In addition, new combinations of therapies are needed to manage existing chronic conditions and at the same time to alleviate any role that chlamydiae could be playing in these conditions. Novel strategies that address these shortcomings are apparent in recent research efforts. This review summarises patent claims of emerging strategies to diagnose, prevent and treat chlamydial infections. In addition, current efforts to develop suitable vaccine candidates are highlighted.     

性病门诊泌尿生殖道沙眼衣原体感染现况调查及基因分型的初步研究

目的对太原地区性病门诊泌尿生殖道沙眼衣原体感染状况和基因分型进行初步研究。方法收集2008—2011年门诊疑诊为沙眼衣原体泌尿生殖道感染患者的尿道或宫颈分泌物标本,应用英国立明视窗沙眼衣原体抗原检测试剂盒检测,阳性标本部分进行细胞培养,并应用聚合酶链反应-限制性片段长度多态性(PCR-RFLP)法进行基因分型。结果 4年共收集2388例临床标本,检测出抗原阳性者365例,各年度感染率比较整体呈下降趋势,男女感染率之比为2.2∶1,感染高峰年龄为21~40岁。取137例临床标本进行细胞培养,阳性52株,阳性率为38.0%,分型得到E型48株、D型4株。结论太原地区性病门诊人群中泌尿生殖道沙眼衣原体感染有较高的发病率,E型为主要基因型,尚需扩大样本量进一步研究。     

广州市番禺区娱乐场所女性性服务人员性病感染情况分析

目的 了解广州市番禺区娱乐场所女性性服务人员性传播疾病感染现状,以及对性病的认识,为进一步做好性传播疾病的预防控制提供科学依据.方法 随机调查15家娱乐场所,将娱乐场所的女性性服务人员作为研究对象,进行4种性病（淋病、衣原体感染、尖锐湿疣和梅毒）检查,并对其进行问卷调查.结果 共筛查了622名女性性服务人员,性病总检出率为21.22%,其中淋病3.38%,衣原体感染10.29%,尖锐湿疣4.18%,梅毒4.50%.结论 积极有效的对娱乐场所进行性病的健康教育和行为干预势在必行.     

淋球菌感染与其他性传播性疾病感染关系的研究

目的探讨高危妇女中淋病的发生率及与生殖道其他感染的关系。方法应用T—M培养基、连接酶链反应（LCR）、TPHA、RPR、阴液革兰染色涂片等对966例高危妇女进行淋病、衣原体、梅毒、HIV、尖锐湿疣、念珠、滴虫和细菌性阴道炎检查。结果966例自愿者中检出淋病172例，发生率17．80％。合并阴道其他感染87．79％，合并衣原体感染41．27％，合并梅毒11．62％，合并尖锐湿疣7．5％，合并HIV1．74％，总合并感染率高达95．94％，仅为单一的淋病患者4．06％。结论淋病患者合并其他生殖感染及性病发生率高，特别是合并阴道感染发生率最高，因此对反复阴道感染或治疗效果欠佳的阴道炎应注意合并淋球菌感染，对发现淋病的患者应同时进行其他生殖感染及性病的检查，以免漏诊，提高诊断率。     

单克隆抗体检测淋球菌和衣原体的应用

单克隆抗体检测淋球菌和衣原体的应用何焱玲＊王朝凤＊窦晓玉＊张景润＊王红兵关键词淋球菌衣原体单克隆抗体性传播疾病（ＳＴＤ）是由性接触而传染的疾病，其中以非淋菌性尿道炎和淋病的发病率最高，是目前ＳＴＤ中常见的疾病。过去传统的检测方法是做病原体的培养或涂...     

Prevalence and treatment of pharyngeal Chlamydia trachomatis infections

In recent years, the number of the patients with pharyngeal infection caused by Chlamydia trachomatis is believed to be on the rise due to diversification in sexual behaviors. In addition, pharyngeal infection by C. trachomatis is often asymptomatic, and this is also believed to be a major factor for the increase of the disease. In this study, we conducted a survey among general females and commercial sex workers (CSWs) to study their sexual behavior and prevalence of chlamydial infections (in uterine cervix and pharynx). The results showed that orogenital contact has become a common act, even for general females. Chlamydial infections of uterine cervix were found in 33.3% and 7.9% of CSWs and general females, respectively. Chlamydial infections of pharynx were found in 22.5% and 5.2% of CSWs and general females, respectively. The evaluation of treatments of these infections with clarithromycin, levofloxacin, and azithromycin showed that 7, 10, and 14 days administrations of 400 mg clarithromycin, 7, 10, and 14 days administrations of 300 mg levofloxacin, and a single dose of 1000 mg of azithromycin, would eradicate 100% of C. trachomatis for infections of uterine cervix. For pharyngeal infections, 10 and 14 days administrations of clarithromycin and levofloxacin were shown to eradicate 100% of C. trachomatis. However, the eradication rates for 7 days administrations of clarithromycin and levofloxacin were 83.9% and 86.2%, respectively, and the rate for a single dose of azithromycin was 85.0%. From these results, it was thought that more than 10 days of administrations of clarithromycin or fluoroquinolone antibacterial agents such as levofloxacin are necessary to treat pharyngeal chlamydial infection. Clinical significance of pharyngeal chlamydial infection is still not clear; however, this study have shown the need for more detailed investigations using culture assay, in corporation with doctors in otolaryngology and internal medicine.     

沙眼衣原体疫苗佐剂研究进展

沙眼衣原体是感染性致盲和细菌性性传播疾病的主要病原体.接种疫苗是预防和控制沙眼衣原体感染最经济有效的途径.蛋白或多肽疫苗、DNA疫苗和树突状细胞疫苗是具有应用前景的三类沙眼衣原体疫苗.与传统灭活疫苗相比,这三类疫苗往往存在免疫原性弱等缺陷,急需发展新型免疫佐剂来增强其免疫效果,此文对这三类沙眼衣原体疫苗佐剂的研究进展作一综述.     

Surveillance of sexually transmitted infections in New Zealand, 1998

AIMS: To describe the surveillance and epidemiology of sexually transmitted infections (STIs) in New Zealand. METHODS: Sexual health clinics submitted STI data to the Institute of Environmental Science and Research (ESR). Infection rates were calculated by dividing the number of diagnoses by the number of total clinic visits. Because the denominator used to calculate infection rates changed in 1998, STI rates in 1998 cannot be directly compared with previous years and case numbers were used to identify recent trends. RESULTS: In 1998, genital warts was the most commonly diagnosed STI (4.7%), followed by chlamydia (3.0%) and genital herpes (1.0%). Approximately two-thirds of gonorrhoea, chlamydia and genital warts diagnoses were in people aged less than 25 years. Chlamydia rates were 7.3% in Maori, 7.1% in Pacific Island people, and 2.1% in European. Gonorrhoea rates were 1.6% in Maori, 1.9% in Pacific Island people and 0.2% in European. The number of chlamydia and gonorrhoea cases increased between 1995 and 1998. CONCLUSIONS: The reporting of data by age, sex and ethnicity has allowed a more useful evaluation of the incidence of STIs. The majority of STIs were diagnosed among young New Zealanders, and disproportionately high chlamydia and gonorrhoea infection rates were found among Maori and Pacific Island people.     

Aetiology of male urethritis in patients recruited from a population with a high HIV prevalence

The aetiology of urethritis, the significance of potential pathogens and the relation of urethritis to HIV infection were determined in 335 men (cases) with and 100 men (controls) without urethral symptoms. Urethral swab specimens were tested for different organisms by PCR or by culture for Neisseria gonorrhoeae. The prevalence of N. gonorrhoeae and Chlamydia trachomatis was 52 and 16%, respectively. The potential pathogens: Mycoplasma genitalium, Ureaplasma urealyticum, Trichomonas vaginalis and herpes simplex virus (HSV), were present in 5, 36, 6 and 6% of the cases respectively. M. genitalium was the only potential pathogen associated with microscopic urethritis. After excluding gonococcal infections, U. urealyticum was more frequent in symptomatic patients, while the prevalence of T. vaginalis was similar among cases and controls. These results strongly suggest an a etiological role for M. genitalium in male urethritis, a possible role for U. urealyticum, but not for T. vaginalis. The control group, with 97% genital ulcer disease patients, was not suitable for the investigation of the role of HSV. The sero-prevalence of HIV was 45%. Current infections were not associated with HIV. However, a history of previous urethral discharge was associated with HIV in a multivariate analysis and supported the hypothesis that non-ulcerative sexually transmitted diseases facilitate HIV transmission.     

PRO-2000, an antimicrobial gel for the potential prevention of HIV infection

Indevus Pharmaceuticals Inc, under license from Paligent Inc, is developing PRO-2000, an antimicrobial gel for the prevention of HIV infection. The company is also investigating its potential to prevent the transmission of other sexually transmitted diseases. In February 2005, Indevus launched a pivotal phase III trial for the prevention of HIV infection in women. At that time, further phase III trials in 12,000 African women were scheduled to begin in 2005. A second phase III trial began for the prevention of sexually transmitted infections, including HIV, herpes, Chlamydia and gonorrhea, in Africa in October 2005.     

High Prevalence of Sexually Transmitted Infections Among Young Peruvians Who Have Sexual Intercourse With Foreign Travelers in Cuzco

Background.  Sexual networking in popular tourist destinations is a problem worldwide. In Peru, locals sexually interacting with travelers bridge high-risk groups, the general population, and travelers.
Methods.  A cross-sectional study was conducted in Cuzco about sexual behavior among young Peruvians who admitted having sex with travelers. A subgroup of the participants had serologic testing for Chlamydia trachomatis , Herpes simplex virus (HSV) type 2, and Treponema pallidum .
Results.  Eighty-eight subjects volunteered for blood sampling. Their mean age was 22.9 years (±4.1) and 53.4% were male. The majority were single (86.2%), but 12.6% had a stable relationship. The median number of sexual partners in the 3 months prior to the study was 2 [interquartile range (IQR): 1–4]. During that period, 43.1% reported foreign partners, 28.4% reported foreign and Peruvian partners, 17% reported Peruvian partners, and the remaining 11.5% reported combinations of Peruvian, foreign, and sex workers partners. The median number of foreign partners in the 12-month period prior to the study was 4 (IQR: 2–8). Only 25.3% reported consistent condom use. Alcohol (69%) and drugs (36.8%) were commonly used before sexual activity. Seventy-eight percent tested positive for HSV type 2, 25% for C trachomatis , and 1.1% for T pallidum .
Conclusions.  The core group of young Peruvians we report on demonstrated a high-risk sexual behavior and a high prevalence of sexually transmitted infections. Our results underscore the need for education on safer sex practices among this group and among travelers.     

Therapeutic approaches to Chlamydia infections

Chlamydia trachomatis ocular and urogenital infections represent major public health problems, whereas Chlamydophila pneumoniae is a common aetiological agent of community-acquired pneumonia. The obligate intracellular lifestyle of these established pathogens poses challenges to both their diagnosis and treatment. Tetracyclines, macrolides and quinolones remain the antimicrobials of choice for the treatment of infections due to Chlamydiaceae.     

Cost-effectiveness of widespread screening for Chlamydia trachomatis

Screening for sexually transmitted diseases is included in routine health care for several infectious agents in many western European countries. Current considerations on extensions of these programs include widespread screening strategies for Chlamydia trachomatis. In women, C. trachomatis infection may lead to sequelae such as infertility and ectopic pregnancy. This paper reviews the goal of screening and subsequent therapy and the available compounds for testing and treating. Furthermore, the current best practice - in particular with respect to economic performance - is discussed, and those factors that most crucially influence the economic profile are described. Illustrations are drawn from recent work in The Netherlands, which may also be representative for other settings.     

Cost-effectiveness of widespread screening for Chlamydia trachomatis

Screening for sexually transmitted diseases is included in routine health care for several infectious agents in many western European countries. Current considerations on extensions of these programs include widespread screening strategies for Chlamydia trachomatis. In women, C. trachomatis infection may lead to sequelae such as infertility and ectopic pregnancy. This paper reviews the goal of screening and subsequent therapy and the available compounds for testing and treating. Furthermore, the current best practice – in particular with respect to economic performance – is discussed, and those factors that most crucially influence the economic profile are described. Illustrations are drawn from recent work in The Netherlands, which may also be representative for other settings.     

The chlamydial pneumonias

Chlamydia psittaci and Chlamydia pneumoniae are important causes of community-acquired pneumonias. Less commonly, C. trachomatis may cause pneumonia in adult immunocompromised hosts but more commonly is responsible for pneumonia in neonates. C. psittaci is the cause of psittacosis and is the only chlamydial zoonotic atypical pneumonia. C. pneumoniae is being increasingly recognized as the cause of up to 10% of community-acquired pneumonias. C. pneumoniae pneumonia has a clinical presentation like Mycoplasma pneumoniae pneumonia. C. pneumoniae is also responsible for a variety of other respiratory tract infections, e.g., sinusitis, bronchitis, otitis, pharyngitis and laryngitis. C. pneumoniae, like M. pneumoniae, may result in permanent airway disease, e.g., asthma, following infection. All chlamydia are sensitive to doxycycline. Macrolides are highly active against C. trachomatis, and in spite of in vitro susceptibility, are relatively inactive in vivo against C. psittaci and C. pneumoniae. Fluoroquinolones are also active against chlamydia. Doxycycline remains the preferred antibiotic to treat all chlamydial infections in nonpregnant adults.