Effective treatment of Chlamydia trachomatis infection during pregnancy to prevent perinatal and infant complications.

Chlamydia trachomatis is the most prevalent cause of sexually transmitted disease in the United States today. Prenatal health care providers must learn to recognize and effectively treat chlamydial infection in order to help prevent serious consequences in the pregnant woman and in the neonate. This article discusses the diagnosis and treatment of chlamydial infection during pregnancy and during the neonatal period. Patient education of women infected during pregnancy should include guidelines for helping parents and care providers monitor the neonate for signs of conjunctivitis and pneumonia.     

Efficacy of erythromycin in the treatment of inner city pregnant women with cervical Chlamydia trachomatis infection.

In this retrospective study, the efficacy of screening for and treating cervical Chlamydia trachomatis infection was evaluated in a pregnant population at increased risk for chlamydial infection. Over a 2 1/2-year period, 5.75% (338) of the 5,875 women tested were found to be infected with this organism. Of the 323 women patients available for follow-up, 76% (244) were successfully treated and 24% (79) remained infected throughout their pregnancies. Forty (12%) patients became infected during pregnancy, while 26 (8%) were reinfected during pregnancy, despite treatment with erythromycin. Twenty-seven (8%) patients had their first antenatal visit and cervical swab less than a week before delivery. The gestational age at which the first cervical chlamydial swab was obtained was significantly more advanced in patients who remained infected (30.23 +/- 6.2 weeks) than those who were successfully treated (22.15 +/- 7.66 weeks; P = 0.00001). The data suggest that in a pregnant population considered to be at increased risk for C trachomatis infection: (1) there is a subgroup of patients with a high risk of remaining infected or becoming reinfected with C trachomatis during pregnancy despite treatment with erythromycin and (2) repeated prenatal testing and treatment of those infected is necessary to detect and eradicate maternal chlamydial infection.     

Incidence of Chlamydia trachomatis infections in pregnant patients in Vienna

Pregnant women were examined for chlamydia trachomatis-infection on a routine basis during a multicentric study in Vienna. Samples were taken from the cervix and fornix between the 30th and 34th week pregnancy. FTIC-conjugated monoclonal antibodies and immunofluorescence techniques were used to verify chlamydia trachomatis. Out of 1238 pregnant women, 101 (8.16%) were positive for chlamydia trachomatis. Since chlamydia infections can result in severe local or generalized complications and also spread to the newborn baby, screening investigations should be regularly performed during pregnancy and, if indicated, adequate treatment undertaken.     

Chlamydia and other sexually transmitted bacterial infections

Chlamydia trachomatis is the most common sexually transmitted bacterium worldwide. In Western Europe, the prevalence of gonorrhoea has decreased by more than 95% since the 1970ies; "tripper" and syphilis are essentially confined to high-risk groups while genital chlamydial infections affect people of all social classes, but information about chlamydia is still scarce in many European countries. Clinically genital chlamydial infections resemble gonorrhoea (dysuria, discharge, irregular bleeding, dyspareunia, perihepatitis) and may be mistaken for appendicitis. However, Chlamydia trachomatis persists longer and more often asymptomatic than Neisseria gonorrhoeae in the urogenital tract of men and women. About 20% of all chlamydia infected women suffer from partial or complete tubal occlusion. Chlamydia trachomatis is the leading cause of female infertility, but most of these women never experienced any clinical sign of pelvic inflammatory disease. Since particle concentrations are often very low in urine and cervical secretions only DNA-amplification tests, e.g. PCR or LCR, exhibit sufficient sensitivity for direct detection Chlamydia trachomatis. While Neisseria gonorrhoeae is eradicated by single-shot treatment with commonly used antibiotics like penicillins or cephalosporins Chlamydia trachomatis affords treatment for at least 10 days with doxycyline or macrolides. Partner treatment is essential to avoid reinfections. Condoms not only protect against HIV, but also against chlamydia, gonorrhoea and syphilis.     

Chlamydial infections

Chlamydia trachomatis is a unique intracellular parasite that causes a number of common sexually transmitted disease syndromes, including nongonococcal urethritis in both men and women, epididymitis in men, and pelvic inflammatory disease in women. Infants exposed at delivery are at risk for the development of conjunctivitis and pneumonia. There is strong evidence that Chlamydia is a cause of obstructive infertility and ectopic pregnancy in women. It appears that these complications result from the chronic inflammatory response and secondary scarring that are elicited by long-term asymptomatic or nearly asymptomatic fallopian tube infections. Because treatment with tetracycline, doxycycline, or erythromycin is simple, effective, and inexpensive, major efforts should be put into identifying asymptomatic young women through screening of the subpopulations at highest risk. These include sexually active adolescent women and older women who are not monogamous. Blacks are at higher risk than other ethnic groups for infection. The cost of diagnosing chlamydial infection has decreased with the introduction of new nonculture diagnostic tests. This should increase the availability of testing for screening purposes. It is critical to remember that male sex partners of infected women must be treated; otherwise all efforts to prevent long-term complications by identifying and treating asymptomatic women are doomed to failure.     

Chlamydia trachomatis: is it possible to reduce the number of infections after abortions?

In a study at the University Hospital in Trondheim during 1983, the frequency of Chlamydia trachomatis among women terminating their pregnancies was 8.2%. Younger women were infected by C. trachomatis at a more frequent rate than older women (p less than 0.001). Treatment of chlamydia-positive women was initiated within the first two weeks after the abortion. However, among women readmitted to the hospital, chlamydia-positive women showed a higher frequency of salpingitis than chlamydia-negative women (p less than 0.08). Preabortion examination for C. trachomatis and treatment of chlamydia-positive women by practitioners before the abortion is carried out, may reduce the postabortal frequency of salpingitis.     

Epidemiology, clinical aspects and therapy of infections with Chlamydia trachomatis serotype D-K

Chlamydia trachomatis serotype D-K is one of the most important pathogens of communicable diseases. 3 to 5 million new infections are observed annually in the USA. 10% to 30% of young sexually active persons in the age group 15 to 20 years are affected. The organism was isolated from 20% to 30% of patients attending dispensaries for sexually transmitted diseases, 5% to 10% of gynaecological outpatients, 1% to 8% of pregnant women and 0% to 5% of asymptomatic control persons. In men, C. trachomatis was found in 30% to 70% of patients with urethritis (15% to 25% simultaneously with gonorrhoea), in 30% to 60% of persons suffering from nongonoccocal urethritis and in 65% to 70% with postgonoccocal urethritis. 20% of newborns from mothers with positive cultures develop pneumonia and 37% conjunctivitis. Complications such as endometritis, salpingitis, periappendicitis, perihepatitis, ectopic pregnancy, premature birth, proctitis, cystitis, deferenitis, epididymitis, reactive arthritis, morbus Reiter, conjunctivitis, pneumonia (in infants and adults) may cause long lasting disease and may leave behind irreversible sequelae. Treatment with tetracyclines or erythromycin is always effective.     

Chlamydial infections

Chlamydia causes many human infections and should be treated aggressively. Tetracycline or doxycycline are the drugs of choice, but erythromycin can be used if a drug allergy is present or if tetracyclines are contraindicated. In the pregnant woman, aggressive treatment can improve neonatal outcome. In the United States, each year 155,000 infants are exposed to Chlamydia trachomatis during the birth process, and more than 100,000 will be infected. Of these, 75,000 will get conjunctivitis, and 30,000 will get pneumonia. In pregnancy, erythromycin is the drug of choice, with treatment recommended after initial culture and at term if repeat cultures are positive. If erythromycin is not tolerated, or the patient has an allergy to it, ampicillin or clindamycin may be effective alternatives.     

Chlamydial infections. Gaining control of a growing epidemic

Infections caused by Chlamydia trachomatis are wide-spread, costly, and damaging. Consequences are harshest for women because of the adverse effects on the reproductive system. Newborns of infected mothers may also be affected. Screening of sexually active patients is important, because many infected patients are asymptomatic. Newer, improved laboratory techniques are available. Treatment with doxycycline, tetracycline, or erythromycin is preferred. Simultaneous treatment of sexual partners is vital.     

A prospective study of Chlamydia trachomatis in first trimester abortion

Chlamydia trachomatis was isolated from 34 (17.9%) of 190 unselected women applying for first trimester abortion and from 27 (15.9%) of the 170 women who actually had the operation. C. trachomatis was more common among the younger women. Neisseria gonorrhoeae was isolated from 3 (1.6%) of 190 women. Culture positive patients and partners were given antibiotic treatment for 10 days, usually postoperatively. Early postoperative genital infection developed in 2 (7.4%) of the 27 chlamydia-positive and in 3 (2.0%) of the 143 chlamydia-negative women. There were no late infections. The antibiotic treatment significantly reduced the rate of postoperative pelvic inflammatory disease. At examination after 4-7 weeks all cultures were negative. Significantly more women with chlamydia-positive cultures were sero-positive preoperatively: with a microimmunofluorescence method, IgG titres greater than or equal to 1:160 were found in 74.1% of culture positive and in 47.6% of culture negative patients (p = 0.01). However, serological IgG screening does not identify individual high risk patients and so is of little clinical use in this context. We recommend preoperative screening for C. trachomatis in all women requesting an abortion and 10 days antibiotic treatment for all carriers.     

Adequate levofloxacin treatment schedules for uterine cervicitis caused by Chlamydia trachomatis

The in vivo efficacy of levofloxacin (LVFX), one of the most standard new quinolone antimicrobial agents, in the different treatment schedules of Chlamydia trachomatis uterine cervicitis in women was evaluated. Cervical C. trachomatis was detected by polymerase chain reaction. LVFX at a dosage of 300 mg t.i.d. for 5, 7 and 14 days was orally administered to 18, 33 and 35 Japanese patients, respectively. The eradication rate and the recurrence rate in the different treatment schedules of C. trachomatis were evaluated. The eradication rate in 5-, 7- or 14-day cases was 44.4, 87.9 or 88.6%, respectively. The recurrence rate of 5-, 7- or 14-day cases was 50.0, 0 or 0%, respectively. Seven-day treatment with LVFX is adequate for and effective in C. trachomatis uterine cervicitis.     

孕妇感染沙眼衣原体、淋病、梅毒及艾滋病的调查分析

目的：了解该院孕妇患性传播疾病（包括生殖道沙眼衣原体感染、淋病、梅毒及艾滋病）的情况,以便采取有效措施确保母婴健康,减少母婴传播的风险。方法对2934例于该院产科门诊进行孕期检查的孕妇进行宫颈分泌物沙眼衣原体、淋病奈瑟菌筛查,血清梅毒螺旋体抗体和 HIV抗体的检测。结果孕妇宫颈分泌物沙眼衣原体阳性率为4．02％（118/2934）,其中小于20岁年龄段孕妇的阳性率最高,为10．53％（10/95）。孕妇感染高峰在5月份和10月份,检出率分别为5．56％（16/288）和6．82％（12/176）。淋病检出率为0．17％（5/2934）,梅毒检出率为0．37％（11/2934）,艾滋病检出1例。结论生殖道沙眼衣原体、淋病奈瑟菌、梅毒螺旋体是孕妇感染性传播疾病中较为常见的病原菌,HIV的感染率相对低一些。沙眼衣原体在小于20岁年龄段中的检出率最高,感染有随季节变化的规律（高发于春、秋季）。对应加强对孕妇性传播疾病的宣传及筛查,做到早发现、早诊断、早治疗,减少母婴传播的风险,达到母婴健康的目的。     

STERILE PYURIA: CONSIDER CHLAMYDIAL INFECTION

SUMMARY We report the cases of two men referred to a genitourinary medicine clinic with sterile pyuria and subsequently found to have their urethras infected with Chlamydia trachomatis. Chlamydial infection should be considered in the differential diagnosis of sterile pyuria, particularly in young, sexually active males. We discuss the consequences of inadequate treatment of the index case.     

An application of fluorescein-conjugated monoclonal antibodies to the diagnosis of Chlamydia trachomatis infection in children

A method for rapid identification of Chlamydia trachomatis (C. trachomatis) from clinical specimens using fluorescein-conjugated monoclonal antibodies was evaluated. Attempts to isolate C. trachomatis by McCoy cell cultures were simultaneously performed. C. trachomatis was isolated from 8 of 62 newborns with neonatal conjunctivitis in tissue culture as compared with 12 positives using monoclonal antibodies. C. trachomatis was isolated from 2 of 7 infants with pneumonia in tissue cultures as compared with 3 positives using monoclonal antibodies. In order to identify either elementary bodies (EB) or reticulate bodies (RB) in clinical specimens, EB and RB of C. trachomatis L2/434 strain were isolated, purified and reacted with monoclonal antibodies. Majority of fluorescence observed in the clinical specimens was considered to be EB.     

Use of vaginal pH in diagnosis of infections and its association with reproductive manifestations

Increase in vaginal secretion pH is an indicator of bacterial vaginosis (BV), but is yet to be in use as a diagnostic tool by clinicians. Similarly, no reports are available on the effect of cervical chlamydia infection and different reproductive manifestations on vaginal secretion pH. This study evaluated the use of vaginal pH for screening of BV, the effect of Chlamydia trachomatis (C. trachomatis) infection, and different reproductive manifestations on vaginal pH of women attending the gynecology outpatient department of a general hospital. Vaginal pH was recorded while diagnosing infections in 358 women, among which 45 were with repeated spontaneous abortion, 79 with infertility, 185 had sign and symptoms of lower genital tract infection, and 49 had no history or symptom of any complications or infections. Normal vaginal pH, BV, and C. trachomatis infection were observed in 72.6, 21.5, and 10.1% of women, respectively. BV and C. trachomatis were observed in 78.6 and 4.1% of women, respectively, with high vaginal pH; 12.3% of women with normal vaginal pH had C. trachomatis infection. C. trachomatis infection or different reproductive manifestations do not lead to change in vaginal pH but high vaginal pH correlated with BV and should be used as a simple tool for its diagnosis.     

Effects of cationic liposome-encapsulated doxycycline on experimental Chlamydia trachomatis genital infection in mice

In a previous study, we demonstrated that cationic liposome-encapsulated doxycycline (CaL-Dox) was two-fold more effective than free doxycycline against Chlamydia trachomatis in vitro. Here, we evaluated the effects of two CaL-Dox regimens in comparison with unencapsulated doxycycline on the course of chlamydial genital infection in mice. Progesterone-treated, female CF-1 mice were challenged intravaginally with 1.2 x 10(5) inclusion-forming units (ifu) of C. trachomatis. Two days post-infection, the animals were divided into four treatment groups for im injection of doxycycline at 10 mg/kg body weight bd for 3 (3 Dox) or 7 days (7 Dox), or of CaL-Dox at the same dose level for 3 (3 CaL-Dox) or 7 days (7 CaL-Dox) consecutively. An infected fifth group served as a control and was given an empty CaL preparation. C. trachomatis were isolated after five blind passages from 82% of infected control mice, 61.4% of 3 Dox, 52.2% of 3 CaL-Dox, 29% of 7 Dox and 20% of 7 CaL-Dox animals. Histopathological reactions were found in various tissues of the genital tract in 79.5% of infected control mice, 80.9% of 3 Dox, 65.2% of 3 CaL-Dox, 47.1% of 7 Dox and 25.7% of 7 CaL-Dox animals. Total antichlamydial antibody titres were lower in 7 CaL-Dox mice than in all the other groups (P < 0.005). The results showed that progesterone-treated CF-1 mice are suitable for investigation of both lower and upper genital tract infection with a lymphogranuloma venereum biovar strain of C. trachomatis. Neither 7 CaL-Dox nor 3 CaL-Dox treatment was more effective than unencapsulated 7 Dox doses in the bacteriological cure of chlamydial genital infection in mice. However, 7 CaL-Dox prevented tissue damage in the genital tract significantly more than all the other regimens (P < 0.05). These results suggest that liposome-encapsulated doxycycline, particularly CaL-Dox, may have potential for the clinical treatment of chlamydial infections.     

Low Prevalence of Chlamydia trachomatis by Urinary Ligase Chain Reaction in Women Patients in the Emergency Department

Recent studies suggest that women with acute urethral syndrome or abdominal pain, presenting to emergency departments (EDs), have a high prevalence of Chlamydia trachomatis. OBJECTIVES: To estimate the prevalence of C. trachomatis in women presenting to an ED and to see whether those with dysuria or abdominal pain have a higher prevalence of C. trachomatis. METHODS: The authors conducted a prospective cross-sectional study of C. trachomatis in the urine of women aged 18 to 50 years who had a urinalysis performed at a university/county ED from February through May 1998. Urine specimens were labeled for the presence of symptoms and analyzed for C. trachomatis by ligase chain reaction (LCR). Polymerase chain reaction (PCR) testing of cervical swabs for C. trachomatis was done for usual clinical indications. Difference in proportions of positive LCR tests among patients was tested with Fisher's exact test. Agreement between PCR and LCR was measured using Cohen's kappa statistic. RESULTS: Of 397 women whose urine was tested, 280 had symptoms of dysuria, abdominal pain, or both, and 117 had no symptoms. The overall prevalence of C. trachomatis by LCR was 3.8% (95% CI = 2.1% to 6.2%); and the combined PCR-LCR prevalence was 4.3% (95% CI = 2.5% to 6.8%). The presence of symptoms was not associated with a positive LCR test for C. trachomatis (p = 0.26, power = 0.8, alpha = 0.05, difference 3% vs. 12%). In the 172 patients who had both a PCR cervical swab and urine LCR, agreement was excellent (kappa = 0.67, 95% CI = 0.45 to 0.90). CONCLUSIONS: This ED had a surprisingly low prevalence of C. trachomatis. Women with symptoms were not more likely to test positive than those without.     

The prevalence of Chlamydia trachomatis in the cervix of puerperal women, and its consequences for the outcome of pregnancy

During a five-month period all puerperal women at the Department of Obstetrics, University Hospital of Trondheim, Norway, were screened for Chlamydia trachomatis (C. trachomatis) from the cervix uteri on the 4-6th day postpartum. Outcomes of the pregnancies were examined. The prevalence of C. trachomatis in the total population of 599 eligible women was 5.8% (35:599), while 3.0% (18:599) of the cultures were inconclusive. The prevalence of C. trachomatis in women aged less than 20 years was 25.8%; aged 20-24 years, 8.9% and greater than 24 years, 2.3%. The prevalence of C. trachomatis among women living alone was 17.2%; among women in cohabitation, 9.2% and among married women, 3.2%. There was no relationship between the presence of C. trachomatis and preterm birth, birth weight and birth weight for gestation, stillbirth or neonatal death. During the first fourteen postpartum days no puerperal infections were seen among chlamydia-positive mothers. The chlamydia-positive women and their partners were then treated with erythromycin stearat 1,000 mg daily for 12 days. Samples for cervix 14 days after completion of the treatment were chlamydia-negative for all 35 women. Screening all pregnant women under the age of 25 years would detect 80% of the pregnant population harbouring C. trachomatis in the cervix uteri. Based on findings from this study and from cost-benefit analyses, we recommend screening of all pregnant women under the age of 25 years in our attachment area.     

结膜炎患者病灶处解脲脲原体及鹦鹉热衣原体核酸的检测

为了探讨解脲脲原体 (Uu)和鹦鹉热衣原体 (Cps)与人类结膜炎的关系 ,本文应用套式聚合酶链反应 (nPCR)对 5 7例 (6 2眼 )结膜炎患者的病灶部刮取物进行了Uu、Cps和沙眼衣原体 (Ct)特异性核酸检测 ,并对Uu和Cps各一例nPCR阳性产物进行了DNA测序。结果显示 57例结膜炎患者中Ct、Uu及Cps的检出率分别是19.3%、14.0%和3.5%。表明除Ct外 ,Uu或Cps可能也是人类结膜炎的致病病原体之一。     

A randomized controlled trial of azithromycin versus doxycycline/ciprofloxacin for the syndromic management of sexually transmitted infections in a resource-poor setting

A randomized controlled trial was carried out to assess the effectiveness of azithromycin versus a standard regimen with doxycycline/ciprofloxacin in the treatment of sexually transmitted infections in a resource-poor environment. Infection with Chlamydia trachomatis was cured in 23/24 (95.8%) of women in the azithromycin arm versus 19/21 (90.5%) in the doxycycline arm (P = 0.6), resulting in three treatment failures. Gonorrhoea was cured in 55/56 (98.2%) women, with one treatment failure in a patient with concomitant C. trachomatis infection. These results indicate that a single oral dose of azithromycin may prove to be a more effective and convenient treatment for sexually transmitted infections in women in a resource-poor environment