A Study on the Prevalence of Chlamydia Trachomatis and Neisseria Gonorrhoeae Infections Using Polymerase Chain Reaction

Abstract

INTRODUCTION : Sexually transmitted infections (STIs) are a major global cause of acute illness, infertility, long term morbidity and mortality, with severe medical and psychological consequences of millions of men, women and infants. STIs most commonly affect people aged between 15 to 44 years. In 2006, 1,030,911 Chlamydial infections and 3,58,366 Gonococcal infections were reported to CDC from 50 states and the districts of Columbia in United states. Chlamydia trachomatis and Neisseria gonorrhoeae remain the two most preventable causes of human infertility. Untreated Gonococcal and Chlamydial infections in women will result in pelvic inflammatory disease in upto 40% of cases. One in four of these will result in infertility. Demographic risk factors for the acquistion of gonorrhoeae include migration of population, unemployment, lack of education, poverty, early onset of sexual activity, unmarried marital status, past history of gonorrhoeae,illicit drug use and now commercial sex have been operative universally, but more severely in certain societies and countries. AIMS AND OBJECTIVES : 1. To study the prevalence of Chlamydia trachomatis and Neisseria gonorrhoeae infections in patients attending the Out-Patient Department of Institute of Venereology, using AMPLICOR CT/NG Polymerase chain reaction. 2. To study the prevalence of Chlamydia trachomatis and Neisseria gonorrhoeae infections among HIV positive patients in the study group. 3. To study about the age distribution, socioeconomic background, educational level and marital status among the patients in the study group. 4. To compare the sensitivity and specificity of AMPLICOR CT/NG Polymerase chain reaction with Culture for Gonococci and IgM ELISA test for Chlamydia trachomatis. CONCLUSION : 1. Gonococcal infections (males –14.64%, females –13.34%) was more common than Chlamydia trachomatis (males-3.57%, females –3.70%) infections. Gonococcal infection was more common in men (14.64%) compared to women (13.34%). Chlamydial infection was more common in women (3.70%) when compared to men (3.57%). 2. In HIV positive patients also, gonococcal infections (M-14%, F- 7%),were more common than chlamydial infections (M-3%, F-11%). 3. AMPLICOR CT /NG PCR for urine specimens (M-16, F-15) was highly sensitive than male urethral (13) and female endocervical swab (13) specimens in detecting gonococcal infections. In Chlamydial infections, urine PCR (7) was highly sensitive than urethral swab PCR (2) in males but in females, endocervical swab PCR(6) was more sensitive than urine PCR (3). 4. Asymptomatic gonococcal infection was common in affected males (29.26%) when compared to affected females (27.78%). Asymptomatic Chalmydial infection was common in affected females (40%) compared to affected males(20%).Asymptomatic gonococcal (M-57.14%, F- 57.14%) and chlamydial infections (M-66.67%, F-100%) were common in HIV positive patients compared to HIV negative patients. 5. AMPLICOR CT/NG PCR had 100% sensitivity in detecting gonococcal infections compared with gonococcal culture and also had 100% sensitivity in detecting chlamydial infections compared with IgM ELISA for C. trachomatis. 6. Majority of gonococoal (M-43.90%, F-47.23%) and Chlamydial (M- 50%, F-60%) infection positive patients belonged to 20-29 years age group. Majority of the affected patients belonged to lower socioeconomic status. 7. Burning micturition (NG-53.65%, CT-80%) was the main complaint in affected males and genital discharge (NG-50%,CT-50%) was the main complaint in affected females. In gonococcal infection positive males, urethral discharge (14.63%) was the common clinical finding and in chlamydial infection positive males genital ulcer (30%) was the common clinical finding .Cervical erosion (NG-58.34%, CT-70%) was the common clinical finding in affected females. 8. In Chlamydial infection positive patients, gonococcal infection was the most commonest associated STI (M-30%, F-70%). In gonococcal infection positive males, C. trachomatis (7.31%) was the commonest associated STI and in females, Bacterial vaginosis (41.67%) was the commonest associated STI. AMPLICOR CT/NG PCR had 100% sensitivity in detecting gonococcal and chlamydial infections. PCR screening will diagnose asymptomatic cases of both gonococcal and chlamydial infections. Since coinfection rate of gonococcal and chlamydial infection were high, all cases of gonorrhoeae should be treated presumptively for chlamydial infection as recommended by CDC and WHO.