Antigen detection of Chlamydia trachomatis from the endocervix is not enough for screening of perinatal complications

Abstract

We read with interest the article by Wiesenfeld et al. (Wiesenfeld HC, Heine RP, Rideout A, Macio I, DiBiasi F, Sweet RL. The vaginal introitus: A novel site for Chlamydia trachomatis testing in women. Am J Obstet Gynecol 1996; 174: 1542-6). The authors report that the vaginal introitus represents a highly effective noninvasive specimen collection site for Chlamydia trachomatis testing by polymerase chain reaction. Chlamydial infections during pregnancy may cause a variety of perinatal complications. Chlamydial infections of infants are usually caused by mother-to-infant transvaginal transmission of C. trachomatis.1Numazaki K Wainberg MA McDonald J Chlamydia trachomatis infections in infants.Can Med Assoc J. 1989; 140: 615-622Google Scholar Antigen detection of C. trachomatis from the endocervix has been used widely for the purpose of the screening chlamydial infections during pregnancy. These tests are easily performed and less costly but have lower sensitivities than culture and have low positive predictive values in low-prevalence populations such as Japan. We report four infants who had neonatal C. trachomatis infections whose mothers had negative chlamydial enzyme immunoassay results during pregnancy. Four cases of chlamydial respiratory infections, including pneumonia and laryngitis, in the early neonatal period were investigated. Time of onset of clinical symptoms was within 2 weeks after birth (0, 1, 3, and 13 days after birth, respectively). Three infants were born at term and one was premature. One infant was born by cesarean section. Diagnosis of neonatal chlamydial infections was obtained by antigen detection from nasopharyngeal swabs and by detection of serum immunoglobulin G and immunoglobulin M antibodies to C. trachomatis. A commercially available enzyme immunoassay kit (IDEIA Chlamydia, Dako Diagnostics) was used. An enzyme immunoassay test kit (SERO IPALisa Chlamydia, Meiji Milk Products, Tokyo) was also used to detect serum immunoglobulin G, immunoglobulin A, and immunoglobulin M antibodies against C. trachomatis. Antigen detection of C. trachomatis from the endocervix of mothers of these four infants was also done with an enzyme immunoassay kit (IDEIA Chlamydia) at 20 and 30 weeks of gestation. However, chlamydial antigen was not detected from any endocervical specimens. Although transmission of the organism from mothers to their infants generally occurs at the time of delivery with passage of the infant through the infected cervix, the possibility of intrauterine infection has been reported.1Numazaki K Wainberg MA McDonald J Chlamydia trachomatis infections in infants.Can Med Assoc J. 1989; 140: 615-622Google Scholar Seropositivity for C. trachomatis is also associated with perinatal complications.2Gencay M Koskiniemi M Saikku P Puolakkainen M Raivio K Koskela P et al.Chlamydia trachomatis seropositivity during pregnancy is associated with perinatal complications.Clin Infect Dis. 1995; 211: 424-426Crossref Scopus (34) Google Scholar, 3Numazaki K Kusaka T Chiba S Perinatal complications are associated with seropositivity for Chlamydia trachomatis during pregnancy.Clin Infect Dis. 1996; 23: 208Crossref PubMed Scopus (5) Google Scholar Early diagnosis and appropriate treatment of chlamydial infections may reduce these complications.