Current Status of the Screening of Chlamydia trachomatis Infection Among Japanese Pregnant Women.

Abstract

Chlamydia trachomatis (CT) infection in pregnancy can cause maternal disease, adverse pregnancy outcomes, and neonatal disease [1-6]. In general, approximately 80% of CT infected women are asymptomatic or minimally symptomatic. There-fore, screening is the only means to effectively identify infec-tions [2]. In Japan, pregnant women are routinely tested for CT with the Japanese public funds. According to the guide-lines for obstetrical practice in Japan [7], Japanese obstetri-cians must provide a test for the detection of CT for the pre-vention of neonatal CT infection and diagnose urogenital CT infection when CT is detected using polymerase chain reac-tion (PCR), strand displacement amplification, transcription mediated amplification, an enzyme immunoassay, or culture methods in specimens obtained from the uterine cervix (CT nucleic acid detection tests). However, CT antibody detection by IgA tests has been substituted for these methods by some of obstetricians.On October 2014, we requested 2,544 obstetrical facilities that are members of Japan Association of Obstetricians and Gynecologists (JAOG) to provide information of CT screen-ing tests in pregnant women between October 2013 and March 2014. A total of 1,644 (64.6%) of 2,544 obstetrical facilities responded with possible statistical analysis information on a total of 328,788 women, accounting for approximately 65% of all deliveries that occurred in Japan during the study period. Of the 1,644 obstetrical facilities, CT nucleic acid detection PCR tests, CT nucleic acid detection tests except PCR and CT antibody detection tests were performed in 1,221 (74.3%), 408 (24.8%) and 15 (0.9%) facilities, respectively.Table 1 shows the maternal age distribution under the three CT screening tests (CT nucleic acid detection tests with and without PCR and CT antibody detection tests). There were no significant differences in the maternal age distribution among the three CT screening tests groups.Table 2 shows the results of CT screening tests (CT nucle-ic acid detection tests with and without PCR and CT antibody detection tests) of the study population by age. There were no significant differences in the rate of positive CT between the two groups of CT nucleic acid detection screening tests with and without PCR. However, the positive rate by the CT anti-body detection tests was significantly higher than those by the two CT nucleic acid detection tests with and without PCR (P < 0.01 by X