Seroepidemiology of Chlamydia trachomatis Infection in the General Population of Northern China: The Jidong Community Cohort Study

Jingwei Shui,Jianhui Zhao,Cailing Ao,Shixing Tang,Haiying Wang,Yingchun Dai,Dongjie Xie,Hongqing Lin,Yuanhao Liang

doi:10.3389/fmicb.2021.729016

Abstract

A longitudinal serological study to investigate the seropositive frequency, incidence, and antibody dynamics of Chlamydia trachomatis infection in the general population of China is urgently needed in order to optimize the strategies for surveillance and precise prevention of C. trachomatis infection. This longitudinal study enrolled 744 subjects aged 18–65 years from Jidong Community of Northern China from 2014 to 2018. Seropositive frequency, incidence, and reinfection of C. trachomatis were determined by detecting antibody against C. trachomatis Pgp3 using “in-house” luciferase immunosorbent assay (LISA). The dynamic of anti-Pgp3 antibody was analyzed using the Generalized Estimating Equation (GEE) model. The overall Pgp3 seropositive frequency among the 18–65-year-old population was 28.1% (95% CI 24.9–31.5), and significantly increased from 12.0% in those aged 18–29 years to 48.6% in the 60–65 years old. The seropositive frequency was slightly higher in women than in men (31.3% vs. 25.4%) without statistical significance. The C. trachomatis incidence and reinfection rate were 11 and 14 per 1,000 person-years, respectively, and showed no significant difference with respect to age, gender, ethnicity, marital status, and education levels. Furthermore, anti-Pgp3 antibody remained detectable in 93.3% (195/209) of the seropositive subjects during the 5 years of follow-up. The overall decay rate for anti-Pgp3 antibody for CT-infected persons was −0.123 Log2 RLU/year, which was dramatically slower than in CT new infection (−3.34 Log2 RLU/year) or reinfection (−1.1 Log2 RLU/year). In conclusion, at least one quarter of the people aged 18–65 years have been infected with C. trachomatis over their lifetime while all age groups are susceptible to C. trachomatis infection in the community of Northern China. Therefore, comprehensive prevention strategies are urgently needed.

Highlights

Genital chlamydia trachomatis (CT) infection is the most common, curable sexually transmitted disease (STD) worldwide (Woodhall et al, 2018)
We have previously described an ultrasensitive and highthroughput luciferase immunosorbent assay (LISA) for detection of anti-human immunodeficiency virus (HIV)-1 antibody, which was 104-fold more sensitive than enzyme-linked immunosorbent assay (ELISA) (Wang et al, 2019)
Receiver operating characteristic curve analysis showed that the plasmid gene product 3 (Pgp3)-based LISA produced comparable area under-ROC curves (AUCs) with the commercial Mikrogen ELISA (0.986 vs. 0.993, p = 0.209; Table 1)

Summary

Introduction

Genital chlamydia trachomatis (CT) infection is the most common, curable sexually transmitted disease (STD) worldwide (Woodhall et al, 2018). Untreated CT infection can Seroepidemiology of Chlamydia trachomatis Infection cause scarring of the upper reproductive tract in women and lead to serious complications, such as pelvic inflammatory disease, ectopic pregnancy, and tubal factor infertility (Haggerty et al, 2010). Chlamydia trachomatis infection is increasing worldwide from about 89 million new cases in 1995 to 127.2 million in 2016 (Newman et al, 2015; Rowley et al, 2019). In 2018, the European Centre for Disease Prevention and Control (ECDC) reported a crude C. trachomatis prevalence of 0.15% in 26 EU/EEA countries, and 5.3% increase of the prevalence from 2009 to 2018.1 In the United States, there were more than 1.7 million C. trachomatis infections in 2018 (Torrone et al, 2014)

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