Genital Chlamydial Infection In Women Research Articles

AAUS guideline for chlamydial urethritis

Urogenital chlamydial infection is the most common sexually transmitted infection. Many cases of chlamydial infection are reported worldwide every year. Genital chlamydial infection in women can also cause obstetric issues, including infertility and miscarriage. For that purpose, appropriate care should be conducted with the latest knowledge.Only few guidelines come from Asian countries. The Asian Association of Urinary Tract Infection and Sexually Transmitted Infection (AAUS) belonging to the Urological Association of Asia (UAA) had developed the guidelines regarding chlamydial urethritis. We have collected the feedback and updated the guidelines which is now submitted for consideration of publication. In addition to the levels of evidence, the recommendation grades were defined using the modified GRADE methodology. Herein, we present the new edition of the UAA-AAUS guidelines for chlamydial urethritis.

Is it time to switch to doxycycline from azithromycin for treating genital chlamydial infections in women? Modelling the impact of autoinoculation from the gastrointestinal tract to the genital tract.

BackgroundSingle-dose azithromycin is recommended over multi-dose doxycycline as treatment for chlamydial infection. However, even with imperfect adherence, doxycycline is more effective in treating genital and rectal infection. Recently, it has been suggested that autoinoculation from the rectum to the genitals may be a source of persistent chlamydial infection in women. We estimated the impact autoinoculation may have on azithromycin and doxycycline effectiveness.MethodsWe estimate treatment effectiveness using a simple mathematical model, incorporating data on azithromycin and doxycycline efficacy from recent meta-analyses, and data on prevalence of rectal infection in women with genital chlamydial infection.ResultsWhen the possibility of autoinoculation is taken into account, we calculate that doxycycline effectiveness may be 97% compared to just 82% for azithromycin.ConclusionsConsideration should be given to re-evaluating azithromycin as the standard treatment for genital chlamydia in women.

Estimation of the risk of tubal factor infertility associated with genital chlamydial infection in women: a statistical modelling study

Using a statistical modelling approach, our study aim is to determine reliable age-related estimates of the risk of all-cause tubal factor infertility (TFI) following past or current chlamydial infection in women in Scotland. Using data from several sources, a Markov-Chain Monte Carlo model was used to estimate the age-related risk of TFI given genital chlamydia infection at any time. The analysis is based on the probability of a woman ever having chlamydial infection, ever having TFI and ever having a previous chlamydial infection given a diagnosis of TFI. The model was programmed and evaluated using WinBugs14. By the age 44 years, the overall risk of a woman having at least a single chlamydial infection is estimated at 42.9% (95% credible interval 30.0, 59.0%). The risk of a woman having TFI increased from 0.5% in those aged 16-19 years to 0.8% in those aged 40-44. The overall estimated probability of TFI, based on lifetime infertility, given a past or current chlamydial infection, is relatively consistent across all five age groups from 16-44 years, being 0.9% among those aged 25-29 and 1.4% in those aged 35-39; The estimates were found to be sensitive to the definition of infertility, with the estimate increasing from 1.3% in the youngest age group to 2.8% and 4.5% for 24-month primary infertility and primary or secondary infertility, respectively. At the population level, the likelihood of all-cause TFI in those with past or current chlamydial infection is low. These findings have relevance both at the policy level, in the development of control programmes, and also at an individual level, particularly for clinicians supporting women undergoing testing or with a positive diagnosis.

Host immune responses to chlamydial inclusion membrane proteins B and C in Chlamydia trachomatis infected women with or without fertility disorders

BackgroundWith an increase in the number of putative inclusion membrane proteins (incs) in chlamydial genomes, there is a need for understanding their contribution in host-pathogen interactions. Thus in this study we determined the host mucosal and peripheral immune responses to incs (IncB and IncC) of Chlamydia trachomatis (CT).MethodsFemale patients (n = 296) attending the gynaecology out patient department of Safdarjung hospital, New Delhi were enrolled for the study and were clinically characterized into two groups; CT-positive fertile women (n = 38) and CT-positive women with fertility disorders (n = 29). Uninfected healthy fertile women were enrolled as controls (n = 31). Gene specific PCRs were used for detection of incB and incC genes in endocervical samples of CT-positive patients. ELISA and Western blot assay were used for detection of IgA and IgG antibodies to IncB and IncC in cervical washes and sera. Effect of IncB and IncC stimulation of cervical cells and PBMCs on cellular proliferation and cytotoxity was determined using MTT assay and Lactate dehydrogenase (LDH)-cytotoxicity assay respectively. Modulation of cytokines (Interleukin (IL)-1 Beta, IL-4, IL-5, IL-6, IL-10, Interferon-gamma, IL-12, Tumor Necrosis Factor-alpha and Granulocyte macrophage colony-stimulating factor (GM-CSF)) in cervical cells and PBMCs upon stimulation with IncB and IncC was determined by real-time reverse-transcriptase (RT)-PCR and ELISA. Further, CD4 positive T cells were purified from cervical cells and peripheral blood mononuclear cells (PBMCs) and secreted cytokines (Interferon-gamma and IL-4) were evaluated by ELISPOT and real-time RT-PCR.ResultsUsing MTT assay, significantly high proliferative responses (P < 0.05) were observed in inc-stimulated cervical cells and PBMCs from CT-positive fertile women compared to CT-positive women with fertility disorders and controls. Interferon-gamma, IL-12 and GM-CSF were found to be elevated in inc-stimulated cervical cells and PBMCs of CT-positive fertile women compared to CT-positive women with fertility disorders and controls (P < 0.05). In contrast, IL-1 Beta, IL-4, IL-5, IL-6 and IL-10 levels were found to be higher in CT-positive women with fertility disorders compared to CT-positive fertile women and controls (P < 0.05). Interferon-gamma secreting cells and mRNA expression in inc-stimulated cervical and peripheral CD4 positive T cells were significantly higher (P < 0.05) in CT positive fertile women compared to CT-positive women with fertility disorders.ConclusionOur data overall suggests that CT incs, IncB and IncC modulate host immune responses and may have a role in protection/pathogenesis of genital chlamydial infection in women.

Protective or pathogenic immune response to genital chlamydial infection in women—A possible role of cytokine secretion profile of cervical mucosal cells

Little is known about genital mucosal immune response to chlamydial infection in women with or without sequelae ( Chlamydia positive women with or without fertility disorders as infertility and multiple spontaneous abortions). Cervical lymphocytes were stimulated with chlamydial EBs and cytokine secretion was determined by ELISA, RT-PCR and ELISPOT assays. Stimulated cervical cells from women with fertility disorders (FD) secrete significantly ( P < 0.05) higher levels of IL-1β, IL-6, IL-8 and IL-10 and cells from fertile women secrete significantly higher levels of IL-12 and IFN-γ compared to other groups. RT-PCR analysis showed similar results for IFN-γ and IL-12. For IL-10 and IL-4, mRNA expression levels were significantly higher ( P < 0.05) in cells obtained from women with FD compared to other groups. Results for ELISPOT assay were similar as those of RT-PCR. The results suggest that cytokine secretion profile of cervical cells may decide whether infection does not hamper fertility or will develop fertility disorder.

Vaccines for Chlamydia Infections of the Female Genital Tract

Genital infection with Chlamydia trachomatis is an escalating global public health concern causing considerable morbidity and socioeconomic burden worldwide. Although antibiotics are used to treat symptomatic urogenital infections, chlamydial infection remains asymptomatic in approximately 50% of infected men and 70% of infected women. The major clinical manifestations of genital chlamydial infection in women include mucopurulent cervicitis, endometritis and pelvic inflammatory disease. Genital infection with C. trachomatis markedly enhances the risk for reproductive tract sequelae in women, including tubal factor infertility, chronic pain and ectopic pregnancy. Definitive infection control of chlamydial infections will likely be achievable through a safe and efficacious vaccine. This will require identifying protective chlamydial antigens in animal models as well as identifying effective adjuvants and delivery systems that target subunit vaccines to immune inductive sites or secondary lymphoid tissues, and will be safe for use in humans.

Prevalence of Chlamydia trachomatis and its association with other sexually transmitted infections in a tertiary care center in North India

The asymptomatic nature of chlamydial genital infections coupled with the occurrence of severe sequelae in untreated patients, makes the laboratory evaluation of great importance in the diagnosis of the disease. Genital chlamydial infections are the leading cause of preventable sexually transmitted infections (STIs) worldwide, with 43 million new cases in Southeast Asia. The present study was designed to determine the prevalence of genital chlamydial infection in women attending a sexually transmitted disease (STD) outpatient department and to determine the association of the disease with other STIs. A total of 276 female patients with a complaint of genital discharge or ulcer were enrolled for the study. Genital discharge specimens (endocervical, vaginal, and urethral swabs) were collected from all the patients. The patients were investigated for the presence of antigen and antibody of Chlamydia trachomatis with the help of the Direct fluorescent Antibody test (DFA) and the Enzyme Linked Immunosorbant Assay (ELISA), respectively. Investigations for aetio-pathogens of other STIs were carried out using the standard methods. Chlamydial infection was found in 19.9% of the patients (10.1% by DFA technique and 10.9% by ELISA). Both the antigen and antibody were positive in only three (1.1%) cases. The overall incidence of other aetio-pathogens was low. In two (0.7%) cases multiple infections were seen. Chlamydia trachomatis was found to be most commonly associated with Candida albicans . However, there was no co-infection of Chlamydia trachomatis with Neisseria gonorrhoeae .

Management of genital chlamydial infections at termination of pregnancy services in England and Wales: where are we now?

To determine the range of policies and practices related to the management of genital chlamydial infection employed at termination of pregnancy services in England and Wales. Cross-sectional descriptive study. England and Wales. Termination of pregnancy providers. Survey questionnaire administered to termination of pregnancy providers. Policies and practices for the management of genital chlamydial infection in women seeking termination of pregnancy with comparison to the national guidelines of the chief medical officer (CMO) and the Royal College of Obstetricians and Gynaecologists (RCOG). One hundred and thirty-eight (48%) practices responded to the survey, with representation across England and Wales. Policies for screening and/or treatment of chlamydial infection existed for 70% of providers. We found three practice patterns for the management of genital chlamydial infection among termination of pregnancy attenders: 70% of providers tested their own attenders prior to termination and treated if necessary; about 25% of providers administered prophylaxis without testing; and a small number of providers (< 5%) neither tested nor treated attenders. These patterns may be the result of differences in the CMO and RCOG guidelines. Given the impact of untreated genital chlamydial infection in women attending for termination, consistent recommendations from the CMO and RCOG may encourage uniform practice for the management of chlamydial infection in this vulnerable population.

Comparison of two methods of screening for genital chlamydial infection in women attending in general practice: cross sectional survey

Objectives: To estimate the prevalence of Chlamydia trachomatis in asymptomatic women attending general practice; to assess the potential of the ligase chain reaction as a screening tool; and to evaluate...

Vulval swabs as alternative specimens for ligase chain reaction detection of genital chlamydial infection in women

A ligase chain reaction (LCR)-based assay was recently shown to be highly sensitive and specific for the detection of Chlamydia trachomatis not only in cervical specimens but also in first-void urine (FVU) specimens form women. The suitability of using vulval swabs as an alternative specimen that can be obtained by noninvasive means for the diagnosis of genital chlamydial infection by LCR was investigated. In a first study of 169 women, vulval, endocervical, and urethral swabs were tested by LCR, culture, and a combination of enzyme immunoassay (EIA) followed by confirmation by direct fluorescent-antibody assay (DFA), and the results were compared with those obtained by testing FVU specimens by LCR and EIA-DFA by using a specimen from an infected patient as a reference standard. Of the 169 women tested, 27 (16%) were shown to be infected. Whereas LCR showed high sensitivities with all specimen types (85.2% for vulval, urine, and endocervical specimens; 92.6% for urethral swabs), the sensitivities of culture and EIA-DFA were high only with endocervical swabs (74.1 and 70.4%, respectively), being 22.2 and 40.7%, respectively, with vulval swabs. In addition, urine testing by EIA-DFA also showed a poor sensitivity (48.1%). In order to further compare LCR performance with vulval specimens to that with FVU specimens, a second study was carried out with specimens from 312 women, of whom 26 were infected. Comparable sensitivity was obtained by LCR with vulval swabs (88.5%; 23 of 26) and FVU specimens (92.3%; 24 of 26). The results indicate that vulval swabs may serve as suitable alternative to specimens that can be obtained by noninvasive means for the detection of C. trachomatis by LCR.

Detection of Chlamydia trachomatis in urine specimens from women by ligase chain reaction

The performance of a plasmid-based ligase chain reaction (LCR) with urine specimens was compared with those of cell culture of cervical swabs and enzyme immunoassay with urine specimens for the detection of Chlamydia trachomatis infection in women who had attended a family planning clinic. The prevalence of chlamydial infection determined by LCR was 3.1%. Discrepant results among the three assays were resolved by testing urine by a second LCR assay based on the C. trachomatis chromosomal gene encoding the major outer membrane protein. Sensitivity, specificity, and positive and negative predictive values for the cell cultures were 56.3, 100, 100, and 98.4%, respectively, whereas those for the enzyme immunoassay were 18.8, 100, 100, and 97.1%, respectively, and those for LCR were 87.5, 100, 100, and 99.5%, respectively. LCR thus provides a highly sensitive and specific noninvasive screening method for detecting genital chlamydial infections in women.

Test-of-Cure for Asymptomatic Genital Chlamydial Infections in Women

Department of Obstetrics and Gynecology, Hamar Hospital, Hamar, Norway, and the Department of Clinical Microbiology, Vest-Agder Central Hospital, Kristiansand S, Norway

Survey of the treatment of Chlamydia trachomatis infection of the female genital tract.

A questionnaire was sent to every tenth (n = 302) general practitioner in Norway. The physicians were to indicate their choice of antibiotic regimen for the treatment of genital chlamydial infections in women. Sixty-nine percent of the practitioners responded. The choice of treatment varied widely between the respondents. Forty-two different regimens were used for chlamydial cervicitis, 34 for cervicitis in pregnancy and 63 for probable pelvic infection. Of the prescribed treatments for these three diagnoses 14%, 5% and 46%, respectively, were compatible with the advice of the World Health Organization or the Centers for Disease Control. For the three previously mentioned diagnoses 49%, 79% and 43%, respectively, of the practioners would prescribe an antibiotic in either smaller doses, fewer daily doses or shorter duration than recommended. There is an urgent need to improve and standardize Norwegian general practitioners' treatment of chlamydial infection in women.

Test-of-Cure for Asymptomatic Genital Chlamydial Infections in Women

Asymptomatic genital infection caused by Chlamydia trachomatis is common, and one or more test-of-cure consultations in such cases is routine. The economic implications of two post-treatment strategies, either no test-of-cure, or one test-of-cure consultation with a single test for C. trachomatis, renewed treatment, and another test-of-cure of those still chlamydia-positive, and so on, have been compared. The costs of the test-of-cure strategy are twice those of the no-test regimen. Without test-of-cure, 79 more cases of pelvic inflammatory disease, 8 cases of infertility requiring treatment, and 2 cases of ectopic pregnancy would occur for every 10,000 patients. It is concluded that routine test-of-cure of asymptomatic genital chlamydial infections after treatment is not cost beneficial.

Early detection of genital chlamydial infection in women: an economic evaluation.

A decision analysis model was constructed for comparison of early detection of asymptomatic genital chlamydial infection in women by the direct immunofluorescence antibody (DFA) test and the enzyme-linked immunosorbent assay (ELISA) with no intervention. Early-detection programs using the DFA test and ELISA were shown to be cost-effective in female populations where the prevalences of chlamydial infection exceeded 6% and 7%, respectively. Sensitivity analysis showed that the two most important factors were the probability of developing pelvic inflammatory disease and the cost of the test. The DFA method was more appropriate for an early-detection program because of its higher sensitivity.

Chlamydia in Women: a Case for More Action?

The 1985 Communicable Disease Surveillance Center figures for sexually transmitted diseases document over 14,000 confirmed cases of genital chlamydial infection in women. Yet, this figure seriously underestimates the size of the problem as many chlamydial infections are silent. The mainstay of diagnosis until recently has been isolation of C. trachomatis in cell culture, which is time consuming, technically demanding, expensive, and available in only a few centers. A firm diagnosis of chlamydial infection cannot be based on serology alone. Antibodies can be detected in 78-100% of womn with C. trachomatis in the cervix, but in those who are culture negative 31-87% also will have antibodies. More support is given to the diagnosis by demonstration of a rising titre of IgG antibody or by detection of IgM, but because of the late presentation of most women with chlamydia this is seldom possible. Newer tests include direct immunofluorescence statining of genital secretions which is rapid and simple. Results of this method compare favorably with those of cell culture, but screening large numbers of smears is expensive and tedious. Enzyme-linked immunosorbent assays also give good results. C trachomatis is a well known cause of cervicitis and salpingitis and is consequently a major factor in infertility. The frequency of chlamydial infection is influenced by sexual activity and promiscuity, but the effect of contraceptive choice is more difficult to determine. An IUD can provide a nidus for many infections, but the role of oral contraceptives (OCs) is more controversial. Instrumentation of the endocervical canal provides a route for introduction of infection, which is therefore a frequent and important complication of induced abortion. Westergaard et al. in a study of women having 1st trimester abortions found that 10% had symptomless cervical chlamydia; postabortal pelvic inflammatory disease developed in 28% of these patients by comparison with 10% in culture-negative women. Other workers have found similar results. The role of chlamydia as a cause of morbidity in pregnancy is unclear. Complications for the newborn are better established. It has been estimated that between 2-37% of mothers will have a chlamydia infection in pregancy. If 33-50% of newborns at risk get conjunctivitis, and 10-20% get pneumonitis, this gives some indication of the extent of the problem. Several studies have suggested an association between cervical chlamydial infection, anti-chlamydial antibodies, and cervical dysplasia. Emphasis on early diagnosis and treatment is of paramount importance to reduce the prevalence of chlamydial infection and its complications; without this rates of ectopic pregnancy and infertility are bound to increase.

Comparison of erythromycin and oxytetracycline in the treatment of cervical infection by Chlamydia trachomatis

A group of women attending a venereal disease clinic was treated for cervical infection by Chlamydia trachomatis ; 109 patients were given oxytetracycline 250 mg q.i.d. for two weeks, and 96 were given erythromycin stearate 500 mg b.d. for two weeks. Seventy women in each treatment group were available for follow-up three to four weeks after beginning therapy, and smaller numbers were followed for up to 12 weeks. In the great majority of women treated with either drug chlamydiae were not re-isolated, and in only two of those treated with oxytetracycline and one in those treated with erythromycin stearate was there evidence of treatment failure. Erythromycin stearate appears to be a useful alternative to tetracycline for the treatment of genital chlamydial infection in women.