Urogenital Chlamydial Infection Research Articles

Anti-chlamydial activity of vaginal fluids: new evidence from an in vitro model.

We assessed the in vitro anti-chlamydial activity of fresh vaginal secretions, deciphering the microbial and metabolic components able to counteract Chlamydia trachomatis viability. Forty vaginal samples were collected from a group of reproductive-aged women and their anti-chlamydial activity was evaluated by inhibition experiments. Each sample underwent 16S rRNA metabarcoding sequencing to determine the bacterial composition, as well as 1H-NMR spectroscopy to detect and quantify the presence of vaginal metabolites. Samples characterized by a high anti-chlamydial activity were enriched in Lactobacillus, especially Lactobacillus crispatus and Lactobacillus iners, while not-active samples exhibited a significant reduction of lactobacilli, along with higher relative abundances of Streptococcus and Olegusella. Lactobacillus gasseri showed an opposite behavior compared to L. crispatus, being more prevalent in not-active vaginal samples. Higher concentrations of several amino acids (i.e., isoleucine, leucine, and aspartate; positively correlated to the abundance of L. crispatus and L. jensenii) lactate, and 4-aminobutyrate were the most significant metabolic fingerprints of highly active samples. Acetate and formate concentrations, on the other hand, were related to the abundances of a group of anaerobic opportunistic bacteria (including Prevotella, Dialister, Olegusella, Peptostreptococcus, Peptoniphilus, Finegoldia and Anaerococcus). Finally, glucose, correlated to Streptococcus, Lachnospira and Alloscardovia genera, emerged as a key molecule of the vaginal environment: indeed, the anti-chlamydial effect of vaginal fluids decreased as glucose concentrations increased. These findings could pave the way for novel strategies in the prevention and treatment of chlamydial urogenital infections, such as lactobacilli probiotic formulations or lactobacilli-derived postbiotics.

Analysis of the problem of molecular identification of wild (wtCT), plasmidless (p-CT) and Swedish (SE-nvCT) variants of Chlamydia trachomatis in Belarus

To date, it is known that the population of Chlamydia trachomatis is genetically heterogeneous. Along with the originally described wild type (wtCT), mutant variants (mtCT) have been found in the world: plasmidless (p-CT), Swedish (SE-nvCT), Mexican (MX-nvCT), Finnish (FI-nvCT), with different virulence and tropicity to various organs and tissues. These variants may escape PCR diagnostics due to the absence of targets or the occurrence of changes in them, which makes it ineffective to use a number of diagnostic test systems for pathogen detection.Isolates of C. trachomatis collected on the territory of the Republic of Belarus during the period 2013–2022 in reproductive age persons with inflammatory urogenital tract diseases were analyzed. It was found that the dominant pathogen genovariant is the wild type wtCT ‒, approximately 93 %. Mutant strains that make up about 7 % of the pathogen population are represented by p-CT and SE-nvCT genovariants. There were no cases of identification of MX-nvCT and FI-nvCT genovariants in the analyzed sample of C. trachomatis isolates.It is necessary to further optimize the tactics of molecular biological identification of various C. trachomatis genovariants for effective microorganism detection and study of the chlamydial urogenital infection pathogenesis.

155. Acceptance and Implementation of 2021 CDC Guidelines for Treatment of Uncomplicated Urogenital Chlamydial Infections by Adolescent Medicine Providers

155. Acceptance and Implementation of 2021 CDC Guidelines for Treatment of Uncomplicated Urogenital Chlamydial Infections by Adolescent Medicine Providers

Efficacy and safety profile of Minolexin in patients with urogenital chlamydia infection: results of an open randomized comparative clinical trial

Background. Urogenital chlamydia infections is a widespread STI: 131 million people are infected every year. Scientists are studying the issue of reducing the sensitivity of the pathogen to traditionally used drugs and are investigating the effectiveness of antibacterial drugs active against C. trachomatis.
 Aims: to study the efficacy and safety of the minocycline in the treatment of urogenital chlamydia infection in comparison with the doxycycline.
 Methods: an open randomized comparative clinical trial included 100 patients: group 1 50 patients who received minocycline 100 mg 2 times a day for 7 days, group 2 50 patients who received doxycycline 100 mg 2 times a day in within 7 days. The diagnosis was confirmed by the detection of C. trachomatis by PCR. The parameter of the effectiveness of therapy was the eradication of C. trachomatis and the absence of clinical symptoms 4 weeks after therapy.
 Results: 1 week after therapy, clinical symptoms were registered in 20;40.8% patients of group 1 and 28;57.1% patients of group 2 (p=0.106), 4 weeks later in 4;8.2% and 7;18.4% patients (p=0.524). In group 1, the absence of most subjective clinical symptoms was recorded in a shorter time than in the comparison group. 100% of patients had achieved eradication C. trachomatis, laboratory signs of an inflammatory reaction were recorded in 2;5.0% patients of group 1 and 3;7.3% patients of group 2 (p=1,000). According to the frequency of adverse drug events, there were also no significant differences between the groups, however, in group 2 patients, adverse drug events that had a high probability of being associated with taking the drug were recorded more often than in the group 1.
 Conclusions. The results of the study demonstrated the comparable effectiveness of minocycline and doxycycline in the treatment of urogenital chlamydia infection and a similar safety profile of these drugs.

Pathogenic NKT cells attenuate urogenital chlamydial clearance and enhance infertility.

Urogenital chlamydial infections continue to increase with over 127 million people affected annually, causing significant economic and public health pressures. While the role of traditional MHCI and II peptide presentation is well defined in chlamydial infections, the role of lipid antigens in immunity remains unclear. Natural killer (NK) T cells are important effector cells that recognize and respond to lipid antigens during infections. Chlamydial infection of antigen-presenting cells facilitates presentation of lipid on the MHCI-like protein, CD1d, which stimulates NKT cells to respond. During urogenital chlamydial infection, wild-type (WT) female mice had significantly greater chlamydial burden than CD1d-/- (NKT-deficient) mice, and had significantly greater incidence and severity of immunopathology in both primary and secondary infections. WT mice had similar vaginal lymphocytic infiltrate, but 59% more oviduct occlusion compared to CD1d-/- mice. Transcriptional array analysis of oviducts day 6 post-infection revealed WT mice had elevated levels of Ifnγ (6-fold), Tnfα (38-fold), Il6 (2.5-fold), Il1β (3-fold) and Il17a (6-fold) mRNA compared to CD1d-/- mice. In infected females, oviduct tissues had an elevated infiltration of CD4+ -invariant NKT (iNKT) cells, however, iNKT-deficient Jα18-/- mice had no significant differences in hydrosalpinx severity or incidence compared to WT controls. Lipid mass spectrometry of surface-cleaved CD1d in infected macrophages revealed an enhancement of presented lipids and cellular sequestration of sphingomyelin. Taken together, these data suggest an immunopathogenic role for non-invariant NKT cells in urogenital chlamydial infections, facilitated by lipid presentation via CD1d via infected antigen-presenting cells.

Urogenital chlamydia infection. Bacterial load of causative agent and features of infection clinical course

Urogenital chlamydia infection. Bacterial load of causative agent and features of infection clinical course

CLINICAL EFFICACY OF TREATMENT OF WOMEN WITH CHRONIC RECURRENT UROGENITAL CHLAMYDIA INFECTION.

Aim: To to increase the efficacy of the treatment of women diagnosed with complicated urogenital chlamydia infection based on the study of the immune status, clinical and pathogenetic features of the course, development and implementation of pathogenetically substantiated therapy methods. Materials and methods: Laboratory diagnostics of chlamydia infection was conducted with the use of direct immunofluorescence, enzyme immunoassay and cytological method. The dynamics of clinical symptoms was studied in the patients of Group I (64 women) who received Wobenzym in combination with Doxycycline and Group II (64 women) who were treated with conventional therapy (CT). Results: Clinical effectiveness of the treatment of women in Groups I and II was analyzed. The treatment according to our developed method was well tolerated by all the patients. No manifestations of the disease exacerbation which could be associated with the inclusion of these drugs in the comprehensive treatment were noted. The insignificant effectiveness of our treatment in the examined patients with complicated urogenital chlamydia infection in Groups I and II was distributed as follows: only 1 (1.56%) woman (Group I) had an insignificant improvement in clinical manifestations after the treatment according to our method. An insignificant improvement in the clinical manifestations after the treatment with conventional therapy (Group II) was observed in 4 women constituting 6.25%. Unfortunately, a small percentage of women in Groups I and II with no changes in clinical symptoms after the treatment was observed. In particular, the absence of treatment effectiveness was noted in 3 (4.69%) women after the application of our method and in 6 women (9.38%) who were treated by the conventional therapy. Therefore, these women were prescribed an additional course of treatment. Conclusions: The dynamics of clinical symptoms was found to be significantly more pronounced and fast in the patients of Group I compared to the patients in Group II who were treated with conventional therapy.

Repeat infections with chlamydia in women may be more transcriptionally active with lower responses from some immune genes.

Chlamydia trachomatis, the most common bacterial sexually transmitted infection worldwide, is responsible for considerable health burden due to its significant sequelae. There are growing concerns about chlamydial treatment and management due to widely documented increasing burden of repeat infections. In the current study, a cohort study design of 305 women with urogenital chlamydial infections demonstrated that 11.8% of women experienced repeat infections after treatment with azithromycin. The chlamydial DNA load measured by quantitative PCR was higher in women who experienced a repeat infection (p = 0.0097) and repeat infection was associated with sexual contact. There was no genomic or phenotypic evidence of azithromycin resistance within the chlamydial isolates. During repeat infection, or repeat positive tests during follow up, vaginal chlamydial gene expression (ompA, euo, omcB, htrA, trpAB) was markedly higher compared to baseline, and two of the selected immune genes analyzed had significantly lower expression at the time of repeat infection. Overall, there are two implications of these results. The results could be generalized to all recent infections, or repeat positive events, and indicate that chlamydial infections are have higher transcriptional activity of select genes early in the infection in women. Alternatively, after azithromycin treatment, repeat infections of Chlamydia may be more transcriptionally active at certain genes, and there may be post-treatment immunological alterations that interplay into repeat exposures establishing an active infection. The potential that recent infections may involve a higher level of activity from the organism may have implications for management by more regular testing of the most at risk women to reduce the risk of sequelae.

First-Void Urine Microbiome in Women with Chlamydia trachomatis Infection.

Background: Chlamydia trachomatis (CT) is the agent of the most common bacterial sexually transmitted infection worldwide. Until now, little information is available about the microbial composition of urine samples during CT urethritis. Therefore, in this study, we characterized the microbiome and metabolome profiles of first-void urines in a cohort of women with CT urethral infection attending an STI clinic. Methods: Based on CT positivity by nucleic acid amplification techniques on urine samples, the enrolled women were divided into two groups, i.e., “CT-negative” (n = 21) and “CT-positive” (n = 11). Urine samples were employed for (i) the microbiome profile analysis by means of 16s rRNA gene sequencing and (ii) the metabolome analysis by 1H-NMR. Results: Irrespective of CT infection, the microbiome of first-void urines was mainly dominated by Lactobacillus, L. iners and L. crispatus being the most represented species. CT-positive samples were characterized by reduced microbial biodiversity compared to the controls. Moreover, a significant reduction of the Mycoplasmataceae family—in particular, of the Ureaplasma parvum species—was observed during CT infection. The Chlamydia genus was positively correlated with urine hippurate and lactulose. Conclusions: These data can help elucidate the pathogenesis of chlamydial urogenital infections, as well as to set up innovative diagnostic and therapeutic approaches.

Incident urogenital and anorectal Chlamydia trachomatis in women: the role of sexual exposure and autoinoculation: a multicentre observational study (FemCure)

BackgroundAnorectal infections with Chlamydia trachomatis (CT) are common in women visiting STI outpatient clinics. We here evaluated the risk posed by sexual exposure and by alternate anatomical site infection for...

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.

In Vitro Antibacterial Activity of Selected Palestinian Medicinal Plants against Chlamydia trachomatis

Chlamydia spp. are intracellular pathogens of humans and animals that cause a wide range of diseases such as blinding trachoma and sexually transmitted infections. According to the World Health Organization (WHO), there are more than 127 million new infections each year worldwide. Chlamydial urogenital infections can cause cervicitis, urethritis, pelvic inflammatory disease and infertility. From within an intracellular niche, termed an inclusion, the Chlamydiae complete their life cycle shielded from host defenses. The host cell defense response used to eliminate the pathogen must subvert this protective shield and is thought to involve the gamma interferon-inducible family of immunity related GTPase proteins and nitric oxide. Typically, azithromycin and doxycycline are the first line drugs for the treatment of chlamydial infections. Although C. trachomatis is sensitive to these antibiotics in vitro, currently, there is increasing bacterial resistance to antibiotics including multidrug-resistant C. trachomatis, which have been described in many instances. Therefore, alternative drug candidates against Chlamydia should be assessed in vitro. In this study, we tested and quantified the activity of plant extracts against Chlamydia-infected HeLa cells with C. trachomatis inclusions. The in vitro results show that post-treatment with Artemisia inculta Delile extract significantly inhibits Chlamydia infection compared to DMSO-treated samples. In conclusion, plant extracts may contain active ingredients with antichlamydial activity potential and can be used as alternative drug candidates for treatment of Chlamydia infection which has significant socio-economic and medical impact.

Some issues of antibacterial therapy in rheumatology

The fight against infectious agents is a topical issue of the day, and treatment of the infectious pathology in rheumatological patients of is often presents a difficult task. The main problems faced by rheumatologists include presence of new pathogens, the role of opportunistic microflora and increased influence of the resistant microorganisms, the issue of the effectiveness and interaction of antibacterial drugs with antirheumatic drugs. All the above listed necessitates the search and development of new schemes and methods of antibiotic therapy in rheumatology. The main diseases associated with bacterial infection include reactive arthritis, Lyme arthritis against the background of Lyme borreliosis, bacterial (septic) arthritis, and others. The authors performed the analysis of literature sources and international recommendations regarding the possibilities of using antibacterial drugs for reactive arthritis, Lyme arthritis and bacterial (septic) arthritis. The current schemes of rational antibacterial therapy are presented. The timely treatment of chlamydial urogenital infection in patients with reactive arthritis plays an important role. The effectiveness of the treatment of the early stages of Lyme arthritis, that is, at the stage of erythema migrans, was noted, which may be the primary prevention of joint damage. Combinations and timing of antibiotic therapy for bacterial (septic) arthritis are highlighted. It should be remembered that a bacterial infection can be a trigger for the development of rheumatological pathology, therefore, the timely use of adequate antibiotic therapy, in some cases, can be considered the primary prevention of certain diseases. Therefore, the development of effective schemes for rational antibiotic therapy and monitoring of infectious agents are urgent problems. Rheumatologists should be aware of new recommendations for the management of patients with infectious diseases and timely prescribe the most effective regimens and therapy programs.

EVO100 prevents chlamydia and gonorrhea in women at high risk of infection

According to the Centers for Disease Control and Prevention, rates of infection for Chlamydia trachomatis and Neisseria gonorrhoeae are increasing in the United States. EVO100 is an investigational antimicrobial, pH-modulating, vaginal gel with active ingredients L-lactic acid, citric acid, and potassium bitartrate that is being evaluated for the prevention of sexually transmitted infections. The objective of this phase 2B/3 study was to assess the efficacy and safety of EVO100 for the prevention of chlamydia and gonorrhea. AMPREVENCE was a double-blinded, placebo-controlled, multicenter study based in the United States conducted over approximately 16 weeks in women at the age of 18 to 45 years who were at risk of urogenital chlamydia and gonorrhea infection. Enrolled women had been diagnosed as having and treated for chlamydia or gonorrhea ≤16 weeks before enrollment. Women received either EVO100 or placebo vaginal gel and were instructed to apply the study drug immediately before or up to 1 hour before each act of vaginal sexual intercourse. The primary and secondary endpoints were the prevention of urogenital chlamydia and gonorrhea, respectively. Exploratory outcomes include women's overall satisfaction with EVO100. In total, 860 women were randomized 1:1 to receive EVO100 (n=426) or placebo (n=434), and 764 women (EVO100, n=376; placebo, n=388) were documented as using the study drug at least once. Baseline characteristics were similar between treatment arms. Overall, women had a mean age of 27.7 years (standard deviation, 6.9) and body mass index of 28.9 kg/m2 (standard deviation, 8.0). Most women were of White (54.3% [467 of 860]) or African American (41.6% [358 of 860]) race and of non-Hispanic/Latina ethnicity (67.1% [577 of 860]). The chlamydia infection rate in EVO100 users was 4.8% (14 of 289) compared with 9.7% (28 of 290) among placebo users (P=.0256), representing a relative risk reduction of 50%. For gonorrhea, the infection rate was 0.7% (2 of 280) in the EVO100 arm compared with 3.2% (9 of 277) in the placebo arm (P=.0316), representing a relative risk reduction of 78%. Increased efficacy was observed with increased adherence, and chlamydia infection rates were significantly reduced with increased adherence in the EVO100 group compared with placebo. Across both arms, there were similar rates of all-cause adverse events (EVO100, 21.3% [80 of 376]; placebo, 20.4% [79 of 388]) and treatment-related adverse events (EVO100, 7.2% [27 of 376]; placebo, 7.5% [29 of 388]). The most common adverse events in the EVO100 arm were vulvovaginal candidiasis (5.1% [19 of 376]), vaginal discharge (3.2% [12 of 376]), and urinary tract infection (3.2% [12 of 376]) and, in the placebo arm, bacterial vaginosis (4.6% [18 of 388]), urinary tract infection (2.6% [10 of 388]), and vaginal discharge (2.6% [10 of 388]). Few women discontinued owing to adverse events in either arm (EVO100, 1.1% [4 of 376]; placebo, 1.5% [6 of 388]). No treatment-related serious adverse events were reported. Most EVO100 users (88%) were satisfied or very satisfied with EVO100 after 16 weeks of use. EVO100 significantly reduced the risk of chlamydia and gonorrhea infections in women at high risk of Chlamydia trachomatis and Neisseria gonorrhoeae infection and was well tolerated, with observed adverse events consistent with its known safety profile.

Role of tumor necrosis factor-α in Chlamydia Muridarum infection in the urogenital tract of mice

To explore the role of tumor necrosis factor-α (TNF-α) in immune response to urogenital chlamydial infection and urogenital pathology in mice. Fifteen female wild-type (WT) C57BL/6J mice and 15 TNF-α receptor knockout (TNF-αR KO) mice were inoculated intravaginally with 1×104 inclusion forming units (IFUs) of live C. muridarum. At 56 days after the first inoculation, 8 mice from each group were subjected to a second inoculation at the same dose. Vaginal swabs were taken every 3 or 4 days to detect the number of inclusion bodies of chlamydia. On day 80 after the first inoculation, the mice were euthanized and peritoneal macrophages were collected and the vaginal tract and spleen were dissected. The pathologies in the fallopian tube and the uterine horn were observed and the severity of inflammatory cell infiltration and lumen dilatation were semi-quantitatively scored. The levels of interleukin-6 (IL-6), IL-8, IL-1α, IL-1β and TNF-α in the supernatant of the peritoneal macrophage were detected. Spleen cell suspension was prepared, and after stimulation with chlamydia EB in vitro, the levels of the cytokines including IL-4, IL-5, IL-17 and interferon-γ (IFN-γ) were determined in the cells. The clearance rate of Chlamydia from the urogenital tract was similar between TNF-αR KO mice and WT mice regardless of the primary or second infection. The severity of inflammation in the fallopian tube and the uterine horn did not differ significantly between the two groups, but TNF-αR KO mice had significantly milder dilation of the fallopian tubes (P < 0.05). The peritoneal macrophages from TNF-αR KO mice produced a significantly higher level of TNF-α than those from WT mice (P < 0.05); the spleen cells from the two groups both produced high levels of IFN-γ, but IL-17 production by the spleen cells was significantly lower in TNF-αR KO mice than in WT mice (P < 0.05). TNF-α is not associated with protective immune response against C. muridarum infection, and can worsen the inflammatory damages of the urogenital tract caused by C. muridarum in mice.

Transactional Sex and Incident Chlamydia and Gonorrhea Among Black Men Who Have Sex With Men in Atlanta, Georgia.

Black men who have sex with men (BMSM) are disproportionately affected by sexually transmitted infections (STI), including chlamydia and gonorrhea. Transactional sex is an hypothesized risk factor for STI acquisition in BMSM. We estimated the association of transactional sex with incident chlamydia/gonococcal infection among BMSM using longitudinal data from a randomized trial in Atlanta (2012-2015). BMSM were eligible for inclusion if they tested human immunodeficiency virus (HIV)-antibody-negative and reported both ≥2 male sex partners and any condomless anal sex in the last year. We defined chlamydia/gonorrhea incidence as the first occurrence of either rectal or urogenital chlamydia or gonococcal infections after a negative result at enrollment. We used Poisson regression to estimate the incidence rate (IR) for chlamydia/gonorrhea over 12 months. Incidence rate ratios (IRR) compared estimates by reported experience of transactional sex. Subgroup analyses assessed potential heterogeneity by age and sexual identity. This analysis included 416 BMSM, of whom 191 (46%) were gay-identified, 146 (42%) reported a history of transactional sex, and 57 (14%) had prevalent chlamydia/gonococcal infection at baseline. Over a median of 1 year of follow-up, an additional 55 men tested laboratory-positive for chlamydia/gonorrhea (IR, 17.3 per 100 person-years). Transactional sex was not associated with chlamydia/gonorrhea incidence overall. However, among gay-identified BMSM, transactional sex was associated with incident chlamydia/gonorrhea (IRR, 2.9; 95% confidence interval, 1.2-6.8). Economic and social vulnerabilities may motivate engagement in high-risk sexual behaviors through commodified sex, potentially increasing the burden of STIs among BMSM. In this investigation, the relationship between transactional sex and chlamydia/gonorrhea was not homogenous across BMSM with diverse sexual identities in Atlanta, suggesting that within select sexual networks, transactional sex may drive STI risks. Delivering accessible and targeted STI screening for marginalized BMSM should be prioritized for STI and HIV prevention.

Getting it Right: The Impact of Point-of-Care Testing for Gonorrhea and Chlamydia in the Urgent Care Setting

Sexually transmitted infections (STIs), including Neisseria gonorrhea and Chlamydia trachomatis, have been at the forefront of public health and world health initiatives because of increasing prevalence, antimicrobial resistance trends, and immense economic health care burdens. Current STI laboratory-based testing impedes timely and accurate treatment in urgent care clinics (UCCs) and emergent care settings; the typical 3- to 5-day turnaround for testing results is not efficient in these settings. Of significance, UCCs and emergency settings often serve as the only point of contact for many exposed or affected individuals, further complicating appropriate treatment and follow-up care. This quality improvement project was conducted at a high-volume, suburban UCC to evaluate the implementation of nucleic acid amplification test (NAAT) point-of-care (POC) STI screening for gonorrhea and chlamydia. Analysis included comparison of appropriate STI treatment based on laboratory results among 100 patients preintervention and 100 patients postintervention, financial feasibility of the POC testing intervention, and staff satisfaction measurement. Results show that STI treatment appropriateness dramatically improved with NAAT; the innovation exceeded cost neutrality by creating revenue through appropriate billing and coding, and clinical staff were highly satisfied using the new testing protocol. The results of this study support the use of POC testing using NAAT for the diagnosis of urogenital gonorrhea and chlamydia infections in urgent and emergent care settings and highlight implications for adoption, sustainability, and expansion into other clinic settings.

Urogenital chlamydia trachomatis treatment failure with azithromycin: A meta-analysis.

Background Chlamydia Trachomatis is one of the most common pathogens transmitted through the genital tract in humans that leads to urogenital infection.ObjectiveGiven the high prevalence of chlamydia infection and its adverse effects on the health of women and men, the present meta-analysis was conducted to determine the rate of treatment failure with azithromycin.Materials and MethodsDatabases including MEDLINE, ISI - Web of Science, PubMed, EMBASE, Scopus, ProQuest, and Science Direct were searched for articles published between 1991 and 2018. The quality of the selected articles was assessed using the Cochrane risk of bias assessment tool. Heterogeneity was determined using the I2 and Cochrane Q-Test. Subgroup analysis and meta-regression were used to compare the prevalence rates on different levels of the variables.ResultsA total of 21 articles that met the inclusion criteria were ultimately assessed. The pooled estimate of azithromycin failure rate was 11.23% (CI 95%: 8.23%-14.24%). Also, the azithromycin failure rate was 15.87% (CI 95%: 10.20%-21.54%) for the treatment of urethritis, 7.41% (CI 95%: 0.60%-14.22%) for cervicitis, and 7.14% (CI 95%: 10.90%-3.39%) for genital chlamydia. The pooled estimate of failure rate difference was 2.37% (CI 95%: 0.68%-4.06%), which shows that azithromycin has a higher failure rate in the treatment of chlamydia compared to doxycycline and other examined medications. The meta-regression results showed that the patient's age contributes significantly to the heterogeneity for azithromycin treatment failure rate (β░=░0.826; p░=░0.017).ConclusionAzithromycin has a higher failure rate than doxycycline and other studied medications in treating urogenital chlamydia infections.

Complications of Urogenital Chlamydial Infection in Women

The objective of the research was to identify the spectrum of complications in women with chronic urogenital chlamydial infection.&#x0D; Materials and methods. There were examined 128 women with chronic inflammatory diseases of genital organs at the age of 16-40 years who were diagnosed with urogenital chlamydial infection and 25 apparently healthy women. In both women with chlamydial infection and healthy ones, urogenital chlamydial infection was diagnosed based on the data of clinical examination and the results of laboratory tests (the identification of chlamydial morphological structure on the pathologic specimens stained according to the Romanowsky-Giemsa method; the identification of chlamydial antigens using the direct immunofluorescence technique; the study of Chlamydia trachomatis antibody titers using the enzyme-linked immunosorbent assay).&#x0D; Results. According to the results of our study, chlamydiae were the most common causes of inflammatory lesions of the urogenital organs in women of different ages leading to different reproductive complications and affecting females mostly at the age of 21-30 years. In women of Group I and Group II, chronic chlamydial disease was detected; disease duration ranged from 6 months to more than 2 years. Miscarriages, infertility (primary, secondary), ectopic pregnancy (tubal, ovarian) were the severest and the most numerous reproductive complications in the examined patients.&#x0D; Conclusion. Chronic chlamydial infection is the most common disease of the female urinogenital organs leading to a wide spectrum of complications including infertility (primary, secondary), miscarriages, ectopic pregnancy (tubal, ovarian), chronic abdominal pain, sexual dysfunction (low libido, hypo/anorgasmia, painful intercourse, neurotic symptoms).

Bacterial sexually transmitted infections.

Worldwide, the incidence of bacterial sexually transmitted infections (STIs) has shown a significant increase in recent years. In Germany, this circumstance is reflected by a rise in the number of reported syphilis cases. There has also been an uptick in the incidence of non-notifiable STIs such as gonorrhea and infections caused by Chlamydia trachomatis and Mycoplasma genitalium. A key factor in the spread of these infections is their varied clinical presentation, which includes urogenital, pharyngeal and rectal involvement as well as a large number of asymptomatic cases. New real-time multiplex PCR methods allow for rapid and targeted detection of STI pathogens. The most common bacterial STI is urogenital chlamydial infection caused by serovars D-K, which affects young adults in particular. Lymphogranuloma venereum (LGV) caused by L serovars often presents as chlamydial proctitis. In recent years, Neisseria (N.) gonorrhoeae has shown a significant development of resistance, with high-level monoresistance and multiresistance to antibiotics commonly used for treatment. It is therefore imperative that sensitivity testing of N. gonorrhoeae be performed in addition to nucleic acid amplification tests (NAATs). Increased drug resistance has also been observed for Mycoplasma genitalium, a fact that complicates treatment.