Chlamydia trachomatis genital infections in tahiti

The rate ofChlamydia trachomatis infection was determined in three populations in Tahiti by means of a direct immunofluorescence test performed in specimens, tissue culture and detection of chlamydial antibody in serum specimens using a single-serotype indirect immunofluorescence test.Chlamydia trachomatis was recovered in 53 % of 53 bar girls, 24 % of 75 women attending a public maternity clinic for routine care, and 37 % of 71 men attending a sexually transmitted disease clinic with acute or subacute urethritis. The presence of chlamydial antibody in a high proportion of the groups studied confirmed the high frequency of chlamydial infections (62.3 %, 66.6 % and 83.1 % respectively).Neisseria gonorrhoeae infection was often associated with chlamydial infection in both bar girls and men with urethritis (11.4 % and 18.3 % respectively). With regard to clinical manifestations, 58.3 % (7/12) of bar girls and 23.2 % (10/43) women at the maternity clinic without clinical complaints were found to beChlamydia trachomatis-positive. The presence ofChlamydia trachomatis in these asymptomatic persons highlights their important role in spread of this organism in Tahiti. The findings indicate that routine testing forChlamydia trachomatis is warranted in patients attending the sexually transmitted disease and public maternity clinics in Tahiti.     

Evaluation of a chemiluminometric immunoassay for detection ofChlamydia trachomatis in the urine of male and female patients

A chemiluminometric immunoassay (Magic Lite Chlamydia) for detection ofChlamydia trachomatis antigens in first-void urine samples was compared with cell culture using urogenital swabs from 221 men and 242 women. The rate of isolation ofChlamydia trachomatis was 23.5 % in men, nearly 80 % of whom had symptoms of urethritis, and 8.3 % in women, in whom both cervix and urethra samples were tested. In urine sediments from men and women respectively the chemiluminometric assay showed a sensitivity of 80.8 % and 70 %, a specificity of 97 % and 95 %, a positive predictive value of 89.4 % and 58.3 %, and a negative predictive value of 94.3 % and 97.2 %. Discrepancies between results obtained with the chemiluminometric assay and cell culture were resolved using two polymerase chain reaction techniques to test urogenital samples. The detection ofChlamydia trachomatis in urine samples with the chemiluminometric assay was confirmed to be superior for screening symptomatic men with urogenital infections than women as a lower prevalence population.     

Evaluation of roxithromycin in the treatment of non-gonococcal urethritis in males

One-hundred and fifty-two male patients suffering from non-gonococcal urethritis were treated with an oral dosage of 300 mg roxithromycin daily for seven days.Chlamydia trachomatis was isolated from the urethra in 53 patients (35 %), and Ureaplasma urealyticum in 42 patients (28 %). After treatment, 49 (92 %) of the 53 patients with positive Chlamydia trachomatis cultures and 34 (81 %) of the 42 patients with positive Ureaplasma urealyticum cultures had negative cultures at follow-up. A clinical cure was observed in 137 patients (90 %). Ten patients (7 %) showed side effects consisting of nausea, sensation of distended abdomen, headache and fatigue. Seventy-eight male patients suffering from nongonococcal urethritis were treated with an oral dosage of 2×150 mg roxithromycin daily for seven days.Chlamydia trachomatis was isolated from the urethra in 22 patients (28 %), and Ureaplasma urealyticum in 30 patients (38 %). After treatment, all of the 22 patients with formerly positive Chlamydia trachomatis cultures and 23 (77 %) of the 30 patients with formerly positive Ureaplasma urealyticum cultures were negative at follow-up. A clinical cure was observed in 70 patients (90 %). Three patients (4 %) showed side-effects consisting of nausea and headache. It is concluded that roxithromycin is a good alternative to tetracycline and erythromycin in the treatment of non-gonococcal urethritis in males.     

Efficacy of single-dose azithromycin versus doxycycline in the treatment of cervical infections caused byChlamydia trachomatis

The efficacy of single-dose azithromycin therapy in the treatment of cervicalChlamydia trachomatis infections was compared to that of a standard seven-day course of treatment with doxycycline. Cervical samples from 60 patients reacted positively in an enzyme immunoassay for detection ofChlamydia trachomatis. In 31 patientsChlamydia trachomatis was isolated from the sample taken before treatment. Fourteen of the 31 patients were treated with doxycycline and 17 with azithromycin. All cultures of samples taken one and four weeks after the start of therapy were negative. All 31 isolates showed a similar pattern of MICs for the seven antibiotics tested, including azithromycin and doxycycline. No differences were observed between isolates of different serovars. In samples from four patients chlamydial DNA could be detected by PCR one week after the start of the therapy and in two patients also after four weeks. No difference in microbiological parameters could be observed between the two treatment groups. It is concluded that single-dose azithromycin is as effective as a seven-day course of doxycycline in the therapy of cervicalChlamydia trachomatis infections.     

Evaluation of urogenitalChlamydia trachomatis infections by cell culture and the polymerase chain reaction using a closed system

Two hundred and fifty-four specimens from males and females consulting a clinic for sexually transmitted diseases were analyzed for genitalChlamydia trachomatis infection. Each clinical sample was tested by the cell culture technique and the polymerase chain reaction using a closed system. When the two test systems were compared, the overall sensitivity of the polymerase chain reaction was 96% and the specificity 94% when compared to the cell culture technique. By use of a closed system for DNA extraction and sample transfer for the polymerase chain reaction, contamination of the samples was minimized. The polymerase chain reaction detected a higher number ofChlamydia trachomatis infections among both symptomatic and asymptomatic females and males, and it also detectedChlamydia trachomatis at an earlier stage of infection when compared to cell culture. The polymerase chain reaction did not detectChlamydia trachomatis after sufficient antibiotic treatment of the chlamydial infections.     

Diagnosis of genitalChlamydia trachomatis infection in males by cell culture and antigen detection test

Urethral Chlamydia trachomatis infection was diagnosed in 204 of 1,011 (20.2 %) male patients by cell culture, in 219 (21.7 %) by an antigen detection test consisting of a solid phase immunoassay, and in 247 (24.4 %) patients by both methods combined. The positive results of the two methods agreed for 176 patients, and both positive and negative results of the tests agreed for 940 patients (93 %). With cell culture as the reference method, the antigen detection test had a sensitivity of 86.3 %, a specificity of 94.7 %, a positive predictive value of 80.4 % and a negative predictive value of 96.5 %. It gave false negative results in 28 patients. In 43 patients the antigen detection test gave a positive result, whereas culture was negative. Thirty-nine of these males were treated with antibiotics (tetracycline or erythromycin), 19 because their consorts had a proven Chlamydia trachomatis infection, and 20 for obvious clinical and/or microscopic findings of urethritis requiring treatment. According to this analysis there were 19 probable misses by cell culture test and four true false-positives by the antigen detection test, i.e. less than 0.4 % of all patients examined. Since one-third of males with a final diagnosis of Chlamydia trachomatis infection were clinically asymptomatic efforts to control genital chlamydial infections must identify this reservoir. The antigen detection test provides an alternative diagnostic method to the more laborious and time-consuming cell culture procedure.     

REVIEW ARTICLE: Chlamydia trachomatis,a Hidden Epidemic: Effects on Female Reproduction and Options for Treatment

Citation Carey AJ, Beagley KW. Chlamydia trachomatis, a hidden epidemic: effects on the female reproduction and options for treatment. Am J Reprod Immunol 2010 The number of genital tract Chlamydia trachomatis infections is steadily increasing worldwide, with approximately 50–70% of infections asymptomatic. There is currently no uniform screening practice, current antibiotic treatment has failed to prevent the increased incidence, and there is no vaccine available. We examined studies on the epidemiology of C. trachomatis infections, the effects infections have on the female reproductive tract and subsequent reproductive health and what measures are being taken to reduce these problems. Undetected or multiple infections in women can lead to the development of severe reproductive sequelae, including pelvic inflammatory disease and tubal infertility. There are two possible paradigms of chlamydial pathogenesis, the cellular and immunological paradigms. While many vaccine candidates are being extensively tested in animal models, they are still years from clinical trials. With no vaccine available and antibiotic treatment unable to halt the increased incidence, infection rates will continue to increase and cause a significant burden on health care systems.     

Immune response toChlamydia trachomatis heat-shock protein in infertile female patients and influence ofChlamydia pneumoniae antibodies

A total of 446 sera from 245 patients with primary or secondary infertility, all of whom were examined laparoscopically, 117 patients withChlamydia trachomatis-positive cervical swabs, and 84 control persons (50 obstetric patients and 34 female blood donors) were tested for antibodies toChlamydia trachomatis and toChlamydia pneumoniae with the microimmunofluorescence (MIF) test. MIF test antibody rates were highest in patients with complete tubal occlusion (73%) and in patients with provenChlamydia trachomatis infection (74%), whereas only 9 to 10% of the control group showedChlamydia trachomatis antibodies. Reaction to the 60 kDa antigen ofChlamydia trachomatis, a heat-shock protein (hsp) analogue, has been suggested as a possible marker for the development of chronic sequelae afterChlamydia trachomatis infection. Immunoblot analysis of 222 sera (169 infertility patients, 20 antigen-positive patients, and 33 mothers) showed a significantly higher anti-hsp antibody rate in patients with complete tubal occlusion than in infertility patients with normal fallopian tubes (76% vs. 19%, p<0.001). The presence of antibodies not only toChlamydia trachomatis but also toChlamydia pneumoniae in the MIF test was associated with a significantly higher rate of anti-hsp antibodies and with complete tubal occlusion. This association did not appear to be due to cross-reactivity betweenChlamydia pneumoniae and Chlamydia trachomatis antibodies in the MIF test.     

<Emphasis Type="Italic">Chlamydia trachomatis</Emphasis> serovar distribution and other concurrent sexually transmitted infections in heterosexual men with urethritis in Italy

The distribution of Chlamydia trachomatis serovars among 157 heterosexual male patients with urethritis and the presence of coinfections with other sexually transmitted infections were studied. One hundred seventeen (74.5%) patients, with a mean age of 33.7 years, were Italians, whereas 40 (25.5%) were immigrants coming from eastern European countries, Africa, and South America. All the immigrants and 82 (70.0%) Italian patients reported sex with prostitutes. Out of 157 patients, 73 (46.5%) were found positive for C. trachomatis in urethral secretions and eight different C. trachomatis serovars were identified. The most common serovars were E (n = 18; 24.7%), D (n = 15; 20.5%), G (n = 14;19.2%), and F (n = 12; 16.4%). The sequencing data showed a high degree of conservation of the omp1 gene. Thirty-six (46.7%) out of the 73 C. trachomatis-positive patients were coinfected with another sexually transmitted infection. The most common coinfection was gonorrhoea detected in 22 (30.1%) patients, followed by condyloma in eight (8.2%) patients, syphilis in five (6.8%), and HIV in three (4.1%).     

Detection ofChlamydia trachomatis in clinical specimens by the polymerase chain reaction

Sequences derived from the endogenous plasmid ofChlamydia trachomatis and from the genes coding for ribosomal 16S RNA ofChlamydia psittaci were used as primers and oligonucleotide probes for detection of chlamydiae by the polymerase chain reaction. The endogenous plasmid primers generated specific amplified products of 517 bp with all knownChlamydia trachomatis serovars. No specific products ofChlamydia psittaci andChlamydia pneumoniae could be detected using these primers. With the rRNA primers specific amplified products of 208 bp were generated withChlamydia psittaci, Chlamydia trachomatis andChlamydia pneumoniae. No specific amplified products were detected with DNA isolated from a variety of microorganisms from the urogenital and the respiratory tract. Of 156 clinical specimens used for evaluation of the polymerase chain reaction, 26 were found to be positive forChlamydia trachomatis on culture. All 26 culture positive samples were also found to be positive forChalmydia trachomatis DNA by the polymerase chain reaction with both primer sets. Two culture negative samples were also found to be positive by this technique. The polymerase chain reaction thus seems to be a sensitive and reliable method for detection ofChlamydia trachomatis.     

Clinical efficacy of ciprofloxacin versus doxycycline in the treatment of non-gonococcal Urethritis in males

In a randomised study the clinical efficacy of ciprofloxacin was compared with that of doxycycline administered in two different dosage schemes to male patients suffering from non-gonococcal urethritis. Fourteen days after completion of therapy (day 21) pyuria was absent in 30 of 100 patients in the ciprofloxacin group;Chlamydia trachomatis was isolated from five andUreaplasma urealyticum from eight patients. In the 100 mg doxycycline group (n=60) pyuria was absent in 36 patients (60 %) andUreaplasma urealyticum was isolated from six patients on day 21. In the 200 mg doxycycline group (n=45) pyuria was absent in 18 patients (40 %) andUreaplasma urealyticum was isolated from two patients on day 21. Side-effects were mild and transient in all groups. It is concluded that ciprofloxacin given in a dosage of 1 g for seven days is not effective in the treatment of non-gonococcal urethritis.     

Detection ofChlamydia trachomatis in urine from men with urethritis

The performance of a commercial EIA (Chlamydiazyme) for detection ofChlamydia trachomatis in urine specimens was compared with that of culture of urethral samples from men with urethritis. The incidence of chlamydial infection on the basis of culture results was 34 % (56/167). The sensitivity, specificity, positive and negative predictive values for the EIA were 55 % (31/56), 98 % (109/111), 94 % (31/33) and 81 % (109/134), respectively, compared with culture. Although this EIA has a high specificity, the low sensitivity makes it valueless as a clinical tool for demonstrating chlamydial antigen in urine from men with urethritis.     

Prevalence ofChlamydia trachomatis infection in a population of asymptomatic women in a screening program for cervical cancer

The prevalence ofChlamydia trachomatis infection in a population of women with no symptoms of sexually transmitted disease was investigated. These women, aged 35–55 years, participated in a screening program for cervical cancer. With the use of a direct immunofluorescence method, 109 out of 2,470 smears tested were positive forChlamydia trachomatis, indicating an overall prevalence of 4.4%. No changes in prevalence were found when five-year cohorts of this group were analyzed, indicating that age-dependent changes or epidemiological factors do not result in a different (decreased) prevalence over the ages 35 to 55 years. The prevalence ofTrichomonas vaginalis and fungi, as detected by cytological screening, was lower than that observed forChlamydia trachomatis: 3.1 and 2.1%, respectively. Of the 109 smears positive forChlamydia trachomatis, 90 showed cervical cells with reactive changes (out of 1,490 smears with PAP II), whereas no cytological changes were found in 15 cases (out of 884 smears with PAP I). Changes suggestive of mild or moderate dysplasia were found in only four cases (out of 93 smears with PAP III). The results indicate thatChlamydia trachomatis is associated with reactive changes of endocervical cells and raise serious questions about whether prevention of possible secondary effects such as infertility and pelvic inflammatory disease can be achieved by a combined screening program for cervical cancer andChlamydia trachomatis.     

Detection ofChlamydia trachomatis by the polymerase chain reaction in young patients with acute epididymitis

Specimens from 11 patients presenting with acute epididymitis were tested for the presence ofChlamydia trachomatis by an enzyme immunoassay (EIA), growth in McCoy cells and the polymerase chain reaction (PCR), and for other microorganisms by standard laboratory techniques.Chlamydia trachomatis urethral infection was detected in four patients by tissue culture, in three patients by EIA and in nine patients by PCR. These findings confirm the usually low detection rate ofChlamydia trachomatis by conventional tissue culture and EIA. Detection by PCR indicated both the diagnostic value of this technique and the importance of this organism in epididymitis.     

Comparison of cell culture with two direct Chlamydia tests using immunofluorescence or enzyme-linked immunosorbent assay

Two direct tests for diagnosis of infection due to Chlamydia trachomatis were evaluated on 417 specimens collected from a population with a low disease prevalence of 8.1 %. The intensity of positive results was graded according to the number of inclusions or elementary bodies and the optical density of the reaction. Thirty-four specimens were positive in cell culture, 39 positive with MicroTrak and 43 positive with Chlamydiazyme assay. The sensitivity of the two direct tests was 91.2 % (31 of 34); the specificity was 97.9 % (381 of 389) for MicroTrak and 96.9 % (377 of 389) for Chlamydiazyme assay. The positive predictive values were 79.5 % (31 of 39) for MicroTrak and 72.1 % (31 of 43) for Chlamydiazyme assay. None of the specimens negative by the culture method were positive by the two direct methods. Discrepancies were restricted to the slightly positive specimens. The direct tests seem to be an alternative for diagnosing Chlamydia trachomatis infections, but slightly positive results require cell culture confirmation.     

Detection of Seroconversion and Persistence of Chlamydia trachomatis Antibodies in Five Different Serological Tests

 Microimmunofluorescence (MIF), a Chlamydia trachomatis species-specific enzyme immunoassay incorporating lipopolysaccharide-extracted Chlamydia trachomatis L2 elementary bodies, two different synthetic peptide-based species-specific tests, and a recombinant lipopolysaccharide genus-specific test were performed on multiple follow-up sera (n=104 total) from 16 women with Chlamydia trachomatis-positive cervical swabs. These women included five with IgG seroconversions, five with Chlamydia trachomatis reinfections after initial therapy, and six with serologic follow-up of more than 6 years after antibiotic therapy. Of all the tests employed in this study, MIF IgG reverted earliest to negative titers, while MIF IgA was the least sensitive. The lipopolysaccharide-extracted elementary body enzyme immunoassay exhibited the closest correlation with the MIF test. The highest test sensitivity was observed in one of the synthetic peptide-based tests, which detected earliest seroconversions and longest IgG persistence. The other synthetic peptide-based test gave false-negative results in 2 of 16 women and did not detect seroconversion earlier than the MIF test. Seroconversion and persistence of genus-specific IgG – cross-reactivity with Chlamydia pneumoniae– against lipopolysaccharide were similar to species-specific IgG. A significant serologic response to reinfection was observed only in women with signs of pelvic inflammatory disease. Species-specific tests of high sensitivity and reproducibility are best suited for gynecological diagnostic purposes.     

A distinct cellular profile is seen in the human endocervix during Chlamydia trachomatis infection

Problem The endocervix is a major target of Chlamydia trachomatis infection, but little is known about the immune repertoire in this tissue, or its response to these common bacteria. Method of study Using a cytobrush, we isolated cells from the endocervix of 20 women during C. trachomatis infection, and post‐antibiotic treatment. Endocervical swabs and blood were taken in parallel. Endocervical cells were enumerated, and endocervical and blood T cells immunophenotyped. Chlamydia trachomatis was genotyped by sequence analysis of the OmpA gene, and quantified by culture. Results Chlamydia trachomatis genotypes were D, E, F and Ia, and infectious burden varied considerably. Endocervical T cell and neutrophil numbers were highly elevated during infection, with both CD4 and CD8 T‐cell subsets accumulating. Regardless of the presence or absence of infection, the endocervical cell infiltrate was dominated by effector memory T cells, and the numbers of CCR5 and CD103 expressing T cells was significantly higher than in the blood. Human leukocyte antigen (HLA‐DR) expression by endocervical T cells was significantly increased during infection. Conclusion The human endocervix exhibits a distinct cellular response to C. trachomatis infection that can be longitudinally evaluated by cytobrush sampling. Infecting organisms can be sampled and analyzed in parallel.     

Lack of utility of risk score and gynecological examination for screening for sexually transmitted infections in sexually active adolescents

Background  

Sexually transmitted infections constitute the main health risk among adolescents. In developing countries the diagnosis and treatment of cervical infections is based on the syndromic approach. In this study we estimated the prevalence of Chlamydia trachomatis and Neisseria gonorrhoeae among female adolescents from a Health Sector of the city of Goiania, Brazil, and validated cervicitis diagnosis using World Health Organization/Ministry of Health risk score and gynecological examination.     

Detection of high risk HPV and Chlamydia trachomatis in vaginal and cervical samples collected with flocked nylon and wrapped rayon dual swabs transported in dry tubes

A dual collection device containing flocked and wrapped rayon swabs was used to collect vaginal and cervical samples from 494 women. The swabs were separated into individual tubes and sent to the laboratory in a dry state, where they were hydrated and tested for high risk HPV DNA [Digene-Qiagen hybrid capture 2] and Chlamydia trachomatis using in-house real-time PCR. The flocked swabs identified more high risk HPV and C. trachomatis infections from both sampling sites.     

Role of quinolones in the treatment of bronchopulmonary infections,particularly pneumococcal and community-acquired pneumonia

In view of their antimicrobial activity and pharmacological properties, fluoroquinolones should be suitable for the treatment of lower respiratory tract infections. The overall clinical success rate using enoxacin, ofloxacin, pefloxacin, and ciprofloxacin ranges from 81 % to 89 %. Despite relatively high MICs of the fluoroquinolones forStreptococcus pneumoniae, the clinical success rate of these drugs in pneumococcal infections is 91 %, but the eradication rate of this pathogen is lower (73 %). In addition, fluoroquinolones appeared to be as effective as standard antibiotic regimens for treatment of bronchopulmonary infections in most of the comparative trials reported. The new quinolones could be a good alternative for treatment of acute exacerbations of chronic bronchitis, especially if examination of the sputum reveals gram-negative pathogens. In community-acquired pneumonia, drugs other than quinolones seem indicated because of the limited efficacy of the new quinolones in the treatment of severe pneumococcal infections and the poor activity of these drugs against the anaerobic flora causing aspiration pneumonia. In contrast, new quinolones should be very suitable for treatment of nosocomial pulmonary infections due to gram-negative pathogens. Quinolones used with or without erythromycin and rifampin, might be useful in the treatment of Legionnaires' disease. The role of these drugs in treatment ofChlamydia andRickettsiae infections remains to be defined.