Ophthalmia neonatorum in a semi-rural African community

Chlamydia trachomatis Infection in Pregnancy: The Global Challenge of Preventing Adverse Pregnancy and Infant Outcomes in Sub-Saharan Africa and Asia

Screening and treatment of sexually transmitted infections (STIs) in pregnancy represents an overlooked opportunity to improve the health outcomes of women and infants worldwide. Although Chlamydia trachomatis is the most common treatable bacterial STI, few countries have routine pregnancy screening and treatment programs. We reviewed the current literature surrounding Chlamydia trachomatis in pregnancy, particularly focusing on countries in sub-Saharan Africa and Asia. We discuss possible chlamydial adverse pregnancy and infant health outcomes (miscarriage, stillbirth, ectopic pregnancy, preterm birth, neonatal conjunctivitis, neonatal pneumonia, and other potential effects including HIV perinatal transmission) and review studies of chlamydial screening and treatment in pregnancy, while simultaneously highlighting research from resource-limited countries in sub-Saharan Africa and Asia.

A controlled trial of povidone-iodine as prophylaxis against ophthalmia neonatorum

BACKGROUND

Neonatal conjunctivitis (ophthalmia neonatorum) continues to cause blindness because the agents used prophylactically to prevent this condition are not completely effective and are not widely available in many parts of the world. Povidone-iodine ophthalmic solution is an effective antibacterial agent with broad antibacterial and antiviral activity to which no bacteria are known to be resistant, and it is far less expensive and less toxic than the agents currently used to prevent neonatal conjunctivitis.

METHODS

We conducted a masked, prospective trial involving 3117 infants born over a period of 30 months in a hospital in Kenya. Shortly after birth each infant received a 2.5 percent solution of povidone-iodine (n = 1076), a 1 percent solution of silver nitrate (n = 929), or 0.5 percent erythromycin ointment (n = 1112) in both eyes. Randomization was achieved by rotating the three medications after each was used for a week.

RESULTS

Of the neonates treated with povidone-iodine, 13.1 percent had infectious conjunctivitis, as compared with 17.5 percent of those treated with silver nitrate (P < 0.001) and 15.2 percent of those treated with erythromycin (P = 0.01). Povidone-iodine was more effective against Chlamydia trachomatis than was silver nitrate (P < 0.001) or erythromycin (P = 0.008). There were 104 cases of noninfectious conjunctivitis (9.7 percent) in the povidone-iodine group, as compared with 129 in the silver nitrate group (13.9 percent, P < 0.001) and 148 in the erythromycin group (13.3 percent, P = 0.004). Many cases of noninfectious conjunctivitis were probably due to a toxic reaction to the treatment itself. The incidence of Neisseria gonorrhoeae and Staphylococcus aureus infections was similar in the three groups.

CONCLUSIONS

A 2.5 percent ophthalmic solution of povidone-iodine as prophylaxis against ophthalmia neonatorum is more effective than treatment with silver nitrate or erythromycin, and it is less toxic and costs less.

Comparative diagnosis of neonatal chlamydial conjunctivitis by polymerase chain reaction and McCoy cell culture

Cervical and ocular swabs from 100 mother/newborn pairs delivering on the clinic service were assayed for Chlamydia trachomatis with standard McCoy cell culture and with standard and biotinylated polymerase chain reaction techniques, using primers directed against the major outer membrane protein gene and C. trachomatis-specific cryptic plasmid, respectively. Using the polymerase chain reaction, 20 (20%) mothers and seven (7%) neonates were positive for Chlamydia. All neonates positive by polymerase chain reaction were from mothers positive by polymerase chain reaction, yielding a 35% transmission rate. Only five of 20 (25%) mothers and two of seven (28%) neonates positive by polymerase chain reaction were positive by cell culture. All cell culture samples were positive by polymerase chain reaction testing. Culture and polymerase chain reaction analysis two weeks after treatment with oral erythromycin were negative. The polymerase chain reaction assay appears to be equally specific and more sensitive than McCoy cell culture for the detection of C. trachomatis from ocular specimens.

Ophthalmia neonatorum in Bangkok: the significance of Chlamydia trachomatis

In a prospective 2-month case-controlled study, 17 cases of neonatal conjunctivitis were diagnosed. A statistically significant association between neonatal conjunctivitis and the presence of Chlamydia trachomatis (five cases) and Staphylococcus aureus (five cases) was shown. No cases of gonococcal conjunctivitis were found, perhaps because of the routine use of silver nitrate (1%) drops. C. trachomatis conjunctivitis could not be diagnosed on clinical grounds, nor was examination of Giemsa-stained conjunctival scrapes sufficiently sensitive to detect all cases. In order to prevent the long-term morbidity of C. trachomatis infection in both mother and child, specific aetiological diagnosis using immunodiagnostic or cultural procedures is required.

A study of the incidence of urogenital Chlamydia trachomatis in patients attending specialized departments of Rome, Milan and Turin, Italy

A study of Chlamydia trachomatis was conducted in 5270 subjects seen at clinics of the Faculty of Medicine and Surgery at La Sapienza University in Rome, the S. Anna Hospital in Turin, and the Provincial Maternity Hospital Institute in Milan. In these areas, C. trachomatis was present in 5.8% of the cases examined; in addition it was present with statistically significant frequencies in cases of salpingitis (49.1) and epididymitis (21.7). It may also be found in cases of extrauterine pregnancy, sterility and abortion. Those most affected were women who had begun their sexual activity at an early age, were under 25, had several sexual partners and who used the coil and/or spermicides. A routine check for C. trachomatis should be considered for those women with those risk factors.

Urogenital Chlamydia trachomatis in Gabon: an unrecognised epidemic

Samples from 218 men with urethritis, 517 women with pelvic pain or pelvic pain and vaginal discharge, 218 women consulting for infertility, and 598 postpartal women were screened for Chlamydia trachomatis by culture and direct immunofluorescence. Chlamydiae were detected in 18% (39/218) of the men, 18% (45/252) of women with vaginal discharge, 14% (38/265) of those with pelvic pain, 10% (21/218) of infertile, and 10% (59/598) of postpartal women. A chlamydial prevalence of 18% (41) was observed in 229 postpartal women aged under 21, whereas only 5% (10) of 360 postpartal women over 21 had C trachomatis. In the other clinical groups, an age related decrease in prevalence was noted in women over 25. The direct immunofluorescence test correlated well with culture. The small difference in isolation between symptomatic and postpartal women indicates that women in this population do not seek medical attention for chlamydial infections and expose themselves to chlamydial salpingitis and infertility.