Genital Chlamydia trachomatis infections in the female

Prevalence of Chlamydia trachomatis in Pregnant Iranian Women: A Systematic Review and Meta-Analysis

Several studies have been conducted regarding the prevalence of Chlamydia trachomatis, Mycoplasma hominis, and Ureaplasma urealyticum in pregnant Iranian women. However, it is necessary to combine the previous results to present a general assessment. We conducted the present study based on systematic review and meta-analysis studies according to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA). We searched the national and international online databases of MagIran, IranMedex, SID, MedLib, IranDoc, Scopus, PubMed, ISI Web of Knowledge, and Google Scholar search engine for certain MeSH keywords until June 16, 2017. In addition, heterogeneity, sensitivity analysis, subgroup analysis, and publication bias were performed. The data were analyzed using random-effects model and Comprehensive Meta-Analysis version 2 and P value was considered lower than 0.05. The prevalence of Chlamydia trachomatis in 11 surveyed articles that assessed 2864 pregnant Iranian women was 8.74% [95% confidence interval (CI): 5.40-13.84]. The prevalence of Chlamydia trachomatis was estimated 5.73% (95% CI: 2.09-14.73) and 13.55% (95% CI: 11.23-16.25) by enzyme-linked immunosorbent assay (ELISA) and polymerase chain reaction (PCR), respectively which the difference was not significant (P=0.082). The lowest and highest prevalence of Chlamydia trachomatis was estimated in Tehran province [4.96% (95% CI: 2.45-9.810)] and Ardabil province [28.60% (95% CI: 20.61-38.20)], respectively. This difference was statistically significant (P<0.001). Meta-regression for the prevalence of Chlamydia trachomatis based on year of the studies was significant with increasing slope (P=0.017). According to the systematic review, the prevalence of Mycoplasma hominis and Urea plasma urealyticum indicated 2 to 22.8% (from 4 articles) and 9.1 to 19.8% (from 3 articles), respectively. There was no evidence of publication bias (P value for Begg and Eggers' tests was 0.161 and 0.173, respectively). The prevalence of Chlamydia trachomatis is high among pregnant Iranian women. Screening pregnant women as part of preventive measures seem necessary considering the potential for maternal and fetal complications.

Home sampling versus conventional swab sampling for screening of Chlamydia trachomatis in women: a cluster-randomized 1-year follow-up study

We compared the efficacy of a screening program for urogenital Chlamydia trachomatis infections based on home sampling with that of a screening program based on conventional swab sampling performed at a physician's office. Female subjects, comprising students at 17 high schools in the county of Aarhus, Denmark, were divided into a study group (tested by home sampling) and a control group (tested in a physician's office). We assessed the number of new infections and the number of subjects who reported being treated for pelvic inflammatory disease (PID) at 1 year of follow-up; 443 (51.1%) of 867 women in the intervention group and 487 (58.5%) of 833 women in the control group were available for follow-up. Thirteen (2.9%) and 32 (6.6%) new infections were identified in the intervention group and the control group, respectively (Wilcoxon exact value, P=.026). Nine (2.1%) women in the intervention group and 20 (4.2%) in the control group reported being treated for PID (P=.045), indicating that a screening strategy involving home sampling is associated with a lower prevalence of C. trachomatis and a lower proportion of reported cases of PID.

Feasibility of patient-collected vulval swabs for the diagnosis of Chlamydia trachomatis in a family planning clinic: a pilot study

This pilot study set out to determine the feasibility of using patient-collected vulval swabs, instead of urine, for the diagnosis of female Chlamydia trachomatis infection. Main outcome measures included prevalence of infection and sensitivity, specificity, and acceptability of both test methods. An assessment was also made of those who declined to be tested. Consecutive women under 25 years of age attending a single urban family planning clinic were invited to participate. Sixty-eight percent (103/152) agreed to undergo testing. Overall prevalence was 11.7%. The sensitivity/specificity for the ligase chain reaction (LCR) assayed patient-collected vulval swabs and urine was 100%/100% and 92%/100%, respectively. The acceptability of self-collection was high with 93% characterising the test as 'not bad', 79% recommending it to a friend, and 79% choosing the test next time. Significantly more women, however, would choose urine for testing on a subsequent occasion (p < 0.001). Less than 1/5 of the patients who declined did not take part because of concerns regarding the vulval swab. Patient-collected vulval swabs assayed by LCR represent a non-invasive, sensitive, and acceptable way to detect genital C. trachomatis infection in women attending a family planning clinic. Compared with urine testing, benefits in terms of transport and processing should encourage more widespread use of this approach.

Which women should be tested for Chlamydia trachomatis?

OBJECTIVE

To assess the prevalence of genitourinary Chlamydia trachomatis infection among women in different clinical settings, with a view to making decisions about who should be tested routinely.

DESIGN

Cross sectional study.

SETTING

One regional hospital and family planning clinic serving an urban centre. Population Two thousand thirty-five sexually active women attending various outpatient settings.

MAIN OUTCOME MEASURES

Prevalence of positivity by clinical setting, stratified by age.

RESULTS

Overall, prevalence of lower genital tract chlamydial infection was similar in a variety of clinical settings. Infertile women were the only exception, demonstrating a much lower prevalence. Stratifying the study population by age found a clear trend towards high prevalence in teenagers and virtually no infection in women over the age of 30 years.

CONCLUSIONS

The prevalence of chlamydial infection in women is related to age, regardless of clinical presentation. In practice, opportunistic screening should target sexually active women under 30 years of age.

Screening for Chlamydia trachomatis in subfertile women

Chlamydia trachomatis is the most common sexually transmitted disease in the UK and Europe. The majority of female infections are asymptomatic and recognized sequelae include pelvic inflammatory disease, infertility, and ectopic pregnancy. Women with chlamydial infection who undergo uterine instrumentation are recognized to be at risk of ascending infection. Most patients attending for infertility investigations and treatment will undergo some form of uterine instrumentation. Published data regarding the prevalence of chlamydial infection in the subfertile are few and conflicting. In this study, more than 400 consecutive women presenting for infertility investigation and treatment at a single regional fertility centre were screened for Chlamydia: Half were screened using enzyme immunoassay (EIA) and half by ligase chain reaction (LCR). Prevalence by diagnostic test was 0% with EIA and 1.9% with LCR. Overall, the low prevalence was at least partly explained by older age. Until more evidence comes from studies testing consecutive subfertile patients both with EIA and a DNA amplification method such as LCR, centres using EIA should consider using prophylactic antibiotics prior to uterine instrumentation.

Chlamydia pneumoniae and its role in chronic obstructive pulmonary disease

The diverging of T-helper (Th) cells into predominantly Th1 and Th2 subsets on the basis of their cytokine profiles has decisively improved our understanding of the pathogenesis of many chronic infectious diseases. Recent data suggest that the presence of interferon-gamma and the subsequent suppression of interleukin-4 production leads to a Th1-type response that is required for the resolution of infections caused by intracellular pathogens. The ability of the macrophages to respond aggressively during early antigen contact seems to be one crucial factor in the development of an appropriate Th-cell response. Several host-related factors can affect macrophage function and the polarization of T-cell responses, ie the shift from a Th1 response to a Th2 one, and thus dramatically deteriorate the resolution of infections caused by intracellular agents such as Chlamydia pneumoniae. Chronic C. pneumoniae infection has been associated with several common chronic diseases, quite recently with chronic obstructive pulmonary disease. Chronic C. pneumoniae infection may amplify smoking-associated inflammation in the bronchi and may be a contributory factor in the development of irreversible pathological changes.

Chlamydia trachomatis in hydrocele fluid

OBJECTIVE

To determine the presence of Chlamydia trachomatis in hydrocele fluid.

METHODS

90 male patients with hydrocele of tunica vaginalis from an endemic area for bancroftian filariasis were investigated for the presence of Chlamydia trachomatis in their hydrocele fluids. C trachomatis antigen detection tests-a direct immunofluorescence assay and an enzyme immunoassay along with polymerase chain reaction assay for amplification of a 517 bp fragment of C trachomatis endogenous plasmid-were used in this study. The patients were also tested for the presence of microfilaria in their hydrocele fluids and night blood. Histopathological examination was carried out to detect adult filarial worm in tunica vaginalis testes.

RESULTS

Eight (8.88%) patients had chlamydia antigen in the hydrocele fluids; C trachomatis plasmid sequences could be amplified from five of these. Seven (7.77%) patients had microfilaria in the hydrocele fluids, three of them having adult worm in tunica vaginalis.

CONCLUSION

C trachomatis infection might be associated with hydrocele in some of these patients.

Immune response to Chlamydia trachomatis heat-shock protein in infertile female patients and influence of Chlamydia pneumoniae antibodies

A total of 446 sera from 245 patients with primary or secondary infertility, all of whom were examined laparoscopically, 117 patients with Chlamydia trachomatis-positive cervical swabs, and 84 control persons (50 obstetric patients and 34 female blood donors) were tested for antibodies to Chlamydia trachomatis and to Chlamydia pneumoniae with the microimmunofluorescence (MIF) test. MIF test antibody rates were highest in patients with complete tubal occlusion (73%) and in patients with proven Chlamydia trachomatis infection (74%), whereas only 9 to 10% of the control group showed Chlamydia trachomatis antibodies. Reaction to the 60 kDa antigen of Chlamydia trachomatis, a heat-shock protein (hsp) analogue, has been suggested as a possible marker for the development of chronic sequelae after Chlamydia 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 to Chlamydia trachomatis but also to Chlamydia 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 between Chlamydia pneumoniae and Chlamydia trachomatis antibodies in the MIF test.