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Waters MB, Hybiske K, Ikeda R, Kaltenboeck B, Manhart LE, Kreisel KM, Khosropour CM. Chlamydia trachomatis Seroassays Used in Epidemiologic Research: A Narrative Review and Practical Considerations. J Infect Dis 2024; 230:250-262. [PMID: 39052727 PMCID: PMC11272089 DOI: 10.1093/infdis/jiae199] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/30/2023] [Revised: 03/20/2024] [Accepted: 04/16/2024] [Indexed: 04/21/2024] Open
Abstract
Chlamydia trachomatis (CT) is a sexually transmitted infection that can lead to adverse reproductive health outcomes. CT prevalence estimates are primarily derived from screening using nucleic acid amplification tests (NAATs). However, screening guidelines in the United States only include particular subpopulations, and NAATs only detect current infections. In contrast, seroassays identify past CT infections, which is important for understanding the public health impacts of CT, including pelvic inflammatory disease and tubal factor infertility. Older seroassays have been plagued by low sensitivity and specificity and have not been validated using a consistent reference measure, making it challenging to compare studies, define the epidemiology of CT, and determine the effectiveness of control programs. Newer seroassays have better performance characteristics. This narrative review summarizes the "state of the science" for CT seroassays that have been applied in epidemiologic studies and provides practical considerations for interpreting the literature and employing seroassays in future research.
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Affiliation(s)
| | - Kevin Hybiske
- Department of Medicine, University of Washington, Seattle
| | - Ren Ikeda
- Department of Medicine, University of Washington, Seattle
| | - Bernhard Kaltenboeck
- Department of Pathobiology, College of Veterinary Medicine, Auburn University, Auburn, Alabama
| | | | - Kristen M Kreisel
- Division of STD Prevention, Centers for Disease Control and Prevention, Atlanta, Georgia
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Woodhall SC, Gorwitz RJ, Migchelsen SJ, Gottlieb SL, Horner PJ, Geisler WM, Winstanley C, Hufnagel K, Waterboer T, Martin DL, Huston WM, Gaydos CA, Deal C, Unemo M, Dunbar JK, Bernstein K. Advancing the public health applications of Chlamydia trachomatis serology. THE LANCET. INFECTIOUS DISEASES 2018; 18:e399-e407. [PMID: 29983342 DOI: 10.1016/s1473-3099(18)30159-2] [Citation(s) in RCA: 45] [Impact Index Per Article: 7.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/05/2017] [Revised: 02/04/2018] [Accepted: 02/09/2018] [Indexed: 12/22/2022]
Abstract
Genital Chlamydia trachomatis infection is the most commonly diagnosed sexually transmitted infection. Trachoma is caused by ocular infection with C trachomatis and is the leading infectious cause of blindness worldwide. New serological assays for C trachomatis could facilitate improved understanding of C trachomatis epidemiology and prevention. C trachomatis serology offers a means of investigating the incidence of chlamydia infection and might be developed as a biomarker of scarring sequelae, such as pelvic inflammatory disease. Therefore, serological assays have potential as epidemiological tools to quantify unmet need, inform service planning, evaluate interventions including screening and treatment, and to assess new vaccine candidates. However, questions about the performance characteristics and interpretation of C trachomatis serological assays remain, which must be addressed to advance development within this field. In this Personal View, we explore the available information about C trachomatis serology and propose several priority actions. These actions involve development of target product profiles to guide assay selection and assessment across multiple applications and populations, establishment of a serum bank to facilitate assay development and evaluation, and development of technical and statistical methods for assay evaluation and analysis of serological findings. The field of C trachomatis serology will benefit from collaboration across the public health community to align technological developments with their potential applications.
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Affiliation(s)
- Sarah C Woodhall
- Blood Safety, Hepatitis, Sexually Transmitted Infections (STI) and HIV Service, Public Health England, London, UK; National Institute for Health Research Health Protection Research Unit in Evaluation of Interventions, University of Bristol, Bristol, UK; National Institute for Health Research Health Protection Research Unit in Blood Borne and Sexually Transmitted Infections, University College London, London, UK.
| | - Rachel J Gorwitz
- Division of STD Prevention, US Centers for Disease Control and Prevention, Atlanta, GA, USA
| | - Stephanie J Migchelsen
- Blood Safety, Hepatitis, Sexually Transmitted Infections (STI) and HIV Service, Public Health England, London, UK; Clinical Research Department, London School of Hygiene & Tropical Medicine, London, UK
| | - Sami L Gottlieb
- Department of Reproductive Health and Research, World Health Organization, Geneva, Switzerland
| | - Patrick J Horner
- National Institute for Health Research Health Protection Research Unit in Evaluation of Interventions, University of Bristol, Bristol, UK; Population Health Sciences, University of Bristol, Bristol, UK
| | - William M Geisler
- Division of Infectious Diseases, University of Alabama at Birmingham, Birmingham, AL, USA
| | | | - Katrin Hufnagel
- Division of Molecular Diagnostics of Oncogenic Infections, German Cancer Research Center (DKFZ), Heidelberg, Germany
| | - Tim Waterboer
- Division of Molecular Diagnostics of Oncogenic Infections, German Cancer Research Center (DKFZ), Heidelberg, Germany
| | - Diana L Martin
- Division of Parasitic Diseases and Malaria, US Centers for Disease Control and Prevention, Atlanta, GA, USA
| | - Wilhelmina M Huston
- School of Life Sciences, University of Technology Sydney, Sydney, NSW, Australia
| | - Charlotte A Gaydos
- Division of Infectious Diseases, Johns Hopkins University, Baltimore, MD, USA
| | - Carolyn Deal
- Division of Microbiology and Infectious Diseases, National Institute of Health, Bethesda, MD, USA
| | - Magnus Unemo
- WHO Collaborating Centre for Gonorrhoea and Other Sexually Transmitted Infections, Örebro University, Örebro, Sweden
| | - J Kevin Dunbar
- Blood Safety, Hepatitis, Sexually Transmitted Infections (STI) and HIV Service, Public Health England, London, UK; National Institute for Health Research Health Protection Research Unit in Evaluation of Interventions, University of Bristol, Bristol, UK; National Institute for Health Research Health Protection Research Unit in Blood Borne and Sexually Transmitted Infections, University College London, London, UK
| | - Kyle Bernstein
- Division of STD Prevention, US Centers for Disease Control and Prevention, Atlanta, GA, USA
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HIV/Sexually Transmitted Infection Prevention Messaging: Targeting Root Causes of Sexual Risk Behavior. Sex Transm Dis 2016; 43:71-77. [PMID: 26760178 DOI: 10.1097/olq.0000000000000402] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
INTRODUCTION Sexual risk behaviors (SRBs) often lead to sexually transmitted infections (STI), yet little is known about what drives SRB and whether this differs by sex. METHOD Participants (n = 920; 75% white) were drawn from the Raising Healthy Children study, enrolled in 1993 and 1994 in grades 1 to 2, and followed up through age 24/25 years. Lifetime STI diagnosis was defined by self-report or seropositivity for Chlamydia trachomatis or herpes simplex virus 2. Multivariable models assessed individual (social skills, behavioral disinhibition) and environmental factors (family involvement, school bonding, antisocial friends) predictive of STI diagnosis as mediated by 3 proximal SRB (sex under the influence of drugs or alcohol, condom use, lifetime number of sex partners). RESULTS Twenty-five percent of participants had ever had an STI. All SRBs differed by sex (P < 0.001), and female participants were more likely to have had an STI (P < 0.001). Behavioral disinhibition and antisocial friends in adolescence were associated with more SRB for both sexes, whereas social skills were associated with less SRB in female but more in male participants. Considering SRB and individual and environmental factors together, lifetime number of sex partners (adjusted relative risk [ARR], 1.04per partner; 95% confidence interval [CI], 1.03-1.05) and inconsistent condom use (ARR, 1.10per year; 95% CI, 1.04-1.16) were associated with increased risk of STI, whereas social skills were associated with decreased risk of STI (ARR, 0.84; 95% CI, 0.75-0.93). Behavioral disinhibition seemed to drive SRB, but family involvement mitigated this in several cases. CONCLUSIONS Adolescent environmental influences and individual characteristics drive some SRB and may be more effective targets for STI/HIV prevention interventions than proximal risk behaviors.
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Kamel RM. Screening for Chlamydia trachomatis infection among infertile women in Saudi Arabia. Int J Womens Health 2013; 5:277-84. [PMID: 23785247 PMCID: PMC3682642 DOI: 10.2147/ijwh.s46678] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022] Open
Abstract
BACKGROUND Chlamydia trachomatis infection is a worldwide-distributed sexually transmitted infection that may lead to infertility. OBJECTIVES This study aims to report the prevalence of Chlamydia trachomatis infection among infertile women in Saudi Arabia. PATIENTS AND METHODS A community-based study carried out at the obstetrics and gynecology clinic at Jazan General Hospital, Saudi Arabia. The study group included 640 Saudi infertile women who were aged between 18 and 40 years and who attended the gynecology clinic for infertility examination throughout 1 year of study (from July 1, 2011 to June 30, 2012). The randomized control group included 100 Saudi fertile women who attended the obstetrics clinic for routine antenatal care. All recruited women were screened for chlamydia infection by enzyme-linked immunosorbent assay (ELISA) for detection of serum-specific antibodies and then retested by the McCoy cell culture technique. RESULTS The prevalence of Chlamydia trachomatis infection among infertile women was high, at 15.0%. The rate of chlamydia infection detected by ELISA was 9.84%, and it was 12.03% by the culture method (P = 0.2443). CONCLUSION The high prevalence of Chlamydia trachomatis infection among Saudi infertile women demands a national screening program for early detection among infertile couples. ELISA is available as a simple screening test alternative to the culture method.
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Affiliation(s)
- Remah M Kamel
- Department of Obstetrics and Gynecology, Faculty of Medicine, University of Jazan, Saudi Arabia
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She RC, Welch R, Wilson AR, Davis D, Litwin CM. Correlation of Chlamydia and Chlamydophila spp. IgG and IgM antibodies by microimmunofluorescence with antigen detection methods. J Clin Lab Anal 2012; 25:305-8. [PMID: 21786334 DOI: 10.1002/jcla.20475] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022] Open
Abstract
Correlation of serologic titers for Chlamydia trachomatis with other tests has been based on direct fluorescence antibody (DFA) testing and culture, but not on nucleic acid-based tests that are used for screening. We retrospectively reviewed the specificity of antibodies against C. trachomatis, Chlamydia psittaci, and Chlamydophila pneumoniae by microimmunofluorescence (MIF) when compared with DFA, culture, nucleic acid probe, and transcription-mediated amplification. Over a 6-year period, 226 cases had both MIF and one of these other methods performed for comparison. Agreement between C. trachomatis antigen or nucleic acid detection and MIF results was 87% (197/226). C. trachomatis serology had a negative predictive value of 98%, and 10.6% of cases were positive by serology and negative by antigen testing. Of the 13 patients who had a positive C. trachomatis antigen or nucleic acid test result, 9 had IgG and/or IgM titers highest against C. trachomatis, 3 had IgG titers highest against C. pneumoniae, and 1 had undetectable titers for the three chlamydial species. Twenty-five patients had positive IgG and/or IgM titers to C. trachomatis but negative antigen test results. Serologic testing can increase the sensitivity of detecting C. trachomatis infections.
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Affiliation(s)
- Rosemary C She
- Department of Pathology, University of Utah School of Medicine, Salt Lake City, UT, USA.
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Jha R, Vardhan H, Bas S, Salhan S, Mittal A. Chlamydia trachomatis heat shock proteins 60 and 10 induce apoptosis in endocervical epithelial cells. Inflamm Res 2010; 60:69-78. [DOI: 10.1007/s00011-010-0237-x] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/14/2009] [Accepted: 07/18/2010] [Indexed: 11/30/2022] Open
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El Hakim EA, Gordon UD, Akande VA. The relationship between serum Chlamydia antibody levels and severity of disease in infertile women with tubal damage. Arch Gynecol Obstet 2009; 281:727-33. [PMID: 19760187 DOI: 10.1007/s00404-009-1225-7] [Citation(s) in RCA: 13] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/15/2009] [Accepted: 09/08/2009] [Indexed: 10/20/2022]
Abstract
BACKGROUND The study explores the relationship between serum Chlamydia antibody titres (CAT) using the whole-cell inclusion immunofluorescence (WIF) test and severity of tubal damage in infertile women undergoing laparoscopy. METHODS Comparisons between the extent of specific lesions, including their severity found at laparoscopy, and CAT levels were analysed in 408 infertile women with tubal damage. CAT levels were assayed using the WIF test. RESULTS There were significant differences in the severity of individual lesions (tubal occlusion, tubal pathology, fimbrial state, extent and type of tubal and ovarian adhesions, type of tubal and ovarian adhesions) for both left and right adnexa in relation to CAT (P < 0.0001). The presence and severity of lesions found in one adnexum significantly correlated with the findings on the contra-lateral side (r > 0.5; P < 0.01). The American Fertility Society grades for tubal occlusion and adhesions in the right adnexum did not correlate with CAT. CONCLUSIONS CAT levels are quantitatively related to the severity of tubal damage in infertile women. Wide variations in the severity of lesions observed in relation to CAT were suggestive of broad individual differences in response to chlamydial infection.
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Taylor-Robinson D, Stacey CM, Jensen JS, Thomas BJ, Munday PE. Further observations, mainly serological, on a cohort of women with or without pelvic inflammatory disease. Int J STD AIDS 2009; 20:712-8. [PMID: 19759049 DOI: 10.1258/ijsa.2008.008489] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
Abstract
An analysis was undertaken of data pertaining to over 100 women with lower abdominal pain who were laparoscoped. Prior to laparoscopy, 11 of the women were considered to almost certainly have salpingitis, of whom six (55%) had salpingitis at laparoscopy; 17 to probably have salpingitis, of whom six (35%) did; 28 to possibly have salpingitis, of whom five (18%) did; and 56 to be very unlikely to have salpingitis, of whom five (9%) did. Of the 22 women who had salpingitis at laparoscopy, 14 (64%) had a Chlamydia trachomatis IgG antibody titre of >or=1:128 and might reasonably be regarded as having chlamydial disease on this basis; six without such a titre probably did not have chlamydial disease as C. trachomatis could not be detected at any genital site. At laparoscopy, 18 women had adhesions without obvious tubal inflammation; clinically, 15 of them had been regarded as possibly having salpingitis or unlikely to have it, with 12 having chronic pelvic pain. Twelve (67%) of the 18 women had a chlamydial IgG antibody titre of >or=1:128. IgM antibody was also detected most often in the 'salpingitis' group. Of 49 women without any abnormality detected at laparoscopy, nine (18%) had a high chlamydial IgG antibody titre. Overall, a woman who had a high titre of chlamydial IgG antibody and acute pelvic pain, together with a clinical picture of pelvic inflammation, was more likely to have salpingitis than adhesions alone. Likewise, a woman who had a high titre of chlamydial IgG antibody and chronic pelvic pain, together with a clinical picture suggesting that salpingitis was unlikely, was more likely to have adhesions alone than acute chlamydial salpingitis. However, while antibody measurement and seeking cervical C. trachomatis may help in formulating a diagnosis, there seems no simple way of detecting the small proportion of women who are infected by C. trachomatis in the upper genital tract but whose laparoscopic findings indicate normality. So far as patient care is concerned, the only way of preventing damage to the upper genital tract is to treat early on the basis of suspicion.
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Affiliation(s)
- D Taylor-Robinson
- Division of Medicine, Imperial College London, St Mary's Campus, London, UK.
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Choi TY, Kang JO, Chung SR, Ahn Y. [Chlamydia trachomatis antibody in Fitz-Hugh-Curtis syndrome]. Korean J Lab Med 2008; 28:293-8. [PMID: 18728379 DOI: 10.3343/kjlm.2008.28.4.293] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022] Open
Abstract
BACKGROUND Fitz-Hugh-Curtis (FHC) syndrome is inflammation of the liver capsule associated with pelvic inflammatory disease. We measured Chlamydia trachomatis antibodies in 30 female patients with acute abdominal pain for diagnosis of FHC-syndrome, and the results were compared with other tests. METHODS A dual-polymerase chain reaction was used for the detection of C. trachomatis in the cervix, and a micro-immunofluorescence test was performed to measure the antibody to C. trachomatis in serum. Cervical specimens were stained with Gram stain and cultured on chocolate agar for detection of Neisseria gonorrhoeae, and abdominal computed tomography (CT) and pelvic examinations were performed. RESULTS Of the 30 patients examined, 19 were diagnosed as having FHC-syndromes and 11 abdominal pains without FHC-syndrome. C. trachomatis was detected from one of the five patients studied, and no N. gonorrhoeae was isolated from the patients with FHC-syndrome. High titers of IgG antibody (1:512-1:1,024) to C. trachomatis were demonstrated in all patients with FHC-syndrome. The CT scan revealed perihepatitis in 14 patients with FHC-syndrome. CONCLUSIONS All patients with FHC-syndrome are associated with C. trachomatis infections, and a high titer of C. trachomatis antibody (IgG) is a very useful marker for FHC-syndrome.
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Affiliation(s)
- Tae Yeal Choi
- Department of Laboratory Medicine, Hanyang University College of Medicine, Seoul, Korea.
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Chlamydia trachomatis-specific heat shock proteins 60 antibodies can serve as prognostic marker in secondary infertile women. Infection 2008; 36:374-8. [PMID: 18642113 DOI: 10.1007/s15010-008-7129-9] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/15/2007] [Accepted: 03/03/2008] [Indexed: 10/21/2022]
Abstract
BACKGROUND The magnitude of reproductive morbidity associated with sexually transmitted Chlamydia trachomatis infection is enormous. A predictive serological test for upper genital tract infection would be a desirable diagnostic tool as C. trachomatis infection may lead to various immunopathological sequelae such as infertility, or ectopic pregnancy. MATERIALS AND METHODS Female patients (n = 198) attending gynecology outpatient department of Safdarjung hospital were enrolled for the study and clinically characterized into four groups on the basis of their symptoms; discharge, chronic cervicitis, primary and secondary infertility. Serological detection of C. trachomatis was done by ELISA using specific peptide sequences of major outer membrane protein (MOMP), Chlamydia heat shock protein (cHSP60 and 10). RESULTS Significant high seropositivity to chlamydial anti-cHSP60 antibodies were detected in patients with secondary infertility. A significant percent of chlamydial reinfection was observed in patients having secondary infertility (82.6%; p < 0.01) and chronic cervicitis (64.28%; p < 0.05). Considering IgG MOMP ELISA as a test standard, anti-cHSP60 antibodies showed higher sensitivity (90.91%) and specificity (89.47%) than cHSP10 ELISA (75.6% and 73.87%) in the secondary infertile group. Further anti-cHSP60 antibodies' detection had a sensitivity of 67.33% and a specificity of 90.67% in secondary infertile women when compared with DFA and PCR. CONCLUSIONS Our data suggest that detection of anti-cHSP60 antibodies would help in early prognosis of immunopathological sequelae in C. trachomatis-infected women and thereby in instituting appropriate therapy for controlling C. trachomatis infection at an early stage.
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Radouani F, Maile J, Betsou F. Serological profiling with Chlamycheck, a commercial multiplex recombinant antigen Western blot assay of chlamydial infections. Can J Microbiol 2007; 53:1360-8. [DOI: 10.1139/w07-107] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
Abstract
A new chlamydial test system, the Chlamycheck assay, which uses 4 purified recombinant antigens of Chlamydia trachomatis and Chlamydophila pneumoniae and one antigen of Chlamydophila psittaci , has been developed and commercialized. We investigated the reactivities of the recombinant antigens with sera from a group of 30 patients with acute Chlamydia trachomatis infection, 88 patients consulting for sexually transmitted infections, and 46 patients with serological evidence of Chlamydophila pneumoniae infection. The results obtained from human and infected mouse sera suggest that Chlamycheck serology against multiple proteins may provide additional useful information that is not available by conventional whole elementary body microimmunofluorescence or single-antigen enzyme-linked immunosorbent assay serology. Specific serological profiles were associated with acute versus past Chlamydia trachomatis infection or with Chlamydia trachomatis primo-infection versus infection in a Chlamydophila pneumoniae history context.
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Affiliation(s)
- Fouzia Radouani
- Laboratoire des Chlamydia, Institut Pasteur, 1 place Abou Kacem Ezzahraoui, B.P. 120, Casablanca, Maroc
- Microgen GmbH, Floriansbogen 2-4, 82061 Neuried, Germany
- Biobanque de Picardie, Centre Hospitalier Universitaire, avenue René Laënnec, 80480 Salouel, France
| | - Julia Maile
- Laboratoire des Chlamydia, Institut Pasteur, 1 place Abou Kacem Ezzahraoui, B.P. 120, Casablanca, Maroc
- Microgen GmbH, Floriansbogen 2-4, 82061 Neuried, Germany
- Biobanque de Picardie, Centre Hospitalier Universitaire, avenue René Laënnec, 80480 Salouel, France
| | - Fotini Betsou
- Laboratoire des Chlamydia, Institut Pasteur, 1 place Abou Kacem Ezzahraoui, B.P. 120, Casablanca, Maroc
- Microgen GmbH, Floriansbogen 2-4, 82061 Neuried, Germany
- Biobanque de Picardie, Centre Hospitalier Universitaire, avenue René Laënnec, 80480 Salouel, France
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Machado ACS, Guimarães EMB, Sakurai E, Fioravante FCR, Amaral WN, Alves MFC. High titers of Chlamydia trachomatis antibodies in Brazilian women with tubal occlusion or previous ectopic pregnancy. Infect Dis Obstet Gynecol 2007; 2007:24816. [PMID: 17541464 PMCID: PMC1874668 DOI: 10.1155/2007/24816] [Citation(s) in RCA: 15] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/05/2007] [Accepted: 03/09/2007] [Indexed: 11/17/2022] Open
Abstract
OBJECTIVE To evaluate serum chlamydia antibody titers (CATs) in tubal occlusion or previous ectopic pregnancy and the associated risk factors. METHODS The study population consisted of 55 women wih tubal damage and 55 parous women. CAT was measured using the whole-cell inclusion immunofluorescence test and cervical chlamydial DNA detected by PCR. Odds ratios were calculated to assess variables associated with C. trachomatis infection. RESULTS The prevalence of chlamydial antibodies and antibody titers in women with tubal occlusion or previous ectopic pregnancy was significantly higher (P < .01) than in parous women. Stepwise logistic regression analysis showed that chlamydia IgG antibodies were associated with tubal damage and with a larger number of lifetime sexual partners. CONCLUSIONS Chlamydia antibody titers were associated with tubal occlusion, prior ectopic pregnancy, and with sexual behavior, suggesting that a chlamydia infection was the major contributor to the tubal damage in these women.
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Affiliation(s)
- A. C. S. Machado
- Department of Microbiology, Immunology, Parasitology, and Pathology, Institute of Tropical Pathology and Public Health, Federal University of Goiás, Rua Delenda Resende de Mello S/N, 74605-050 Goiânia, Goiás, Brazil
| | - E. M. B. Guimarães
- Division of Adolescent Medicine, Department of Pediatrics, Faculty of Medicine, Federal University of Goiás, Setor Universitário, 74233-180 Goiânia, Goiás, Brazil
| | - E. Sakurai
- Department of Statistics, Federal University of Minas Gerais, Rua Juiz de Fora 801, 30180-060 Belo Horizonte, Minas Gerais, Brazil
| | - F. C. R. Fioravante
- Department of Microbiology, Immunology, Parasitology, and Pathology, Institute of Tropical Pathology and Public Health, Federal University of Goiás, Rua Delenda Resende de Mello S/N, 74605-050 Goiânia, Goiás, Brazil
| | - W. N. Amaral
- Department of Gynecology and Obstetrics, Faculty of Medicine, Federal University of Goiás, Setor Universitário, 74233-180 Goiânia, Goiás, Brazil
| | - M. F. C. Alves
- Department of Microbiology, Immunology, Parasitology, and Pathology, Institute of Tropical Pathology and Public Health, Federal University of Goiás, Rua Delenda Resende de Mello S/N, 74605-050 Goiânia, Goiás, Brazil
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Smellie WSA, Forth J, Sundar S, Kalu E, McNulty CAM, Sherriff E, Watson ID, Croucher C, Reynolds TM, Carey PJ. Best practice in primary care pathology: review 4. J Clin Pathol 2006; 59:893-902. [PMID: 16714397 PMCID: PMC1860479 DOI: 10.1136/jcp.2005.035212] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 01/20/2006] [Indexed: 11/04/2022]
Abstract
This fourth best practice review examines four series of common primary care questions in laboratory medicine are examined in this review: (1) safety monitoring for three common drugs; (2) use of prostate-specific antigen; (3) investigation of vaginal discharge; and (4) investigation of subfertility. The review is presented in question-answer format, referenced for each question series. The recommendations represent a precis of the guidance found using a standardised literature search of national and international guidance notes, consensus statements, health policy documents and evidence-based medicine reviews, supplemented by Medline Embase searches to identify relevant primary research documents. They are not standards but form a guide to be set in the clinical context. Most of them are consensus based rather than evidence based. They will be updated periodically to take account of new information.
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Affiliation(s)
- W S A Smellie
- Department of Chemical Pathology, Bishop Auckland General Hospital, Cockton Hill Road, Bishop Auckland, County Durham, UK.
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Forrester B, Pawade J, Horner P. The potential role of serology in diagnosing chronic lymphogranuloma venereum (LGV): a case of LGV mimicking Crohn's disease. Sex Transm Infect 2006; 82:139-40; discussion 141. [PMID: 16581740 PMCID: PMC2564686 DOI: 10.1136/sti.2005.016667] [Citation(s) in RCA: 21] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Abstract
We present the case of a 26 year old HIV positive homosexual man who was managed for suspected Crohn's disease for over 1 year before lymphogranuloma venereum (LGV) was clinically diagnosed. He had presented with constipation, secondary to acute haemorrhagic proctitis, and subsequently had two chlamydia negative rectal smears, using direct fluorescent antibody (DFA) Chlamydia trachomatis staining. Positive chlamydial serology guided retrospective testing of an early rectal biopsy, which was found to have C trachomatis by polymerase chain reaction (Roche Cobas) and identified as LGV serovar L2 by the Sexually Transmitted Bacteria Reference Laboratory (STBRL), Health Protection Agency (HPA), Colindale, London. Chlamydial serology may have a role in identifying late stage LGV infection. Although no standardised test currently exists, consideration should be given to evaluating the role of chlamydial serology in establishing a diagnosis of LGV.
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Affiliation(s)
- B Forrester
- Milne Sexual Health Centre, Bristol Royal Infirmary, United Bristol Healthcare NHS Trust, Bristol, UK
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Chernesky MA. The laboratory diagnosis of Chlamydia trachomatis infections. THE CANADIAN JOURNAL OF INFECTIOUS DISEASES & MEDICAL MICROBIOLOGY = JOURNAL CANADIEN DES MALADIES INFECTIEUSES ET DE LA MICROBIOLOGIE MEDICALE 2005; 16:39-44. [PMID: 18159527 PMCID: PMC2095010 DOI: 10.1155/2005/359046] [Citation(s) in RCA: 34] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
Lower genital tract infections with Chlamydia trachomatis are predominantly asymptomatic in men and women. Diagnostic technology has provided several approaches to the diagnosis of C trachomatis. Outside of cells, Chlamydia can die or degrade without optimal storage and transportation. Because some of the other assays perform better on certain specimen types, it is important for laboratories to recognize these differences and provide advice to physicians and nurses collecting patient specimens, with the objective of diagnosing lower genital tract infections to prevent transmission and upper tract damage. Most invasive specimens, such as cervical or urethral swabs, may be collected for culture, antigen or nucleic acid detection. Noninvasive samples such as first-void urine and vaginal swabs can be easily collected by the patient; these samples must be tested by more sensitive nucleic acid amplification tests. These newer investigative strategies should enable implementation of screening programs to identify and treat partners. Serology has not been particularly useful for the diagnosis of acute C trachomatis infections in adults. Presently, it appears that antibiotic-resistant C trachomatis is not a clinical problem. Laboratories providing C trachomatis diagnosis require participation in continuous quality improvement programs.
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Affiliation(s)
- Max A Chernesky
- Pathology and Molecular Medicine, McMaster University; Medical Microbiology, St Joseph's Healthcare, Hamilton, Ontario
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16
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Jones CS, Maple PAC, Andrews NJ, Paul ID, Caul EO. Measurement of IgG antibodies to Chlamydia trachomatis by commercial enzyme immunoassays and immunofluorescence in sera from pregnant women and patients with infertility, pelvic inflammatory disease, ectopic pregnancy, and laboratory diagnosed Chlamydia psittaci/Chlamydia pneumoniae infection. J Clin Pathol 2003; 56:225-9. [PMID: 12610104 PMCID: PMC1769898 DOI: 10.1136/jcp.56.3.225] [Citation(s) in RCA: 18] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
Abstract
BACKGROUND Screening for Chlamydia trachomatis specific antibodies is valuable in diagnosing asymptomatic pelvic inflammatory disease (PID) and tubal damage following repeated episodes of PID. The assays in current use are unsuitable for screening large numbers of samples so there is a need to develop more suitable assays. AIMS To compare the performance of several commercial C trachomatis enzyme immunoassays (EIAs) (SeroCT, C tracho(pep), Medac p-EIA, Vircell and Labsystems C trachomatis IgG EIAs) using major outer membrane protein (MOMP), an inactivated organism EIA (Genzyme Virotech EIA), and a genus specific EIA (Platelia Chlamydia IgG) with the whole cell inclusion immunofluorescence (WIF) assay. In addition, to adapt, using time resolved fluorescence technology, the assay showing the highest correlation with WIF. METHODS Ninety sera from patients presenting with ectopic pregnancies, 187 sera from those with a variety of types of infertility, 33 sera from cases of PID where a fourfold rise in WIF titre occurred, and 90 sera from antenatal clinic attenders were tested. A panel of 36 sera from laboratory diagnosed cases of Chlamydia psittaci/Chlamydia pneumoniae infection was also tested. RESULTS The Genzyme Virotech EIA showed the highest rank correlation coefficient (0.82) with WIF, particularly at high WIF titres. The MOMP specific assays varied in their correlation with WIF, with rank correlation coefficients ranging from 0.70 (Medac p-EIA) to 0.80 (Vircell EIA). The Genzyme Virotech assay showed poor specificity (5.6%; 95% confidence interval (CI), 0.68% to 18.7%)--it was reactive with 34 of the panel of 36 C psittaci/C pneumoniae positive sera. The MOMP based EIAs showed high specificity, particularly the Medac p-ELISA (97.2%; 95% CI, 85.5% to 99.9%)--only one serum was reactive. In view of the good correlation between WIF and the Genzyme Virotech EIA, a time resolved fluorescence immunoassay (TRFIA) was developed using the Genzyme Virotech antigen. Using an appropriate cut off the TRFIA assay showed excellent correlation with WIF. CONCLUSIONS The TRFIA assay may be useful as a screening assay, possibly in conjunction with one of the highly specific EIAs studied (for example, Medac p-EIA) to confirm the antibody specificity of sera selected by the screening assay.
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Affiliation(s)
- C S Jones
- Public Health Laboratory, Myrtle Road, Bristol BS2 8EL, UK
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17
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Portig I, Goodall JC, Bailey RL, Gaston JSH. Characterization of the humoral immune response to Chlamydia outer membrane protein 2 in chlamydial infection. CLINICAL AND DIAGNOSTIC LABORATORY IMMUNOLOGY 2003; 10:103-7. [PMID: 12522047 PMCID: PMC145281 DOI: 10.1128/cdli.10.1.103-107.2003] [Citation(s) in RCA: 17] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
Detection of antibodies to an outer membrane protein 2 (OMP2) by enzyme-linked immunosorbent assay (ELISA) by using either the Chlamydia trachomatis- or the Chlamydia pneumoniae-specific protein was investigated. OMP2 is an immunodominant antigen giving rise to antibody responses in humans infected with different C. trachomatis serovars (A to C and D to K) or with C. pneumoniae, which could be detected by OMP2 ELISA. OMP2 ELISA is not species specific, but antibody titers were usually higher on the homologous protein. The sensitivity of this assay was high but varied according to the "gold standard" applied. Levels of antibody to C. pneumoniae OMP2 as detected by ELISA seem to return to background or near-background values within a shorter period of time compared to antibodies to C. pneumoniae detected by microimmunofluorescence (MIF), making it more likely that positive results in ELISA reflect recent infection. Thus, OMP2 ELISA has distinct advantages over MIF and commercially available ELISAs and might be a useful tool for the serodiagnosis of chlamydial infection.
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Affiliation(s)
- I Portig
- Department of Medicine, Addenbrooke's Hospital, Cambridge, United Kingdom
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Persson K. The role of serology, antibiotic susceptibility testing and serovar determination in genital chlamydial infections. Best Pract Res Clin Obstet Gynaecol 2002; 16:801-14. [PMID: 12473283 DOI: 10.1053/beog.2002.0321] [Citation(s) in RCA: 24] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
Systemic and local antibodies regularly develop in genital infections caused by Chlamydia trachomatis. Such antibodies cannot be used as a sign of current infection as they often persist for years after the infection has resolved. Chlamydial antibodies have, however, been extremely useful for demonstrating associations between C. trachomatis and clinical conditions such as ectopic pregnancy and tubal factor infertility. In particular, antibodies to the chlamydial heat shock protein 60 predict the presence of tubal scarring.C. trachomatis has been divided into 15 (or 18) serovars, with many genotypes within each serovar. Differences in pathogenicity between serovars have been reported but no general pattern has emerged. Genotyping is a powerful epidemiological tool but is not yet ready for routine clinical use.C. trachomatis infections can be successfully treated by tetracycline or macrolides. Some resistant strains have been reported, causing treatment failures, and the problem of emerging antibiotic resistance cannot be neglected.
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Affiliation(s)
- Kenneth Persson
- Department of Clinical Microbiology, Malmö University Hospital, SE 205 02 Malmö, Sweden
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Bas S, Muzzin P, Ninet B, Bornand JE, Scieux C, Vischer TL. Chlamydial serology: comparative diagnostic value of immunoblotting, microimmunofluorescence test, and immunoassays using different recombinant proteins as antigens. J Clin Microbiol 2001; 39:1368-77. [PMID: 11283058 PMCID: PMC87941 DOI: 10.1128/jcm.39.4.1368-1377.2001] [Citation(s) in RCA: 58] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
To improve the reliability of the serodiagnosis of Chlamydia trachomatis infections, an immunoblot analysis, a microimmunofluorescence titration, and different immunoassays using synthetic peptides derived from species-specific epitopes in variable domain IV of the major outer membrane protein or recombinant antigens (heat shock protein 70 [hsp70], hsp60, hsp10, polypeptide encoded by open reading frame 3 of the plasmid [pgp3], macrophage infectivity potentiator, and a fragment of the total lipopolysaccharide) were evaluated. Because cross-reactions between chlamydial species have been reported, the microimmunofluorescence tests were also performed with Chlamydia pneumoniae and Chlamydia psittaci used as antigens, and C. pneumoniae-specific antibodies were also determined by immunoassays. Since the presence of antimicrobial antibodies must be interpreted in light of their prevalence in the general population, responses obtained with serum samples from patients with well-defined infection (i.e., with positive urethral or endocervical C. trachomatis DNA amplification) were compared to those obtained with samples from healthy blood donors. The best sensitivity (86%) with a specificity of 81% was obtained for immunoblotting results, when the number of individuals with > or =10 immunoglobulin G (IgG) and/or > or =2 IgM responses to the different C. trachomatis antigens was considered. A 13-kDa antigen was recognized by most of the samples (86% for IgG) from patients with acute urogenital infection but rarely (3%) by those from healthy blood donors (P < 0.0001). The sensitivity and specificity results obtained for serum antibodies to peptides or recombinant antigens were slightly lower than those results obtained for the number of responses to whole C. trachomatis antigens, which were 76 and 77%, respectively, when IgG responses to both recombinant hsp60 and pgp3 were considered.
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Affiliation(s)
- S Bas
- Division of Rheumatology, University Hospital, 1211 Geneva 14, Switzerland.
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Abstract
Our understanding of genitourinary chlamydial infection and disease remains limited. That natural defences and/or apparently adequate treatments leave some patients with latent disease is suspected. There is, however, no consensus as to its nature. Furthermore, many patients, most obviously males, presenting with similar or identical symptoms and signs remain unexplained in microbiological terms; this in spite of many years of dedicated research endeavour. The recent trend towards an impasse has coincided with a growing acquaintance with the immunobiology and immunopathology of chlamydial infections. The time would seem to have arrived for a reappraisal of available clinical and laboratory observations. A hypothesis with research suggestions is presented for discussion.
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Russell EG. Evaluation of two serological tests for the diagnosis of chlamydial respiratory disease. Pathology 1999; 31:403-5. [PMID: 10643015 DOI: 10.1080/003130299104819] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/17/2022]
Abstract
Serological tests for chlamydial infection are one of the most frequently used methods in the diagnosis of atypical respiratory infections. Use of serological tests has implicated chlamydial infections in asthma, arthritis and coronary heart disease, but the specificity of chlamydial serology tests has been questioned. The immunofluorescence test is the most sensitive and specific serological test available for detection of chlamydial antibodies. This study compares two commercially available immunofluorescent antibody tests. The SeroFIA test using purified elementary bodies of Chlamydia pneumoniae, C. psittaci and C. trachomatis, detected 24 cases of acute C. pneumoniae infection, whereas the Spot IF test using whole cell antigen of C. psittaci and C. trachomatis, misdiagnosed 20 of these as psittacosis and missed four cases.
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Affiliation(s)
- E G Russell
- Department of Microbiology, Monash Medical Centre, Clayton, Victoria, Australia.
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Betsou F, Sueur JM, Orfila J. Serological investigation of Chlamydia trachomatis heat shock protein 10. Infect Immun 1999; 67:5243-6. [PMID: 10496901 PMCID: PMC96876 DOI: 10.1128/iai.67.10.5243-5246.1999] [Citation(s) in RCA: 15] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
The humoral immune response to Chlamydia trachomatis 10-kDa heat shock protein (Chsp10) in populations of Russian and French origin was studied by using a recombinant Chsp10 enzyme-linked immunosorbent assay. A physiological but not a serological correlation of Chsp10 exposure with Chsp60 exposure was observed in the Russian population. In the French population studied, there was a significant association between detection of anti-r-Chsp10 immunoglobulin G (IgG) antibodies and chronic genital tract infections. Chsp10 residues 50 to 67 were found to contain an immunodominant although not universal B epitope. Cross-reactions with Chlamydia pneumoniae or Escherichia coli GroES protein are limited but may occur. Our study suggests that detection of anti-Chsp10 IgG antibodies is associated with chronicity of C. trachomatis genital tract infection and does not parallel that of anti-Chsp60 IgG antibodies.
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Affiliation(s)
- F Betsou
- Biobanque de Picardie, University Hospital, Amiens, France
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Liversedge NH, Turner A, Horner PJ, Keay SD, Jenkins JM, Hull MG. The influence of bacterial vaginosis on in-vitro fertilization and embryo implantation during assisted reproduction treatment. Hum Reprod 1999; 14:2411-5. [PMID: 10469722 DOI: 10.1093/humrep/14.9.2411] [Citation(s) in RCA: 45] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
There is growing evidence that the pathogenic effects of bacterial vaginosis may not be confined to the lower genital tract. Possible associations with infertility and effects on fertilization and implantation were studied in patients undergoing in-vitro fertilization (IVF) treatment. High vaginal swabs taken at the time of oocyte collection were assessed by Gram staining. The prevalence of bacterial vaginosis and of intermediate and normal flora in 301 patients was 25.6, 14.0 and 60.4% respectively. Bacterial vaginosis was more prevalent in patients with tubal (31.5%, n = 149) compared with non-tubal (19.7%, n = 152) infertility (odds ratio (OR) 1.87, CI 1.11-3.18, P = 0.02). Bacterial vaginosis did not have an adverse effect on fertilization rate. Further, no significant difference in implantation rates was seen when comparing bacterial vaginosis (15. 8%, OR 1.03, CI 0.66-1.61) and intermediate flora (13.1%, OR 0.82, CI 0.45-1.52) with normal flora (15.5%). Though confidence intervals around the observations were relatively wide, the findings suggest that routine screening for bacterial vaginosis in the hope of improving the success of IVF treatment is not justified. The prevention of complications in pregnancy associated with bacterial vaginosis might be a more relevant indication for screening at the time of IVF treatment, in particular patients with tubal disease, if treatment were shown to be effective for that particular purpose. However, antibiotic treatment before IVF has been shown to be positively disadvantageous for IVF by encouraging other organisms.
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Affiliation(s)
- N H Liversedge
- Department of Obstetrics and Gynaecology, St Michael's Hospital, Southwell Street, Bristol BS2 8EG, Public Health Laboratory, Bristol , UK
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