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Visnyaiová K, Varga I, Feitscherová C, Pavlíková L, Záhumenský J, Mikušová R. Morphology of the immune cells in the wall of the human uterine tube and their possible impact on reproduction-uterine tube as a possible immune privileged organ. Front Cell Dev Biol 2024; 12:1325565. [PMID: 38516130 PMCID: PMC10955054 DOI: 10.3389/fcell.2024.1325565] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/21/2023] [Accepted: 02/27/2024] [Indexed: 03/23/2024] Open
Abstract
The uterine tube, as well as other parts of the upper female reproductive system, is immunologically unique in its requirements for tolerance to allogenic sperm and semi-allogenic embryos, yet responds to an array of sexually transmitted pathogens. To understand this dichotomy, there is a need to understand the functional morphology of immune cells in the wall of the uterine tube. Thus, we reviewed scientific literature regarding immune cells and the human uterine tube by using the scientific databases. The human uterine tube has a diverse population of immunocompetent cells representing both the innate and adaptive immune systems. We describe in detail the possible roles of cells of the mononuclear phagocyte system (macrophages and dendritic cells), T and B lymphocytes, natural killer cells, neutrophils and mast cells in association with the reproductive functions of uterine tubes. We are also discussing about the possible "immune privilege" of the uterine tube, as another mechanism to tolerate sperm and embryo without eliciting an inflammatory immune response. In uterine tube is not present an anatomical blood-tissue barrier between antigens and circulation. However, the immune cells of the uterine tube probably represent a type of "immunological barrier," which probably includes the uterine tube among the immunologically privileged organs. Understanding how immune cells in the female reproductive tract play roles in reproduction is essential to understand not only the mechanisms of gamete transport and fertilization as well as embryo transport through the uterine tube, but also in improving results from assisted reproduction.
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Affiliation(s)
- Kristína Visnyaiová
- Second Department of Gynecology and Obstetrics, Faculty of Medicine, Comenius University in Bratislava and University Hospital, Bratislava, Slovakia
| | - Ivan Varga
- Institute of Histology and Embryology, Faculty of Medicine, Comenius University in Bratislava, Bratislava, Slovakia
| | - Claudia Feitscherová
- Institute of Histology and Embryology, Faculty of Medicine, Comenius University in Bratislava, Bratislava, Slovakia
| | - Lada Pavlíková
- Department of Rehabilitation Studies, Faculty of Health Care Studies, University of Western Bohemia, Pilsen, Czechia
| | - Jozef Záhumenský
- Second Department of Gynecology and Obstetrics, Faculty of Medicine, Comenius University in Bratislava and University Hospital, Bratislava, Slovakia
| | - Renáta Mikušová
- Institute of Histology and Embryology, Faculty of Medicine, Comenius University in Bratislava, Bratislava, Slovakia
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Ji JS, Liu L, Huang H, Chen HW, Xiao L, Lu XY, Ni YY, Jia WJ, Huang L. The body mass index and the risk of ectopic pregnancy: a 5-year retrospective case-control study. BMC Pregnancy Childbirth 2024; 24:143. [PMID: 38368325 PMCID: PMC10873945 DOI: 10.1186/s12884-024-06319-z] [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: 03/13/2023] [Accepted: 02/04/2024] [Indexed: 02/19/2024] Open
Abstract
PURPOSE Acknowledging the associated risk factors may have a positive impact on reducing the incidence of ectopic pregnancy (EP). In recent years, body mass index (BMI) has been mentioned in research. However, few studies are available and controversial on the relationship between EP and BMI. METHODS We retrospectively studied the EP women as a case group and the deliveries as a control group in the central hospital of Wuhan during 2017 ~ 2021. χ2 test of variables associated with ectopic pregnancy was performed to find differences. Univariate and multivariate binary logistic regression analysis was conducted to analyze the association of the variables of age, parity, history of induced abortion, history of ectopic pregnancy, history of spontaneous abortion, history of appendectomy surgery and BMI (< 18.5 kg/m2, 18.5 ~ 24.9 kg/m2, 25 kg/m2 ~ 29.9 kg/m2, ≥ 30 kg /m2) with EP. RESULTS They were 659 EP and 1460 deliveries. The variables of age, parity, history of induced abortion, history of ectopic pregnancy and BMI were different significantly(P < 0.05). Multivariate analysis showed that the variables of age > 35 years old [(OR (Odds Ratio), 5.415; 95%CI (Confidence Interval), 4.006 ~ 7.320, P < 0.001], history of ectopic pregnancy (OR, 3.944; 95%CI, 2.405 ~ 6.467; P < 0.001), history of induced abortion(OR, 3.365; 95%CI, 2.724 ~ 4.158, P < 0.001) and low BMI (< 18.5 kg/m2) (OR, 1.929; 95%CI, 1.416 ~ 2.628, P < 0.001])increased the risk of EP. CONCLUSION The history of ectopic pregnancy, history of induced abortion and age > 35 years old were the risk factors with EP. In addition to these traditional factors, we found low BMI (< 18.5 kg/m2) with women may increase the risk to EP.
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Affiliation(s)
- Jin-Shuang Ji
- Department of Gynecology & Obstetrics, Tongji Medical College, The Central Hospital of Wuhan, Huazhong University of Science and Technology, Wuhan, 430014, Hubei, China
| | - Ling Liu
- The Diagnosis and Therapy Center of Pelvic Floor Rehabilitation and Electrophysiology, Tongji Medical College, The Central Hospital of Wuhan, Huazhong University of Science and Technology, Wuhan, 430014, Hubei, China
| | - Huan Huang
- Department of Gynecology & Obstetrics, Tongji Medical College, The Central Hospital of Wuhan, Huazhong University of Science and Technology, Wuhan, 430014, Hubei, China
| | - Hong-Wei Chen
- Department of Gynecology & Obstetrics, Tongji Medical College, The Central Hospital of Wuhan, Huazhong University of Science and Technology, Wuhan, 430014, Hubei, China
| | - Li Xiao
- Department of Gynecology & Obstetrics, Tongji Medical College, The Central Hospital of Wuhan, Huazhong University of Science and Technology, Wuhan, 430014, Hubei, China
- The Diagnosis and Therapy Center of Pelvic Floor Rehabilitation and Electrophysiology, Tongji Medical College, The Central Hospital of Wuhan, Huazhong University of Science and Technology, Wuhan, 430014, Hubei, China
| | - Xiang-Yi Lu
- Department of Gynecology & Obstetrics, Tongji Medical College, The Central Hospital of Wuhan, Huazhong University of Science and Technology, Wuhan, 430014, Hubei, China
| | - Yang-Yang Ni
- Department of Gynecology & Obstetrics, Tongji Medical College, The Central Hospital of Wuhan, Huazhong University of Science and Technology, Wuhan, 430014, Hubei, China
| | - Wen-Juan Jia
- Department of Gynecology & Obstetrics, Tongji Medical College, The Central Hospital of Wuhan, Huazhong University of Science and Technology, Wuhan, 430014, Hubei, China
| | - Lei Huang
- Department of Gynecology & Obstetrics, Tongji Medical College, The Central Hospital of Wuhan, Huazhong University of Science and Technology, Wuhan, 430014, Hubei, China.
- The Diagnosis and Therapy Center of Pelvic Floor Rehabilitation and Electrophysiology, Tongji Medical College, The Central Hospital of Wuhan, Huazhong University of Science and Technology, Wuhan, 430014, Hubei, China.
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Armijo-Sánchez A, Santamaría-López E, Fernández-Sánchez M, Galiano-Gutiérrez N, Mantrana-Bermejo E. Sequential-contingent strategy for fallopian tube evaluation using hysterosalpingo foam sonography: a cost analysis. Quant Imaging Med Surg 2024; 14:540-547. [PMID: 38223069 PMCID: PMC10784089 DOI: 10.21037/qims-23-816] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/07/2023] [Accepted: 10/30/2023] [Indexed: 01/16/2024]
Abstract
Background Tubal pathology is the etiological factor in 20% of couples with female infertility. Historically, diagnostic evaluation of the fallopian tubes has been performed by means of hysterosalpingography (HSG). Hysterosonosalpingography with EXEM® foam is a recent technique with supposedly comparable effectiveness to HSG, but with better tolerability for patients. Methods Tubal patency was assessed in patients who were candidates for intrauterine insemination (IUI) between January 2020 and July 2021. (I) Hysterosonosalpingography with EXEM® foam. (II) If the patient had both tubes patent, IUI was proposed. In case of inconclusive or pathological results, HSG was performed. (III) If the HSG concludes tubal patency, IUI is proposed. On the other hand, if it results in tubal obstruction, in vitro fertilization (IVF) is proposed. Results Assessment of tubal patency by HSG showed concordance with previous Hysterosonosalpingography with EXEM® foam results in 45.5% (n=15) of cases of unilateral obstruction and 66.7% (n=6) of cases of bilateral obstruction. When we compare the total cost of HSG (€54,899.46) with the sum of patients who only required Hysterosonosalpingography with EXEM® foam together with those who underwent both tests (€45,575.96), it shows that the latter represents a cost benefit strategy (cost difference €9,323.50). Conclusions Our results suggest a benefit of €9,323.50 when performing the contingent sequential strategy, in case of pathological or inconclusive results, compared to performing a systematic HSG in all patients. Patients with an obstructive hysterosalpingogram with EXEM® and a patent hysterosalpingogram will be the subgroup that will benefit the most, as IUI can be proposed instead of IVF. In addition, there is a benefit in terms of optimizing the medical procedure, hospital visits and speeding up the time to start assisted reproductive technology (ART).
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Affiliation(s)
- Alberto Armijo-Sánchez
- Department of Obstetrics and Gynecology, Valme University Hospital, Seville, Spain
- Research Department, IVI-RMA Seville, Seville, Spain
- IVI Foundation, Health Research Institute La Fe (IIS La Fe), Valencia, Spain
| | - Esther Santamaría-López
- Research Department, IVI-RMA Seville, Seville, Spain
- IVI Foundation, Health Research Institute La Fe (IIS La Fe), Valencia, Spain
| | - Manuel Fernández-Sánchez
- Research Department, IVI-RMA Seville, Seville, Spain
- IVI Foundation, Health Research Institute La Fe (IIS La Fe), Valencia, Spain
- Department of Molecular Biology and Biochemical Engineering, Pablo de Olavide University, Seville, Spain
- Department of Surgery, Sevilla University, Seville, Spain
| | - Noelia Galiano-Gutiérrez
- Research Department, IVI-RMA Seville, Seville, Spain
- IVI Foundation, Health Research Institute La Fe (IIS La Fe), Valencia, Spain
| | - Elena Mantrana-Bermejo
- Department of Obstetrics and Gynecology, Valme University Hospital, Seville, Spain
- Research Department, IVI-RMA Seville, Seville, Spain
- IVI Foundation, Health Research Institute La Fe (IIS La Fe), Valencia, Spain
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Groene EA, Norby FL, Eaton AA, Mason SM, Enns EA, Kulasingam S, Vock DM. Diagnosed Gonorrhea Among Privately Insured Women: Analysis of United States Claims Data. J Womens Health (Larchmt) 2023; 32:942-949. [PMID: 37384920 PMCID: PMC10510688 DOI: 10.1089/jwh.2023.0006] [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] [Indexed: 07/01/2023] Open
Abstract
Background: Gonorrhea incidence in the United States has risen by nearly 50% in the last decade, while screening rates have increased. Gonorrhea sequelae rates could indicate whether increased gonorrhea incidence is due to better screening. We estimated the association of gonorrhea diagnosis with pelvic inflammatory disease (PID), ectopic pregnancy (EP), and tubal factor infertility (TFI) in women and detected changes in associations over time. Materials and Methods: This retrospective cohort study included 5,553,506 women aged 18-49 tested for gonorrhea in the IBM MarketScan claims administrative database from 2013-2018 in the United States. We estimated incidence rates and hazard ratios (HRs) of gonorrhea diagnosis for each outcome, adjusting for potential confounders using Cox proportional hazards models. We tested the interaction between gonorrhea diagnosis and the initial gonorrhea test year to identify changes in associations over time. Results: We identified 32,729 women with a gonorrhea diagnosis (mean follow-up time in years: PID = 1.73, EP = 1.75, TFI = 1.76). A total of 131,500 women were diagnosed with PID, 64,225 had EP, and 41,507 had TFI. Women with gonorrhea diagnoses had greater incidence per 1000 person-years for all outcomes (PID = 33.5, EP = 9.4, TFI = 5.3) compared to women without gonorrhea diagnoses (PID = 13.9, EP = 6.7, TFI = 4.3). After adjustment, HRs were higher in women with a gonorrhea diagnosis vs. those without [PID = 2.29 (95% confidence interval, CI: 2.15-2.44), EP = 1.57, (95% CI: 1.41-1.76), TFI = 1.70 (95% CI: 1.47-1.97)]. The interaction of gonorrhea diagnosis and test year was not significant, indicating no change in relationship by initial test year. Conclusion: The relationship between gonorrhea and reproductive outcomes has persisted, suggesting a higher disease burden.
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Affiliation(s)
- Emily A. Groene
- Division of Epidemiology and Community Health, University of Minnesota School of Public Health, Minneapolis, Minnesota, USA
| | - Faye L. Norby
- Department of Cardiology, Smidt Heart Institute, Cedars-Sinai Health System, Los Angeles, California, USA
| | - Anne A. Eaton
- Divisions of Biostatistics and University of Minnesota School of Public Health, Minneapolis, Minnesota, USA
| | - Susan M. Mason
- Division of Epidemiology and Community Health, University of Minnesota School of Public Health, Minneapolis, Minnesota, USA
| | - Eva A. Enns
- Divisions of Health Policy and Management, University of Minnesota School of Public Health, Minneapolis, Minnesota, USA
| | - Shalini Kulasingam
- Division of Epidemiology and Community Health, University of Minnesota School of Public Health, Minneapolis, Minnesota, USA
| | - David M. Vock
- Divisions of Biostatistics and University of Minnesota School of Public Health, Minneapolis, Minnesota, USA
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Zhao L, Lundy SR, Eko FO, Igietseme JU, Omosun YO. Genital tract microbiome dynamics are associated with time of Chlamydia infection in mice. Sci Rep 2023; 13:9006. [PMID: 37268696 PMCID: PMC10238418 DOI: 10.1038/s41598-023-36130-3] [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: 02/17/2023] [Accepted: 05/30/2023] [Indexed: 06/04/2023] Open
Abstract
We have previously shown that the time of Chlamydia infection was crucial in determining the chlamydial infectivity and pathogenesis. This study aims to determine whether the time of Chlamydia infection affects the genital tract microbiome. This study analyzed mice vaginal, uterine, and ovary/oviduct microbiome with and without Chlamydia infection. The mice were infected with Chlamydia at either 10:00 am (ZT3) or 10:00 pm (ZT15). The results showed that mice infected at ZT3 had higher Chlamydia infectivity than those infected at ZT15. There was more variation in the compositional complexity of the vaginal microbiome (alpha diversity) of mice infected at ZT3 than those mice infected at ZT15 throughout the infection within each treatment group, with both Shannon and Simpson diversity index values decreased over time. The analysis of samples collected four weeks post-infection showed that there were significant taxonomical differences (beta diversity) between different parts of the genital tract-vagina, uterus, and ovary/oviduct-and this difference was associated with the time of infection. Firmicutes and Proteobacteria were the most abundant phyla within the microbiome in all three genital tract regions for all the samples collected during this experiment. Additionally, Firmicutes was the dominant phylum in the uterine microbiome of ZT3 Chlamydia infected mice. The results show that the time of infection is associated with the microbial dynamics in the genital tract. And this association is more robust in the upper genital tract than in the vagina. This result implies that more emphasis should be placed on understanding the changes in the microbial dynamics of the upper genital tract over the course of infection.
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Affiliation(s)
- Lihong Zhao
- Department of Applied Mathematics, University of California, Merced, Merced, CA, USA.
| | - Stephanie R Lundy
- Duke Human Vaccine Institute, Durham, NC, USA
- Division of STD Prevention, NCHHSTP, Centers for Disease Control and Prevention, Atlanta, Georgia, USA
| | - Francis O Eko
- Department of Microbiology, Biochemistry and Immunology, Morehouse School of Medicine, Atlanta, GA, USA
| | - Joeseph U Igietseme
- Molecular Pathogenesis Laboratory, NCEZID, Centers for Disease Control and Prevention, Atlanta, GA, USA
| | - Yusuf O Omosun
- Department of Microbiology, Biochemistry and Immunology, Morehouse School of Medicine, Atlanta, GA, USA.
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Wood SM, Fiks AG. Growing Evidence Supports an Implementation Shift Toward Vaginal Sampling for Chlamydia trachomatis, Neisseria gonorrhoeae, and Trichomonas vaginalis Screening. Ann Fam Med 2023; 21:100-102. [PMID: 36973048 PMCID: PMC10042558 DOI: 10.1370/afm.2959] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/19/2023] [Accepted: 01/25/2023] [Indexed: 03/29/2023] Open
Affiliation(s)
- Sarah M Wood
- Department of Pediatrics, Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania
- Division of Adolescent Medicine, Children's Hospital of Philadelphia, Philadelphia, Pennsylvania
- Clinical Futures, Children's Hospital of Philadelphia, Philadelphia, Pennsylvania
| | - Alexander G Fiks
- Department of Pediatrics, Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania
- Clinical Futures, Children's Hospital of Philadelphia, Philadelphia, Pennsylvania
- Division of General Pediatrics, Children's Hospital of Philadelphia, Philadelphia, Pennsylvania
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7
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Li P, Chen Z. Association between serum Chlamydia trachomatis antibody levels and infertility among reproductive-aged women in the U.S. Front Public Health 2023; 11:1117245. [PMID: 37089503 PMCID: PMC10113615 DOI: 10.3389/fpubh.2023.1117245] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/06/2022] [Accepted: 03/21/2023] [Indexed: 04/25/2023] Open
Abstract
Introduction Chlamydia trachomatis infection, the most prevalent sexually transmitted bacterial infection worldwide, is a significant cause of infertility. Many countries have introduced the widespread use of serologic assays for IgG seropositivity to chlamydial plasmid gene product 3 (Pgp3). However, data on the association between the level of Pgp3-IgG in the multiplex bead array assay (Pgp3AbMBA) and female infertility are still scarce. Methods This cross-sectional analysis included 1,425 women from the National Health and Nutrition Examination Survey (NHANES) from 2013 to 2016. Results In the fully adjusted logistic regression model, each standard deviation increments of Pgp3AbMBA (SD = 17,079.63) led to a 28% increase in the risk of infertility. The relationship remained consistent in women who had been pregnant and women who gave birth. Smooth curve fitting revealed that the association was linear across the entire range of Pgp3AbMBA. Subgroup analysis suggested that the association was significantly stronger in women who had ever used marijuana and lived in poverty. Conclusions This study revealed a linear and independent association between the level of Pgp3AbMBA and self-reported infertility in U.S. women. Furthermore, we found that women who had ever used marijuana and lived in poverty were at the highest risk of infertility upon chlamydial infection.
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Obress L, Berke O, Fisman DN, Raju S, Tuite AR, Varia M, Greer AL. Estimating the test-adjusted incidence of Chlamydia trachomatis infections identified through Public Health Ontario Laboratories in Peel region, Ontario, 2010-2018: a population-based study. CMAJ Open 2023; 11:E62-E69. [PMID: 36693657 PMCID: PMC9876583 DOI: 10.9778/cmajo.20210236] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/26/2023] Open
Abstract
BACKGROUND Public health guidelines for chlamydia testing are not sex specific, but young females test at a disproportionally higher rate than males and other age groups. This study aims to describe testing trends across age and sex subgroups, then estimate a test-adjusted incidence of chlamydia in these subgroups to identify gaps in current testing practices. METHODS We used a population-based study to examine observed chlamydia rates by age and sex subgroups: 15-19 years, 20-29 years, 30-39 years and older than 40 years. The study included diagnostic test results recorded by Public Health Ontario Laboratories between Jan. 1, 2010, and Dec. 31, 2018, for individuals living in Peel region, Ontario. We then employed meta-regression models as a method of standardization to estimate the effect of sex and age on standardized morbidity ratio, testing ratio and test positivity, then calculate a test-adjusted incidence of chlamydia for each subgroup. RESULTS Over the study period, infection, testing and test positivity varied across age and sex subgroups. Observed incidence and testing were highest in females aged 20-29 years, whereas males had the highest standardized test positivity across all age groups. After estimating test-adjusted incidence for each age-sex subgroup, males in the 15-19-year and 30-39-year age groups had an increase in incidence of 60.2% and 9.7%, respectively, compared with the observed incidence. INTERPRETATION We found that estimated test-adjusted incidence was higher than observed incidence in males aged 15-19 years and 30-39 years. This suggests that infections in males are likely being missed owing to differential testing, and this may be contributing to the persistent increase in reported cases in Canada. Public health programming that targets males, especially in high-risk settings and communities, and use of innovative partner notification methods could be critical to curbing overall rates of chlamydia.
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Affiliation(s)
- Lindsay Obress
- Department of Population Medicine (Obress, Berke, Greer), University of Guelph, Guelph, Ont.; Dalla Lana School of Public Health (Fisman, Tuite, Greer), University of Toronto, Toronto, Ont.; Peel Public Health (Raju, Varia), Mississauga, Ont
| | - Olaf Berke
- Department of Population Medicine (Obress, Berke, Greer), University of Guelph, Guelph, Ont.; Dalla Lana School of Public Health (Fisman, Tuite, Greer), University of Toronto, Toronto, Ont.; Peel Public Health (Raju, Varia), Mississauga, Ont
| | - David N Fisman
- Department of Population Medicine (Obress, Berke, Greer), University of Guelph, Guelph, Ont.; Dalla Lana School of Public Health (Fisman, Tuite, Greer), University of Toronto, Toronto, Ont.; Peel Public Health (Raju, Varia), Mississauga, Ont
| | - Shilpa Raju
- Department of Population Medicine (Obress, Berke, Greer), University of Guelph, Guelph, Ont.; Dalla Lana School of Public Health (Fisman, Tuite, Greer), University of Toronto, Toronto, Ont.; Peel Public Health (Raju, Varia), Mississauga, Ont
| | - Ashleigh R Tuite
- Department of Population Medicine (Obress, Berke, Greer), University of Guelph, Guelph, Ont.; Dalla Lana School of Public Health (Fisman, Tuite, Greer), University of Toronto, Toronto, Ont.; Peel Public Health (Raju, Varia), Mississauga, Ont
| | - Monali Varia
- Department of Population Medicine (Obress, Berke, Greer), University of Guelph, Guelph, Ont.; Dalla Lana School of Public Health (Fisman, Tuite, Greer), University of Toronto, Toronto, Ont.; Peel Public Health (Raju, Varia), Mississauga, Ont
| | - Amy L Greer
- Department of Population Medicine (Obress, Berke, Greer), University of Guelph, Guelph, Ont.; Dalla Lana School of Public Health (Fisman, Tuite, Greer), University of Toronto, Toronto, Ont.; Peel Public Health (Raju, Varia), Mississauga, Ont.
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Bonett S, Teixeira da Silva D, Lazar N, Makeneni S, Wood S. Trends in sexually transmitted infection screening during COVID-19 and missed cases among adolescents. Public Health 2022; 213:171-176. [PMID: 36423495 PMCID: PMC9576220 DOI: 10.1016/j.puhe.2022.10.007] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/03/2022] [Revised: 09/30/2022] [Accepted: 10/04/2022] [Indexed: 11/22/2022]
Abstract
OBJECTIVE The COVID-19 pandemic disrupted sexual health services for young people, with potential consequences of decreasing preventive screening and increasing undiagnosed sexually transmitted infections (STIs). This study aimed to assess trends in asymptomatic screening among patients receiving STI testing and to estimate the number of STI cases that were missed during the early months of the pandemic. STUDY DESIGN A cross-sectional study of electronic health records for chlamydia, gonorrhea, and trichomonas testing encounters from six pediatric primary care clinics in Philadelphia, July 2014 to November 2020. METHODS A total of 35,548 testing encounters were analyzed, including 2958 during the pandemic. We assessed whether testing at each encounter was performed as asymptomatic screening, risk-based testing, or symptomatic testing. We evaluated screening trends over time and estimated the number of missed STI cases during the pandemic. RESULTS The mean monthly testing encounters decreased from 479 per month prepandemic to 329 per month during the pandemic. The percent of tests performed as asymptomatic screening dropped from 72.5% prepandemic to a nadir of 54.5% in April 2020. We estimate that this decrease in asymptomatic screening would represent 159 missed cases (23.8% of expected cases) based on patient volume from the previous year. CONCLUSIONS During the pandemic, the total volume of STI testing encounters and the proportion of tests performed as asymptomatic screening decreased, potentially resulting in missed diagnoses. Undiagnosed STIs can result in severe sequelae and contribute to community transmission of STIs. Efforts are needed to re-establish and sustain access to STI services for adolescents in response to disruptions caused by the pandemic.
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Affiliation(s)
- S. Bonett
- School of Nursing, University of Pennsylvania, USA,Corresponding author. School of Nursing, University of Pennsylvania, 418 Curie Blvd, Philadelphia, PA, 19104, USA. Tel.: +215-573-4299
| | | | - N. Lazar
- Perelman School of Medicine, University of Pennsylvania, USA,Craig-Dalsimer Division of Adolescent Medicine, Children's Hospital of Philadelphia, USA
| | - S. Makeneni
- PolicyLab, Children's Hospital of Philadelphia, USA
| | - S.M. Wood
- Perelman School of Medicine, University of Pennsylvania, USA,Craig-Dalsimer Division of Adolescent Medicine, Children's Hospital of Philadelphia, USA,PolicyLab, Children's Hospital of Philadelphia, USA
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10
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Cortes E, Montero B, Yuguero O. Chlamydia trachomatis Infection Could Be a Risk Factor for Infertility in Women: A Prospective Descriptive Study. Cureus 2022; 14:e30697. [DOI: 10.7759/cureus.30697] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 10/26/2022] [Indexed: 11/06/2022] Open
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Association between Chlamydial Infection with Ectopic and Full-Term Pregnancies: A Case-Control Study. Trop Med Infect Dis 2022; 7:tropicalmed7100285. [PMID: 36288026 PMCID: PMC9609621 DOI: 10.3390/tropicalmed7100285] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/01/2022] [Revised: 10/01/2022] [Accepted: 10/02/2022] [Indexed: 11/05/2022] Open
Abstract
Ectopic pregnancies (EPs) are potentially fatal if not recognized early. Evidence of an association with chlamydial infection in South East Asia is lacking. This case-control study aims to (i) compare chlamydial infection in women with EP to women who delivered a full-term pregnancy, (ii) investigate classical factors associated with EP, and (iii) investigate rupture status in EP. Seventy-two women with a confirmed diagnosis of EP and sixty-nine who delivered a full-term pregnancy in a tertiary hospital in Malaysia were recruited from November 2019 to January 2022. Demographic and relevant clinical data and intraoperative findings were documented. Blood samples for testing IgG levels of chlamydia were obtained. Women with EP were more likely to have tested positive for chlamydia than those with a full-term delivery (34.7% vs. 13.0%, AOR = 4.18, 95% CI = 1.67-10.48, p = 0.002). The majority did not have the classic risk factors associated with EP. An amount of 52.8% presented with a ruptured EP, with 84.2% of ruptures occurring after six weeks of gestation. An amount of 44.2% had an estimated blood loss of more than 500 cc, with 20% losing more than 1500 cc of blood. The prevalence of prior chlamydial infection in women with EP is significant enough to necessitate a review of early pregnancy care.
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Borges ÁH, Follmann F, Dietrich J. Chlamydia trachomatis vaccine development - a view on the current challenges and how to move forward. Expert Rev Vaccines 2022; 21:1555-1567. [PMID: 36004386 DOI: 10.1080/14760584.2022.2117694] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
Abstract
INTRODUCTION Chlamydia trachomatis is the most common sexually transmitted bacterial pathogen in the world. A licensed vaccine is not yet available, but the first vaccines have entered clinical trials. AREAS COVERED : We describe the progress that has been made in our understanding of the type of immunity that a protective vaccine should induce, and the challenges that vaccine developers face. We also focus on the clinical development of a chlamydia vaccine. The first chlamydia vaccine candidate has now been tested in a clinical phase-I trial, and another phase-I trial is currently running. We discuss what it will take to continue this development and what future trial setups could look like. EXPERT OPINION The chlamydia field is coming of age and the first phase I clinical trial of a C. trachomatis vaccine has been successfully completed. We expect and hope that this will motivate various stakeholders to support further development of chlamydia vaccines in humans.
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Affiliation(s)
- Álvaro H Borges
- Statens Serum Institut, Department of Infectious Diseases Immunology, Kobenhavn, 2300 Denmark
| | | | - Jes Dietrich
- Statens Serum Institut, Department of Infectious Diseases Immunology, Kobenhavn, 2300 Denmark
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13
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dos Santos LM, de Souza JD, Mbakwa HA, Nobre AFS, Vieira RC, Ferrari SF, Rodrigues AR, Ishikawa EAY, Guerreiro JF, de Sousa MS. High prevalence of sexual infection by human papillomavirus and Chlamydia trachomatis in sexually-active women from a large city in the Amazon region of Brazil. PLoS One 2022; 17:e0270874. [PMID: 35849577 PMCID: PMC9292084 DOI: 10.1371/journal.pone.0270874] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/02/2021] [Accepted: 06/07/2022] [Indexed: 11/18/2022] Open
Abstract
BACKGROUND The Human Papillomavirus (HPV) and Chlamydia trachomatis are the most prevalent Sexually Transmitted Infections (STIs) worldwide, and are associated cervical cancer and pelvic inflammatory disease, respectively. However, 80% of women testing positive are asymptomatic. In the Amazon region, young women, in particular, are widely exposed to the infections and their consequences. OBJECTIVES Determine the prevalence of sexual infection by HPV and C. trachomatis in young, sexually-active women treated at a university health program in a large city of the Brazilian Amazon region. METHODS We amplified the L1 gene of HPV. We amplified ompA gene of C. trachomatis by nested PCR, and the study participants filled in a questionnaire on their social, epidemiological, and reproductive health characteristics. The data were analyzed using the Odds Ratio, to evaluate the degree of association of these variables with the observed infections. RESULTS The prevalence of infection by HPV was 15.5% (47/303). This infection was recorded in 32.2% of the women of less than 25 years of age (OR:3.02 [CI95%] = 1.32-6.92; p = 0.014), 17.9% of the single women (OR: 2.41 [CI95%] = 1.22-4.75; p = 0.014), 23.8% of the women that reported having first sexual intercourse at less than 15 years of age (OR: 2.22 [CI95%] = 1.16-4.23; p = 0.021), 20% of those that reported having had more than one sexual partner during their lifetime (OR: 3.83 [CI95%] = 1.56-9.37; p = 0.003), and in 28.3% that use oral contraceptives (CI95% = 1.33-5.43; p = 0.008). The prevalence of sexual infection by C. trachomatis was 4.6% (14/303), and this bacterium was present in 16.1% of the young women of less than 25 years of age (OR: 2.86 [CI95%] = 1.33-5.43; p = 0.008). CONCLUSIONS We found a high prevalence of HPV in young, unmarried women who started their sex lives early, who had several sexual partners in their lives and who used oral contraceptives. The prevalence of C. trachomatis was high only in young women. Our data are in accordance with other studies in Brazil and in the world and may serve to base the formulation of diagnostic and screening measures for these infections in women in the Amazon.
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Affiliation(s)
- Leonardo Miranda dos Santos
- Laboratory of Molecular and Cellular Biology, Tropical Medicine Center, Universidade Federal do Pará, Belém, Pará, Brazil
- Tropical Medicine Center, Universidade Federal do Pará, Belém, Pará, Brazil
- * E-mail:
| | | | - Hilary Acha Mbakwa
- Graduation in Medicine, Universidade Federal do Pará, Belém, Pará, Brazil
| | - Akim Felipe Santos Nobre
- Laboratory of Molecular and Cellular Biology, Tropical Medicine Center, Universidade Federal do Pará, Belém, Pará, Brazil
| | - Rodrigo Covre Vieira
- Laboratory of Molecular and Cellular Biology, Tropical Medicine Center, Universidade Federal do Pará, Belém, Pará, Brazil
| | | | | | - Edna Aoba Yassui Ishikawa
- Laboratory of Molecular and Cellular Biology, Tropical Medicine Center, Universidade Federal do Pará, Belém, Pará, Brazil
| | | | - Maísa Silva de Sousa
- Laboratory of Molecular and Cellular Biology, Tropical Medicine Center, Universidade Federal do Pará, Belém, Pará, Brazil
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14
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Wood SK, Ford K, Madden HCE, Sharp CA, Hughes KE, Bellis MA. Adverse Childhood Experiences and Their Relationship with Poor Sexual Health Outcomes: Results from Four Cross-Sectional Surveys. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2022; 19:8869. [PMID: 35886718 PMCID: PMC9316235 DOI: 10.3390/ijerph19148869] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 06/22/2022] [Revised: 07/05/2022] [Accepted: 07/05/2022] [Indexed: 02/04/2023]
Abstract
Improving understanding of risk factors for risky sexual behaviour is fundamental to achieve better population sexual health. Exposure to adverse childhood experiences (ACEs) can increase the risk of poor sexual health outcomes, but most research is US-based. This study explored associations between ACEs and poor sexual health outcomes in the UK. Data from four cross-sectional ACE surveys with adult general populations in different regions of the UK from 2013−2015 (n = 12,788) were analysed. Data included participants’ demographics, ACE exposure, and four sexual health outcomes: having early sex (<16 years), having an accidental teenage pregnancy, becoming a teenage parent, or having a lifetime diagnosis of a sexually transmitted infection. ACE count was a consistent and significant predictor of all four sexual health outcomes for both males and females, with odds of these outcomes between three and seven times higher for those with 4+ ACEs compared to those with no ACEs. Increased risks of some, but not all, sexual health outcomes were also found with higher residential deprivation, younger age, being of white ethnicity, and being born to a teenage mother. Findings highlight the need for effective interventions to prevent and ameliorate the lifelong effects of ACEs. Trauma-informed relationships and sex education, sexual health services, and antenatal/postnatal services, particularly for teenagers and young parents, could provide opportunities to prevent ACEs and support those affected. Ensuring that those living in deprived areas have access to services and that barriers to uptake are addressed is also key.
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Affiliation(s)
- Sara K. Wood
- Policy and International Health, World Health Organization Collaborating Centre on Investment for Health and Well-Being, Public Health Wales, Wrexham LL13 7YP, UK; (K.E.H.); (M.A.B.)
| | - Kat Ford
- Public Health Collaborating Unit, School of Medical and Health Sciences, College of Human Sciences, Bangor University, Wrexham LL13 7YP, UK;
| | - Hannah C. E. Madden
- School of Social Sciences, Liverpool Hope University, Hope Park, Liverpool L6 1HP, UK;
| | - Catherine A. Sharp
- Applied Sports, Technology, Exercise and Medicine Research Centre, Faculty of Science and Engineering, Swansea University, Swansea SA1 8EN, UK;
| | - Karen E. Hughes
- Policy and International Health, World Health Organization Collaborating Centre on Investment for Health and Well-Being, Public Health Wales, Wrexham LL13 7YP, UK; (K.E.H.); (M.A.B.)
- Public Health Collaborating Unit, School of Medical and Health Sciences, College of Human Sciences, Bangor University, Wrexham LL13 7YP, UK;
| | - Mark A. Bellis
- Policy and International Health, World Health Organization Collaborating Centre on Investment for Health and Well-Being, Public Health Wales, Wrexham LL13 7YP, UK; (K.E.H.); (M.A.B.)
- Public Health Collaborating Unit, School of Medical and Health Sciences, College of Human Sciences, Bangor University, Wrexham LL13 7YP, UK;
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15
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Lee Y, Bohlin J, Page CM, Nustad HE, Harris JR, Magnus P, Jugessur A, Magnus MC, Håberg SE, Hanevik HI. Associations between epigenetic age acceleration and infertility. Hum Reprod 2022; 37:2063-2074. [PMID: 35771672 PMCID: PMC9433848 DOI: 10.1093/humrep/deac147] [Citation(s) in RCA: 9] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/05/2022] [Revised: 06/12/2022] [Indexed: 12/17/2022] Open
Abstract
STUDY QUESTION Is the use of ART, a proxy for infertility, associated with epigenetic age acceleration? SUMMARY ANSWER The epigenetic age acceleration measured by Dunedin Pace of Aging methylation (DunedinPoAm) differed significantly between non-ART and ART mothers. WHAT IS KNOWN ALREADY Among mothers who used ART, epigenetic age acceleration may be associated with low oocyte yield and poor ovarian response. However, the difference in epigenetic age acceleration between non-ART and ART mothers (or even fathers) has not been examined. STUDY DESIGN, SIZE, DURATION The Norwegian Mother, Father and Child Cohort Study (MoBa) recruited pregnant women and their partners across Norway at around 18 gestational weeks between 1999 and 2008. Approximately 95 000 mothers, 75 000 fathers and 114 000 children were included. Peripheral blood samples were taken from mothers and fathers at ultrasound appointments or from mothers at childbirth, and umbilical cord blood samples were collected from the newborns at birth. PARTICIPANTS/MATERIALS, SETTING, METHODS Among the MoBa participants, we selected 1000 couples who conceived by coitus and 894 couples who conceived by IVF (n = 525) or ICSI (n = 369). We measured their DNA methylation (DNAm) levels using the Illumina MethylationEPIC array and calculated epigenetic age acceleration. A linear mixed model was used to examine the differences in five different epigenetic age accelerations between non-ART and ART parents. MAIN RESULTS AND THE ROLE OF CHANCE We found a significant difference in the epigenetic age acceleration calculated by DunedinPoAm between IVF and non-ART mothers (0.021 years, P-value = 2.89E−06) after adjustment for potential confounders. Further, we detected elevated DunedinPoAm in mothers with tubal factor infertility (0.030 years, P-value = 1.34E−05), ovulation factor (0.023 years, P-value = 0.0018) and unexplained infertility (0.023 years, P-value = 1.39E−04) compared with non-ART mothers. No differences in epigenetic age accelerations between non-ART and ICSI fathers were found. DunedinPoAm also showed stronger associations with smoking, education and parity than the other four epigenetic age accelerations. LIMITATIONS, REASONS FOR CAUTION We were not able to determine the directionality of the causal pathway between the epigenetic age accelerations and infertility. Since parents’ peripheral blood samples were collected after conception, we cannot rule out the possibility that the epigenetic profile of ART mothers was influenced by the ART treatment. Hence, the results should be interpreted with caution, and our results might not be generalizable to non-pregnant women. WIDER IMPLICATIONS OF THE FINDINGS A plausible biological mechanism behind the reported association is that IVF mothers could be closer to menopause than non-ART mothers. The pace of decline of the ovarian reserve that eventually leads to menopause varies between females yet, in general, accelerates after the age of 30, and some studies show an increased risk of infertility in females with low ovarian reserve. STUDY FUNDING/COMPETING INTEREST(S) This study was partly funded by the Research Council of Norway (Women’s fertility, project no. 320656) and through its Centres of Excellence Funding Scheme (project no. 262700). M.C.M. has received funding from the European Research Council (ERC) under the European Union’s Horizon 2020 research and innovation programme (grant agreement number 947684). The authors declare no conflict of interest. TRIAL REGISTRATION NUMBER N/A.
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Affiliation(s)
- Yunsung Lee
- Centre for Fertility and Health, Norwegian Institute of Public Health, Oslo, Norway
| | - Jon Bohlin
- Centre for Fertility and Health, Norwegian Institute of Public Health, Oslo, Norway
| | - Christian M Page
- Centre for Fertility and Health, Norwegian Institute of Public Health, Oslo, Norway.,Department of Mathematics, Faculty of Mathematics and Natural Sciences, University of Oslo, Oslo, Norway
| | - Haakon E Nustad
- Centre for Fertility and Health, Norwegian Institute of Public Health, Oslo, Norway.,Deepinsight, Oslo, Norway
| | - Jennifer R Harris
- Centre for Fertility and Health, Norwegian Institute of Public Health, Oslo, Norway
| | - Per Magnus
- Centre for Fertility and Health, Norwegian Institute of Public Health, Oslo, Norway
| | - Astanand Jugessur
- Centre for Fertility and Health, Norwegian Institute of Public Health, Oslo, Norway.,Department of Global Public Health and Primary Care, University of Bergen, Bergen, Norway
| | - Maria C Magnus
- Centre for Fertility and Health, Norwegian Institute of Public Health, Oslo, Norway
| | - Siri E Håberg
- Centre for Fertility and Health, Norwegian Institute of Public Health, Oslo, Norway
| | - Hans I Hanevik
- Centre for Fertility and Health, Norwegian Institute of Public Health, Oslo, Norway.,Fertility Department Sør, Telemark Hospital Trust, Porsgrunn, Norway
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16
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Passos LG, Terraciano P, Wolf N, Oliveira FDSD, Almeida ID, Passos EP. The Correlation between Chlamydia Trachomatis and Female Infertility: A Systematic Review. REVISTA BRASILEIRA DE GINECOLOGIA E OBSTETRICIA : REVISTA DA FEDERACAO BRASILEIRA DAS SOCIEDADES DE GINECOLOGIA E OBSTETRICIA 2022; 44:614-620. [PMID: 35576969 PMCID: PMC9948125 DOI: 10.1055/s-0042-1748023] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
Abstract
The impact of Chlamydia trachomatis (CT) infection on female's fertility is not completely established yet, since the level of evidence associating these factors is still weak. Hence, the goal of the present review is to contribute to a better elucidation of this matter. The electronic database chosen was the Medline/PubMed, with the last survey on May 11, 2021. Publication date was used as a filter, with the previous 5 years having been selected. The following describers were used: chlamydia trachomatis AND infertility; chlamydia trachomatis AND tubal alteration AND infertility; chlamydia AND low pregnancy rates. From the 322 studies screened, 293 that failed to meet our eligibility criteria were excluded. Subsequently, we removed seven studies for not having the possible correlation between CT infections and female infertility as its main focus, and three for being about sexually transmitted infections (STIs) in general. Moreover, two studies designed as reviews were also excluded. Ergo, we included 17 studies in our qualitative analysis. The authors conducted research individually and analyzed carefully the studies selected. As we retrieved the information needed for our study through reading the texts, no contact was made with the authors of the studies selected. This systematic review corroborates the hypothesis that CT infection potentiates female infertility, as 76.47% of the included studies found a positive correlation between them. We conclude that there is an important association between CT infection and female infertility. Ergo, making CT screening part of the infertility investigation routine is relevant and has a reasonable justification.
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Affiliation(s)
- Laura Gazal Passos
- Medicine school of Pontifícia Universidade Católica do Rio Grande do Sul, Porto Alegre, RS, Brazil.,Center for Experimental Research, Hospital de Clínicas de Porto Alegre, Porto Alegre, Brazil
| | - Paula Terraciano
- Center for Experimental Research, Hospital de Clínicas de Porto Alegre, Porto Alegre, Brazil.,Medicine school of Universidade Federal do Rio Grande do Sul, Porto Alegre, RS, Brazil
| | - Nicole Wolf
- Center for Experimental Research, Hospital de Clínicas de Porto Alegre, Porto Alegre, Brazil.,Medicine school of Universidade Federal do Rio Grande do Sul, Porto Alegre, RS, Brazil
| | - Fernanda Dos Santos de Oliveira
- Center for Experimental Research, Hospital de Clínicas de Porto Alegre, Porto Alegre, Brazil.,Medicine school of Universidade Federal do Rio Grande do Sul, Porto Alegre, RS, Brazil
| | - Isabel de Almeida
- Fertility Center, Hospital Moinhos de Vento, Porto Alegre, RS, Brazil
| | - Eduardo Pandolfi Passos
- Center for Experimental Research, Hospital de Clínicas de Porto Alegre, Porto Alegre, Brazil.,Medicine school of Universidade Federal do Rio Grande do Sul, Porto Alegre, RS, Brazil.,Fertility Center, Hospital Moinhos de Vento, Porto Alegre, RS, Brazil
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17
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Rosielle K, Kamphuis D, van Welie N, Roest I, Mozes A, van Santbrink EJP, van de Laar T, Hooker AB, Huppelschoten AG, Li W, Bongers MY, Stoker J, van Wely M, Koks C, Lambalk CB, Hemingway A, Mol BWJ, Dreyer K, Mijatovic V. Oil-based versus water-based contrast media for hysterosalpingography in infertile women of advanced age, with ovulation disorders or a high risk for tubal pathology: study protocol of a randomized controlled trial (H2Oil2 study). BMC Womens Health 2022; 22:123. [PMID: 35436944 PMCID: PMC9016997 DOI: 10.1186/s12905-022-01707-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/28/2022] [Accepted: 04/07/2022] [Indexed: 11/30/2022] Open
Abstract
BACKGROUND In women with unexplained infertility, tubal flushing with oil-based contrast during hysterosalpingography (HSG) increases ongoing pregnancy and subsequent live birth rates when compared to tubal flushing with water-based contrast. It is currently unclear whether an HSG with oil-based contrast also results in more ongoing pregnancies and live births in women of advanced age, women with ovulation disorders, and women with potential tubal pathology when compared to an HSG with water-based contrast. METHODS We plan an international, multicentre, open-label, randomized controlled trial (RCT) studying three groups of infertile women who have an indication for tubal patency testing according to their treating physician and additionally; (1) are 39 years of age or older, (2) have an ovulation disorder or (3) have a high risk for tubal pathology based on their medical history. Women with an allergy for iodinated contrast medium are excluded, as are women with diabetes, hyperprolactinemia or untreated hyper- or hypothyroidism, and women with a partner with severe male infertility. After informed consent, women will be randomly allocated to the intervention, tubal flushing with the use of oil-based contrast during HSG or the control group, tubal flushing with the use of water-based contrast during HSG in a 1:1 ratio by the web-based system Castor. The primary endpoint will be ongoing pregnancy leading to live birth with conception within six months after randomization. Secondary outcomes are other pregnancy outcomes, used fertility treatments, adverse events and cost-effectiveness. Based on the expected ongoing pregnancy rate of 17% in the control group and 27% in the intervention group, the sample size will be 930 women (465 per group). Study inclusion is expected to be complete in four years. DISCUSSION This multicentre RCT will establish whether, for women of advanced age, women with ovulatory disease, and women who have a high risk for tubal pathology, there is a fertility enhancing effect of tubal flushing with oil-based contrast during HSG and whether the use of this contrast medium is cost-effective. Trial Registration The study was prospectively registered in the Netherlands Trial Register on August 1st 2019 as 'H2Oil2' (reference number NL7925, https://www.trialregister.nl/trial/7925 ).
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Affiliation(s)
- K Rosielle
- Department of Reproductive Medicine, Amsterdam UMC location Vrije Universiteit Amsterdam, De Boelelaan 1117, 1081 HV, Amsterdam, The Netherlands.
- Amsterdam Reproduction and Development, Amsterdam, The Netherlands.
| | - D Kamphuis
- Department of Reproductive Medicine, Amsterdam UMC location Vrije Universiteit Amsterdam, De Boelelaan 1117, 1081 HV, Amsterdam, The Netherlands
- Amsterdam Reproduction and Development, Amsterdam, The Netherlands
| | - N van Welie
- Department of Reproductive Medicine, Amsterdam UMC location Vrije Universiteit Amsterdam, De Boelelaan 1117, 1081 HV, Amsterdam, The Netherlands
- Amsterdam Reproduction and Development, Amsterdam, The Netherlands
| | - I Roest
- Department of Reproductive Medicine, Amsterdam UMC location Vrije Universiteit Amsterdam, De Boelelaan 1117, 1081 HV, Amsterdam, The Netherlands
- Amsterdam Reproduction and Development, Amsterdam, The Netherlands
- Grow Research School for Oncology and Reproduction, Maastricht University, Universiteitssingel 40, 6229 ER, Maastricht, The Netherlands
- Department of Obstetrics and Gynaecology, Máxima MC, De Run 4600, 5504 DB, Veldhoven, Eindhoven, The Netherlands
| | - A Mozes
- Department of Obstetrics and Gynaecology, Ziekenhuis Amstelland, Laan van de Helende Meesters 8, 1186 AM, Amstelveen, The Netherlands
| | - E J P van Santbrink
- Department of Reproductive Medicine, Reinier de Graaf Gasthuis, Reinier de Graafweg 5, 2625 AD, Delft, The Netherlands
| | - T van de Laar
- Department of Obstetrics and Gynaecology, Elkerliek Ziekenhuis, Wesselmanlaan 25, 5707 HA, Helmond, The Netherlands
| | - A B Hooker
- Department of Obstetrics and Gynaecology, Zaans Medisch Centrum, Koningin Julianaplein 58, 1502 DV, Zaandam, The Netherlands
| | - A G Huppelschoten
- Department of Obstetrics and Gynaecology, Catharina Ziekenhuis, Michelangelolaan 2, 5623 EJ, Eindhoven, The Netherlands
| | - W Li
- Department of Obstetrics and Gynaecology, Monash University, 246 Clayton Rd, Clayton, VIC, 3168, Australia
| | - M Y Bongers
- Grow Research School for Oncology and Reproduction, Maastricht University, Universiteitssingel 40, 6229 ER, Maastricht, The Netherlands
- Department of Obstetrics and Gynaecology, Máxima MC, De Run 4600, 5504 DB, Veldhoven, Eindhoven, The Netherlands
| | - J Stoker
- Department of Radiology and Nuclear Medicine, Amsterdam UMC location University of Amsterdam, Meibergdreef 9, 1105 AZ, Amsterdam, The Netherlands
| | - M van Wely
- Amsterdam Reproduction and Development, Amsterdam, The Netherlands
- Centre for Reproductive Medicine, Amsterdam Reproduction and Development, Amsterdam UMC location University of Amsterdam, Meibergdreef 9, 1105 AZ, Amsterdam, The Netherlands
| | - C Koks
- Department of Obstetrics and Gynaecology, Máxima MC, De Run 4600, 5504 DB, Veldhoven, Eindhoven, The Netherlands
| | - C B Lambalk
- Department of Reproductive Medicine, Amsterdam UMC location Vrije Universiteit Amsterdam, De Boelelaan 1117, 1081 HV, Amsterdam, The Netherlands
- Amsterdam Reproduction and Development, Amsterdam, The Netherlands
| | - A Hemingway
- Department of Radiology, Imperial College Healthcare NHS Trust, Hammersmith Hospital, DuCane Road, London, W12 0HS, England
| | - B W J Mol
- Department of Obstetrics and Gynaecology, Monash University, 246 Clayton Rd, Clayton, VIC, 3168, Australia
| | - K Dreyer
- Department of Reproductive Medicine, Amsterdam UMC location Vrije Universiteit Amsterdam, De Boelelaan 1117, 1081 HV, Amsterdam, The Netherlands
- Amsterdam Reproduction and Development, Amsterdam, The Netherlands
| | - V Mijatovic
- Department of Reproductive Medicine, Amsterdam UMC location Vrije Universiteit Amsterdam, De Boelelaan 1117, 1081 HV, Amsterdam, The Netherlands
- Amsterdam Reproduction and Development, Amsterdam, The Netherlands
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18
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Peng L, Gao J, Hu Z, Zhang H, Tang L, Wang F, Cui L, Liu S, Zhao Y, Xu H, Su X, Feng X, Fang Y, Chen J. A Novel Cleavage Pattern of Complement C5 Induced by Chlamydia trachomatis Infection via the Chlamydial Protease CPAF. Front Cell Infect Microbiol 2022; 11:732163. [PMID: 35087765 PMCID: PMC8787135 DOI: 10.3389/fcimb.2021.732163] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/28/2021] [Accepted: 12/10/2021] [Indexed: 11/24/2022] Open
Abstract
Urogenital Chlamydia trachomatis infection is one of the most common bacterial sexually transmitted diseases globally. Untreated C. trachomatis infections can ascend to the upper genital tract and establish a series of severe complications. Previous studies using C3−/− and C5−/− mice models demonstrated that C3-independent activation of C5 occurred during C. trachomatis infection. However, the mechanism of how chlamydial infection activates C5 in the absence of C3 has yet to be elucidated. To delineate interactions between C5 and chlamydial infection, cleavage products in a co-incubation system containing purified human C5 and C. trachomatis-HeLa229 cell lysates were analyzed, and a novel cleavage pattern of C5 activation induced by C. trachomatis infection was identified. C5 was cleaved efficiently at the previously unidentified site K970, but was cleaved poorly at site R751. C5b was modified to C5bCt, which later formed C5bCt-9, which had enhanced lytic ability compared with C5b-9. The chlamydial serine protease CPAF contributed to C3-independent C5 activation during C. trachomatis infection. Nafamostat mesylate, a serine protease inhibitor with a good safety profile, had a strong inhibitory effect on C5 activation induced by chlamydial infection. These discoveries reveal the mechanism of C3-independent C5 activation induced by chlamydial infection, and furthermore provide a potential therapeutic target and drug for preventing tubal fibrosis caused by chlamydial infection.
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Affiliation(s)
- Liang Peng
- Reproductive Medicine Center, Department of Obstetrics and Gynecology, The Second Xiangya Hospital, Central South University, Changsha, China
| | - Jingping Gao
- Reproductive Medicine Center, Department of Obstetrics and Gynecology, The Second Xiangya Hospital, Central South University, Changsha, China
| | - Zihao Hu
- Reproductive Medicine Center, Department of Obstetrics and Gynecology, The Second Xiangya Hospital, Central South University, Changsha, China
| | - Hongbo Zhang
- Department of Pathology, The Second Xiangya Hospital, Central South University, Changsha, China
| | - Lingli Tang
- Department of Laboratory Medicine, The Second Xiangya Hospital, Central South University, Changsha, China
| | - Fuyan Wang
- Department of Immunology, School of Basic Medical Science, Central South University, Changsha, China
| | - Lei Cui
- Reproductive Medicine Center, Department of Obstetrics and Gynecology, The Second Xiangya Hospital, Central South University, Changsha, China
| | - Shanshan Liu
- Department of Pathology, The Second Xiangya Hospital, Central South University, Changsha, China
| | - Yujie Zhao
- Reproductive Medicine Center, Department of Obstetrics and Gynecology, The Second Xiangya Hospital, Central South University, Changsha, China
| | - Hong Xu
- Reproductive Medicine Center, Department of Obstetrics and Gynecology, The Second Xiangya Hospital, Central South University, Changsha, China
| | - Xin Su
- Department of Radiology, The Second Xiangya Hospital, Central South University, Changsha, China
| | - Xiaojing Feng
- Department of Laboratory Medicine, The Second Xiangya Hospital, Central South University, Changsha, China
| | - Yiyuan Fang
- Department of Laboratory Medicine, The Second Xiangya Hospital, Central South University, Changsha, China
| | - Jianlin Chen
- Reproductive Medicine Center, Department of Obstetrics and Gynecology, The Second Xiangya Hospital, Central South University, Changsha, China
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19
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Patterns of sexual behaviour associated with repeated chlamydia testing and infection in men and women: a latent class analysis. BMC Public Health 2022; 22:652. [PMID: 35382799 PMCID: PMC8981706 DOI: 10.1186/s12889-021-12394-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/12/2021] [Accepted: 12/08/2021] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Adolescents and young adults are at higher risk of acquiring Chlamydia trachomatis infection (chlamydia), so testing is promoted in these populations. Studies have shown that re-testing for chlamydia is common amongst them. We investigated how sexual risk behaviour profiles are associated with repeated testing for chlamydia. METHODS We used baseline data from a cohort of 2814 individuals recruited at an urban STI -clinic. We applied latent class (LC) analysis using 9 manifest variables on sexual behaviour and substance use self-reported by the study participants. We fitted ordered logistic regression to investigate the association of LC membership with the outcomes repeated testing during the past 12 months and lifetime repeated testing for chlamydia. Models were fit separately for men and women. RESULTS We identified four LCs for men and three LCs for women with increasing gradient of risky sexual behaviour. The two classes with the highest risk among men were associated with lifetime repeated testing for chlamydia: adjOR = 2.26 (95%CI: 1.50-3.40) and adjOR = 3.03 (95%CI: 1.93-4.74) as compared with the class with lowest risk. In women, the class with the highest risk was associated with increased odds of repeated lifetime testing (adjOR =1.85 (95%CI: 1.24-2.76)) and repeated testing during past 12 months (adjOR = 1.72 (95%CI: 1.16-2.54)). An association with chlamydia positive test at the time of the study and during the participant's lifetime was only found in the male highest risk classes. CONCLUSION Prevention messages with regard to testing for chlamydia after unprotected sexual contact with new/casual partners seem to reach individuals in highest risk behaviour classes who are more likely to test repeatedly. Further prevention efforts should involve potentially more tailored sex-specific interventions taking into consideration risk behaviour patterns.
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20
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Link RA, Link CA, Benin Lima MH, Pasetti BW, Savaris RF. Prevalence of Chlamydia trachomatis in Women Who Are Candidates for In Vitro Fertilization in a Private Reference Service in Southern Brazil: A Cross-Sectional Study. Cureus 2022; 14:e24109. [PMID: 35573565 PMCID: PMC9106103 DOI: 10.7759/cureus.24109] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 04/13/2022] [Indexed: 11/05/2022] Open
Abstract
Introduction Chlamydia trachomatis (CT) has been related to fallopian tube damage and infertility. Its prevalence in the population that attend public services is known; however, there is scant data on this factor in private infertility clinics. The objective of this study is to verify the prevalence of CT among women attending a private in vitro fertilization (IVF) reference clinic in southern Brazil. Methods This is a cross-sectional study carried out between January 1, 2019, and August 30, 2021, at an IVF private clinic in southern Brazil. Infertile women between 18 and 50 years old, who provided a morning urinary sample for reverse transcription-polymerase chain reaction (RT-PCR) test for CT analysis, were included in the study. The variables studied included the patient's age, body mass index (BMI), duration of infertility, type of infertility, indication for IVF, and detection or not of CT in the urine. Results The prevalence of CT was 10.84% (22 out of 203; 95% CI: 7.27-15.87). Patients with secondary infertility were older and had more ovarian and tubal factors compared to cases of primary infertility. The tubal factor was the most prevalent (27.3% in women with primary infertility and 35.8% in those with secondary). Time of infertility and BMI were similar between groups. Our results are derived from a single private IVF clinic which reduces the external validity. Conclusion The prevalence of 10.84% of CT in this population raises the importance of screening for sexually transmitted infections for proper treatment and to achieve better IVF outcomes.
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Affiliation(s)
- Rafaela A Link
- Obstetrics and Gynecology Department, Universidade de Passo Fundo, Faculdade de Medicina, Passo Fundo, BRA
| | - Carlos A Link
- Surgical Sciences, Universidade Federal do Rio Grande do Sul, Postgraduate Program in Medicine, Porto Alegre, BRA
- Reproductive Endocrinology and Infertility, Clínica PROSER, Porto Alegre, BRA
| | - Matheus H Benin Lima
- Obstetrics and Gynecology Department, Universidade de Passo Fundo, Faculdade de Medicina, Passo Fundo, BRA
| | - Bruna W Pasetti
- Obstetrics and Gynecology Department, Universidade de Passo Fundo, Faculdade de Medicina, Passo Fundo, BRA
| | - Ricardo F Savaris
- Obstetrics and Gynecology Department, Universidade Federal do Rio Grande do Sul, Porto Alegre, BRA
- Surgical Sciences, Universidade Federal do Rio Grande do Sul, Postgraduate Program in Medicine, Porto Alegre, BRA
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21
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Dukers-Muijrers NHTM, Evers YJ, Hoebe CJPA, Wolffs PFG, de Vries HJC, Hoenderboom B, van der Sande MAB, Heijne J, Klausner JD, Hocking JS, van Bergen J. Controversies and evidence on Chlamydia testing and treatment in asymptomatic women and men who have sex with men: a narrative review. BMC Infect Dis 2022; 22:255. [PMID: 35287617 PMCID: PMC8922931 DOI: 10.1186/s12879-022-07171-2] [Citation(s) in RCA: 14] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/20/2021] [Accepted: 02/03/2022] [Indexed: 11/19/2022] Open
Abstract
Background Chlamydia trachomatis (CT) is the most common bacterial sexually transmitted infection (STI) worldwide. CT is mainly asymptomatic. Test-and-treat strategies are widely implemented to prevent transmission and complications. Strategies are not without controversy in asymptomatic women and men who have sex with men (MSM). Concerns are emerging to test and treat asymptomatic persons for urogenital CT (‘Controversy 1’) and pharyngeal or rectal CT (‘Controversy 2’), whereby testing symptomatic persons is not under debate. Opposed views in CT treatment involve using azithromycin versus doxycycline (‘Controversy 3’). The objective of this review is to provide coverage of these public health and clinical controversies by reviewing the current scientific evidence. Methods A literature search was performed using PubMed for relevant publications between 2018 and September 2021, and iterative retrieval of additional relevant publications. Results Controversy 1. In women, the majority of asymptomatic CT are at the urogenital site, and detections mostly include viable CT. CT easily transmits to a partner and potentially also between the vaginal and rectal areas; the clinical impact of urogenital CT is established, although risks for adverse outcomes are uncertain. Wide-scale testing in asymptomatic women has not resulted in reduced prevalence. In MSM, evidence for the clinical impact of asymptomatic urogenital CT is lacking. Controversy 2. Rectal CT is common in women diagnosed with urogenital CT, but the clinical impact of asymptomatic rectal CT is uncertain. In MSM, rectal CT is common, and most CT infections are at the rectal site, yet the risk of longer term complications is unknown. In both sexes, pharyngeal CT is uncommon and has no documented clinical impact. Controversy 3. In the treatment of rectal CT, doxycycline has superior effectiveness to azithromycin. Evidence has also accumulated on the harms of test-and-treat strategies. Conclusions Current practices vary widely, from widescale test-and-treat approaches to more individual patient- and partner-level case management. Choosing which asymptomatic people to test at what anatomic site, and whether to test or not, requires an urgent (re-)definition of the goals of testing and treating asymptomatic persons. Treatment guidelines are shifting toward universal doxycycline use, and clinical practice now faces the challenge of implementation. Supplementary Information The online version contains supplementary material available at 10.1186/s12879-022-07171-2. Test-and-treat is a key strategy in the control of Chlamydia trachomatis (CT). We discuss recent controversies and present scientific evidence regarding urogenital, rectal, and pharyngeal CT test-and-treat strategies in women and in men who have sex with men (MSM). This should inform best practices for the prevention and management of the most common bacterial sexually transmitted infection (STI) worldwide.
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Affiliation(s)
- Nicole H T M Dukers-Muijrers
- Department of Sexual Health, Infectious Diseases, and Environmental Health, South Limburg Public Health Service, PO Box 33, 6400 AA, Heerlen, The Netherlands. .,Department of Health Promotion, Care and Public Health Research Institute (CAPHRI), Maastricht University Medical Center (MUMC+), Maastricht, The Netherlands.
| | - Ymke J Evers
- Department of Sexual Health, Infectious Diseases, and Environmental Health, South Limburg Public Health Service, PO Box 33, 6400 AA, Heerlen, The Netherlands.,Department of Social Medicine, Care and Public Health Research Institute (CAPHRI), Maastricht University Medical Center (MUMC+), Maastricht, The Netherlands
| | - Christian J P A Hoebe
- Department of Sexual Health, Infectious Diseases, and Environmental Health, South Limburg Public Health Service, PO Box 33, 6400 AA, Heerlen, The Netherlands.,Department of Social Medicine, Care and Public Health Research Institute (CAPHRI), Maastricht University Medical Center (MUMC+), Maastricht, The Netherlands.,Department of Medical Microbiology, Care and Public Health Research Institute (CAPHRI), Maastricht University Medical Center (MUMC+), Maastricht, The Netherlands
| | - Petra F G Wolffs
- Department of Medical Microbiology, Care and Public Health Research Institute (CAPHRI), Maastricht University Medical Center (MUMC+), Maastricht, The Netherlands
| | - Henry J C de Vries
- Epidemiology and Surveillance Unit, Centre for Infectious Disease Control, National Institute of Public Health and the Environment (RIVM), Bilthoven, The Netherlands.,Department of Infectious Diseases, Public Health Service of Amsterdam (GGD Amsterdam), Amsterdam, The Netherlands.,Department of Dermatology, Amsterdam Infection & Immunity Institute (AII), Amsterdam University Medical Center (UMC), Amsterdam, The Netherlands
| | - Bernice Hoenderboom
- Epidemiology and Surveillance Unit, Centre for Infectious Disease Control, National Institute of Public Health and the Environment (RIVM), Bilthoven, The Netherlands.,Institute for Public Health Genomics, Genetics & Cell Biology, Maastricht University, Faculty of Health and Medicine and Life Sciences, Maastricht, The Netherlands
| | - Marianne A B van der Sande
- Department of Public Health, Institute of Tropical Medicine, Antwerp, Belgium.,Global Health, Julius Centre for Health Sciences and Primary Care, UMC Utrecht, Utrecht University, Utrecht, The Netherlands
| | - Janneke Heijne
- Epidemiology and Surveillance Unit, Centre for Infectious Disease Control, National Institute of Public Health and the Environment (RIVM), Bilthoven, The Netherlands
| | - Jeffrey D Klausner
- Department of Population and Public Health Sciences, Keck School of Medicine of the University of Southern California, Los Angeles, USA
| | - Jane S Hocking
- Melbourne School of Population and Global Health, University of Melbourne, Parkville, Victoria, Australia
| | - Jan van Bergen
- Epidemiology and Surveillance Unit, Centre for Infectious Disease Control, National Institute of Public Health and the Environment (RIVM), Bilthoven, The Netherlands.,Department of General Practice, Amsterdam UMC, University of Amsterdam, Amsterdam, The Netherlands.,STI AIDS Netherlands, Amsterdam, The Netherlands
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22
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Dukers-Muijrers NHTM, Schim van der Loeff M, Wolffs P, Bruisten SM, Götz HM, Heijman T, Zondag H, Lucchesi M, De Vries H, Hoebe CJPA. Incident urogenital and anorectal Chlamydia trachomatis in women: the role of sexual exposure and autoinoculation: a multicentre observational study (FemCure). Sex Transm Infect 2022; 98:427-437. [PMID: 35039435 DOI: 10.1136/sextrans-2021-055032] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/21/2021] [Accepted: 11/08/2021] [Indexed: 12/27/2022] Open
Abstract
BACKGROUND Anorectal infections with Chlamydia trachomatis (CT) are common in women visiting STI outpatient clinics. We here evaluated the risk posed by sexual exposure and by alternate anatomical site infection for incident anorectal and urogenital CT. METHODS Prospective multicentre cohort study, FemCure. Participants were treated for CT, and after 4, 6, 8, 10 and 12 weeks, they self-collected anorectal and urogenital samples (swabs) for CT-DNA testing. We calculated the proportion with incident CT, that is, CT incidence (at weeks 6-12) by 2-week time-periods. Compared with no exposure (A), we estimated the risk of incident CT for (B) sexual exposure, (C) alternate site anatomic site infection and (D) both, adjusted for confounders and expressed as adjusted ORs with 95% CIs. RESULTS We analysed data of 385 participants contributing 1540 2-week periods. The anorectal CT incidence was 2.9% (39/1343) (95 CI 1.8 to 3.6); 1.3% (A), 1.3% (B), 27.8% (C) and 36.7% (D). The ORs were: 0.91 (95% CI 0.32 to 2.60) (B), 26.0 (95% CI 7.16 to 94.34) (C), 44.26 (95% CI 14.38 to 136.21) (D).The urogenital CT incidence was 3.3% (47/1428) (95% CI 2.4 to 4.4); 0.7% (A), 1.9% (B), 13.9% (C) and 25.4% (D). The ORs were: 2.73 (95% CI 0.87 to 8.61) (B), 21.77 (95% CI 6.70 to 70 71) (C) and 49.66 (95% CI 15.37 to 160.41) (D). CONCLUSIONS After initial treatment, an alternate anatomical site CT infection increased the risk for an incident CT in women, especially when also sex was reported. This may suggest a key role for autoinoculation in the re-establishment or persistence of urogenital and anorectal chlamydia infections.
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Affiliation(s)
- Nicole H T M Dukers-Muijrers
- Department of Health Promotion, CAPHRI, University of Maastricht, Maastricht, The Netherlands .,Department of Sexual Health, Infectious Diseases, and Environment, Public Health Service South Limburg, Heerlen, The Netherlands
| | - Maarten Schim van der Loeff
- Department of Infectious Diseases, Public Health Service Amsterdam, Amsterdam, The Netherlands.,Department of Internal Medicine, Amsterdam Infection & Immunity Institute (AII), Amsterdam University Medical Center (UMC), Amsterdam, The Netherlands
| | - Petra Wolffs
- Department of Medical Microbiology, CAPHRI, Maastricht University Medical Center, Maastricht, The Netherlands
| | - Sylvia M Bruisten
- Department of Infectious Diseases, Public Health Service Amsterdam, Amsterdam, The Netherlands.,Department of Medical Microbiology, Amsterdam Infection & Immunity Institute (AII), Amsterdam University Medical Center (UMC), Amsterdam, Netherlands
| | - Hannelore M Götz
- Department of Infectious Disease Control, Rotterdam Rijnmond Public Health Service, Rotterdam, The Netherlands.,Center for Infectious Diseases Control, Rijksinstituut voor Volksgezondheid en Milieu, Bilthoven, The Netherlands.,Department of Public Health, Erasmus MC-University Medical Center Rotterdam, Rotterdam, Netherlands
| | - Titia Heijman
- Department of Infectious Diseases, Public Health Service Amsterdam, Amsterdam, The Netherlands
| | - Helene Zondag
- Department of Infectious Diseases, Public Health Service Amsterdam, Amsterdam, The Netherlands
| | - Mayk Lucchesi
- Department of Medical Microbiology, CAPHRI, Maastricht University Medical Center, Maastricht, The Netherlands
| | - Henry De Vries
- Department of Infectious Diseases, Public Health Service Amsterdam, Amsterdam, The Netherlands.,Department of Dermatology, Amsterdam Infection & Immunity Institute (AII), Amsterdam University Medical Center (UMC), Amsterdam, The Netherlands
| | - Christian J P A Hoebe
- Department of Sexual Health, Infectious Diseases, and Environment, Public Health Service South Limburg, Heerlen, The Netherlands.,Department of Medical Microbiology, CAPHRI, Maastricht University Medical Center, Maastricht, The Netherlands.,Department of Social Medicine, CAPHRI, Maastricht University Medical Centre, Maastricht, Netherlands
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23
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Ardizzone CM, Albritton HL, Lillis RA, Bagnetto CEL, Shen L, Cavacini LA, Kozlowski PA, Quayle AJ. Human genital antibody-mediated inhibition of Chlamydia trachomatis infection and evidence for ompA genotype-specific neutralization. PLoS One 2021; 16:e0258759. [PMID: 34662351 PMCID: PMC8523062 DOI: 10.1371/journal.pone.0258759] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/31/2021] [Accepted: 10/04/2021] [Indexed: 11/19/2022] Open
Abstract
The endocervix, the primary site of Chlamydia trachomatis (Ct) infection in women, has a unique repertoire of locally synthesized IgG and secretory IgA (SIgA) with contributions from serum IgG. Here, we assessed the ability of genital and serum-derived IgG and IgA from women with a recent positive Ct test to neutralize Ct elementary bodies (EBs) and inhibit inclusion formation in vitro in human endocervical epithelial cells. We also determined if neutralization was influenced by the major outer membrane protein (MOMP) of the infecting strain, as indicated by ompA gene sequencing and genotyping. At equivalent low concentrations of Ct EB (D/UW-3/Cx + E/UW-5/Cx)-specific antibody, genital-derived IgG and IgA and serum IgA, but not serum IgG, significantly inhibited inclusion formation, with genital IgA being most effective, followed by genital IgG, then serum IgA. The well-characterized Ct genotype D strain, D/UW-3/Cx, was neutralized by serum-derived IgG from patients infected with genotype D strains, genital IgG from patients infected with genotype D or E strains, and by genital IgA from patients infected with genotype D, E, or F strains. Additionally, inhibition of D/UW-3/Cx infection by whole serum, rather than purified immunoglobulin, was associated with levels of serum EB-specific IgG rather than the genotype of infecting strain. In contrast, a Ct genotype Ia clinical isolate, Ia/LSU-56/Cx, was neutralized by whole serum in a genotype and genogroup-specific manner, and inhibition also correlated with EB-specific IgG concentrations in serum. Taken together, these data suggest that (i) genital IgA most effectively inhibits Ct infection in vitro, (ii) human antibody-mediated inhibition of Ct infection is significantly influenced by the ompA genotype of the infecting strain, (iii) the genital antibody repertoire develops or matures differently compared to systemic antibody, and (iv) ompA genotype-specificity of inhibition of infection by whole serum can be overcome by high concentrations of Ct-specific IgG.
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Affiliation(s)
- Caleb M. Ardizzone
- Department of Microbiology, Immunology, and Parasitology, Louisiana State University Health Sciences Center, New Orleans, Louisiana, United States of America
| | - Hannah L. Albritton
- Department of Microbiology, Immunology, and Parasitology, Louisiana State University Health Sciences Center, New Orleans, Louisiana, United States of America
| | - Rebecca A. Lillis
- Division of Infectious Diseases, Department of Medicine, Louisiana State University Health Sciences Center, New Orleans, Louisiana, United States of America
| | - Caitlyn E. L. Bagnetto
- Department of Microbiology, Immunology, and Parasitology, Louisiana State University Health Sciences Center, New Orleans, Louisiana, United States of America
| | - Li Shen
- Department of Microbiology, Immunology, and Parasitology, Louisiana State University Health Sciences Center, New Orleans, Louisiana, United States of America
| | - Lisa A. Cavacini
- MassBiologics, University of Massachusetts Medical School, Boston, Massachusetts, United States of America
| | - Pamela A. Kozlowski
- Department of Microbiology, Immunology, and Parasitology, Louisiana State University Health Sciences Center, New Orleans, Louisiana, United States of America
| | - Alison J. Quayle
- Department of Microbiology, Immunology, and Parasitology, Louisiana State University Health Sciences Center, New Orleans, Louisiana, United States of America
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24
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Zheng X, Zhong W, O'Connell CM, Liu Y, Haggerty CL, Geisler WM, Anyalechi GE, Kirkcaldy RD, Wiesenfeld HC, Hillier SL, Steinkampf MP, Hammond KR, Fine J, Li Y, Darville T. Host Genetic Risk Factors for Chlamydia trachomatis-Related Infertility in Women. J Infect Dis 2021; 224:S64-S71. [PMID: 34396400 DOI: 10.1093/infdis/jiab149] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/14/2023] Open
Abstract
BACKGROUND Chlamydia trachomatis (Ct) infection ascending to the upper genital tract can cause infertility. Direct association of genetic variants as contributors is challenging because infertility may not be diagnosed until years after infection. Investigating the intermediate trait of ascension bridges this gap. METHODS We identified infertility genome-wide association study (GWAS) loci using deoxyribonucleic acid from Ct-seropositive cisgender women in a tubal factor infertility study and Ct-infected cisgender women from a longitudinal pelvic inflammatory disease cohort with known fertility status. Deoxyribonucleic acid and blood messenger ribonucleic acid from 2 additional female cohorts with active Ct infection and known endometrial infection status were used to investigate the impact of infertility single-nucleotide polymorphisms (SNPs) on Ct ascension. A statistical mediation test examined whether multiple infertility SNPs jointly influenced ascension risk by modulating expression of mediator genes. RESULTS We identified 112 candidate infertility GWAS loci, and 31 associated with Ct ascension. The SNPs altered chlamydial ascension by modulating expression of 40 mediator genes. Mediator genes identified are involved in innate immune responses including type I interferon production, T-cell function, fibrosis, female reproductive tract health, and protein synthesis and degradation. CONCLUSIONS We identified Ct-related infertility loci and their potential functional effects on Ct ascension.
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Affiliation(s)
- Xiaojing Zheng
- Department of Pediatrics, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina, USA.,Department of Biostatistics, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina, USA
| | - Wujuan Zhong
- Department of Biostatistics, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina, USA
| | - Catherine M O'Connell
- Department of Pediatrics, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina, USA
| | - Yutong Liu
- Department of Biostatistics, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina, USA
| | - Catherine L Haggerty
- Department of Epidemiology, Graduate School of Public Health, University of Pittsburgh, Pittsburgh, Pennsylvania, USA
| | - William M Geisler
- Departments of Medicine and Epidemiology, University of Alabama at Birmingham, Birmingham, Alabama, USA
| | - Gloria E Anyalechi
- Centers for Disease Control and Prevention, Division of STD Prevention, Atlanta, Georgia, USA
| | - Robert D Kirkcaldy
- Centers for Disease Control and Prevention, Division of STD Prevention, Atlanta, Georgia, USA
| | - Harold C Wiesenfeld
- Department of Obstetrics, Gynecology and Reproductive Sciences, the University of Pittsburgh School of Medicine and the Magee-Womens Research Institute Pittsburgh, Pittsburgh, Pennsylvania, USA
| | - Sharon L Hillier
- Department of Obstetrics, Gynecology and Reproductive Sciences, the University of Pittsburgh School of Medicine and the Magee-Womens Research Institute Pittsburgh, Pittsburgh, Pennsylvania, USA
| | | | | | - Jason Fine
- Department of Biostatistics, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina, USA
| | - Yun Li
- Department of Biostatistics, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina, USA.,Department of Genetics, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina, USA
| | - Toni Darville
- Department of Pediatrics, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina, USA
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25
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Lanfermann C, Kohn M, Laudeley R, Rheinheimer C, Klos A. Chlamydia trachomatis Cross-Serovar Protection during Experimental Lung Reinfection in Mice. Vaccines (Basel) 2021; 9:vaccines9080871. [PMID: 34451996 PMCID: PMC8402589 DOI: 10.3390/vaccines9080871] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/16/2021] [Revised: 08/02/2021] [Accepted: 08/04/2021] [Indexed: 12/02/2022] Open
Abstract
Chlamydia trachomatis causes most bacterial sexually transmitted diseases worldwide. Different major outer membrane proteins (MOMPs) define various serovars of this intracellular pathogen: In women, D to L3 can cause urethritis, cervicitis, salpingitis, and oophoritis, and, thus, infertility. Protective immunity might be serovar-specific since chlamydial infection does not appear to induce an effective acquired immunity and reinfections occur. A better understanding of induced cross-serovar protection is essential for the selection of suitable antigens in vaccine development. In our mouse lung infection screening model, we evaluated the urogenital serovars D, E, and L2 in this regard. Seven weeks after primary infection or mock-infection, respectively, mice were infected a second time with the identical or one of the other serovars. Body weight and clinical score were monitored for 7 days. Near the peak of the second lung infection, bacterial load, myeloperoxidase, IFN-γ, and TNF-α in lung homogenate, as well as chlamydia-specific IgG levels in blood were determined. Surprisingly, compared with mice that were infected then for the first time, almost independent of the serovar combination used, all acquired parameters of disease were similarly diminished. Our reinfection study suggests that efficient cross-serovar protection could be achieved by a vaccine combining chlamydial antigens that do not include nonconserved MOMP regions.
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26
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Prophylactic Multi-Subunit Vaccine against Chlamydia trachomatis: In Vivo Evaluation in Mice. Vaccines (Basel) 2021; 9:vaccines9060609. [PMID: 34204170 PMCID: PMC8226540 DOI: 10.3390/vaccines9060609] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/03/2021] [Revised: 05/31/2021] [Accepted: 06/03/2021] [Indexed: 01/08/2023] Open
Abstract
Chlamydia trachomatis is the most frequent sexually-transmitted disease-causing bacterium. Urogenital serovars of this intracellular pathogen lead to urethritis and cervicitis. Ascending infections result in pelvic inflammatory disease, salpingitis, and oophoritis. One of 200 urogenital infections leads to tubal infertility. Serovars A–C cause trachoma with visual impairment. There is an urgent need for a vaccine. We characterized a new five-component subunit vaccine in a mouse vaccination-lung challenge infection model. Four recombinant Pmp family-members and Ctad1 from C. trachomatis serovar E, all of which participate in adhesion and binding of chlamydial elementary bodies to host cells, were combined with the mucosal adjuvant cyclic-di-adenosine monophosphate. Intranasal application led to a high degree of cross-serovar protection against urogenital and ocular strains of C. trachomatis, which lasted at least five months. Critical evaluated parameters were body weight, clinical score, chlamydial load, a granulocyte marker and the cytokines IFN-γ/TNF-α in lung homogenate. Vaccine antigen-specific antibodies and a mixed Th1/Th2/Th17 T cell response with multi-functional CD4+ and CD8+ T cells correlate with protection. However, serum-transfer did not protect the recipients suggesting that circulating antibodies play only a minor role. In the long run, our new vaccine might help to prevent the feared consequences of human C. trachomatis infections.
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27
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Davis A, Gaynor A. A Comparison of US Clinical Laboratory Chlamydia and Gonorrhea Testing Practices Before and After the 2014 Centers for Disease Control and Prevention Testing Recommendations. Sex Transm Dis 2021; 48:e73-e76. [PMID: 32956240 PMCID: PMC7969476 DOI: 10.1097/olq.0000000000001299] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/03/2020] [Accepted: 09/13/2020] [Indexed: 12/04/2022]
Abstract
BACKGROUND Adherence to recommended laboratory testing practices is crucial for sexually transmitted infection prevention and control. The objective of this article is to compare Chlamydia trachomatis (CT) and Neisseria gonorrhoeae (NG) testing practices of US clinical laboratories in 2013 before the updated 2014 Centers for Disease Control and Prevention recommendations and in 2015 after the updated recommendations. METHODS A total of 236 clinical laboratories participated in surveys about their 2013 and 2015 CT and NG testing practices, including questions on specimen types collected and assays used. RESULTS There was an increase of 5 laboratories offering CT nucleic acid amplification testing (NAAT) from 2013 to 2015 and an increase of 5 laboratories offering NG NAAT. There was a net increase of 3 laboratories accepting urine for CT and NG NAAT, the preferred specimen type for male individuals. There was not a net increase in the total number of laboratories accepting vaginal swabs for CT NAAT (n = 89 in 2013 and 2015), the preferred specimen type for female individuals, but there was an increase of 3 laboratories accepting vaginal swabs for NG NAAT. The number of laboratories performing NG susceptibility testing decreased from 100 in 2013 to 89 in 2015 (χ2 = 1.07, P > 0.10). CONCLUSIONS There were no major changes in testing practices in the 2-year period from 2013 to 2015. However, there were some small shifts, including increases in the use of NAATs, acceptance of Centers for Disease Control and Prevention-preferred specimen types for CT/NG, and changes in usage of assays by manufacturer.
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Affiliation(s)
- Alissa Davis
- From the Columbia University School of Social Work, New York, NY
| | - Anne Gaynor
- Association of Public Health Laboratories, Silver Spring, MD
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28
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Menezes MLB, Giraldo PC, Linhares IM, Boldrini NAT, Aragon MG. Brazilian Protocol for Sexually Transmitted infections, 2020: pelvic inflammatory disease. Rev Soc Bras Med Trop 2021; 54:e2020602. [PMID: 34008722 PMCID: PMC8210479 DOI: 10.1590/0037-8682-602-2020] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/01/2021] [Accepted: 03/10/2021] [Indexed: 11/25/2022] Open
Abstract
Pelvic Inflammatory Disease is a topic included in the Clinical Protocol and Therapeutic Guidelines for Comprehensive Care for People with Sexually Transmitted Infections, published by the Brazilian Ministry of Health in 2020. Pelvic inflammatory disease is an upper female genital tract acute infection due to canalicular spread of endogenous cervicovaginal microorganisms and especially the sexually transmitted microorganisms. Standing out among the etiological agents involved are Chlamydia trachomatis and Neisseria gonorrhoeae. The main sequelae are chronic pelvic pain, infertility, and ectopic pregnancy. Clinical diagnosis is the most important practical approach. Antibiotic treatment must start immediately after the clinical suspicion. Guidelines for health service managers and health professionals on diagnostic tests, treatment, follow-up, counseling, notification, handling sexual partners and special populations are described. Given the increased availability of the molecular biology techniques in Brazil, C. trachomatis and N. gonorrhoeae screening are recommended as a disease prevention strategy. Pelvic inflammatory disease is one of the most significant sexually transmitted infections, and in most cases, it is a main consequence of cervicitis.
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Affiliation(s)
| | - Paulo Cesar Giraldo
- Universidade Estadual de Campinas, Departamento de Tocoginecologia, Campinas, SP, Brasil
| | - Iara Moreno Linhares
- Universidade de São Paulo, Disciplina de Ginecologia, Departamento de Obstetrícia e Ginecologia, São Paulo, SP, Brasil
| | | | - Mayra Gonçalves Aragon
- Ministério da Saúde, Secretaria de Vigilância em Saúde, Brasilia, DF, Brasil
- Universidade Federal do Espírito Santo, Programa de Pós-Graduação em Doenças Infecciosas, Vitória, ES, Brasil
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Wang X, Shi W, Shi X, Lin H, Qian X. The effect of adjuvant treatment in chronic pelvic inflammation by Fukejing capsules and its influence on hemorheology and inflammatory factors. Am J Transl Res 2021; 13:3480-3486. [PMID: 34017525 PMCID: PMC8129380] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/07/2020] [Accepted: 12/26/2020] [Indexed: 06/12/2023]
Abstract
OBJECTIVES This study investigated and analyzed the therapeutic effect of Fukejing capsules combined with ceftriaxone sodium and metronidazole in treating chronic pelvic inflammation and its influence on hemorheology and inflammatory factors. METHODS 137 patients with chronic pelvic inflammation admitted to our hospital from March 2018 to April 2020 were selected as the research subjects, and randomly classified into observation group (n=70) and control group (n=67) based on the random number table. The control-group were treated with ceftriaxone sodium and metronidazole, while the observation-group received Fukejing capsules based on the medication taken by the control group. The clinical efficacy, changes of hemorheology indexes and inflammatory factors of the two groups were compared. RESULTS The overall response rate of the observation group was critically higher than that of the control group (P<0.05). The hemorheology indicators of plasma viscosity, the blood viscosity at low and high shear rate of the two groups of patients in post-treatment were notably lower than those in pre-treatment (P<0.05), and the indexes of the observation group in post-treatment were remarkably lower than that of the control group (P<0.05). The two groups' degree of serum TNF-α, IL-6 and CRP in post-treatment were critically lower than in pre-treatment (P<0.05), and the indicators of the observation group in post-treatment were dramatically lower than that of the control group (P<0.05). CONCLUSION The treatment of Fukejing capsules combined with ceftriaxone sodium and metronidazole is effective in the chronic pelvic inflammation. It can efficiently reduce the blood viscosity of patients and cut down the inflammatory response of the body, which is worthy of clinical promotion.
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Affiliation(s)
- Xuefang Wang
- Department of Obstetrics and Gynecology, Wuwei People’s HospitalWuwei 733000, Gansu, China
| | - Wenyao Shi
- Department of Obstetrics and Gynecology, Yueqing Maternal and Child Care Service HospitalYueqing 325600, Zhejiang, China
| | - Xiaohua Shi
- Department of Obstetrics and Gynecology, Yueqing Maternal and Child Care Service HospitalYueqing 325600, Zhejiang, China
| | - Haiping Lin
- Department of Clinical Laboratory, Yueqing Maternal and Child Care Service HospitalYueqing 325600, Zhejiang, China
| | - Xiaoquan Qian
- Department of Obstetrics and Gynecology, Yueqing Maternal and Child Care Service HospitalYueqing 325600, Zhejiang, China
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[Postinfectious reactive arthritis after chlamydia infection in competitive sports : Clinical management and current literature review]. DER ORTHOPADE 2021; 50:179-187. [PMID: 32583060 PMCID: PMC7925465 DOI: 10.1007/s00132-020-03935-3] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Abstract
BACKGROUND Reactive arthritis following infection with chlamydia is a rare but important differential diagnosis in atraumatic joint swelling. A delayed diagnosis often leads to prolonged periods of absence from physical activity. This can have serious consequences, especially for the career of competitive athletes. OBJECTIVES Recommendation for the clinical management of postinfectious reactive arthritis for rapid diagnosis and targeted treatment in the symptomatic clinical course. MATERIALS AND METHODS Review of the literature on the topics "chlamydia", "reactive arthritis", "postinfectious arthritis" and "sexually acquired reactive arthritis", including presentation of two clinical cases of postinfectious reactive arthritis after chlamydia infection from competitive sports. RESULTS AND CONCLUSION Reactive arthritis following chlamydia infection in competitive athletes is a rare entity. However, it can be accompanied by far-reaching individual consequences, especially with regard to possible downtime in sports. Long-term consequences such as chronic joint damage in maintained synovitis must also be considered. In order to make a diagnosis, a specific anamnesis and the direct detection of the pathogen in the specimen of synovial fluid by polymerase chain reaction is essential. This allows a reliable diagnosis to be made with immediate initiation of therapy. However, a prolonged course of the disease cannot be excluded even if therapy is started in due time.
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van Wees DA, den Daas C, Kretzschmar MEE, Heijne JCM. Modelling the impact of tailored behavioural interventions on chlamydia transmission. Sci Rep 2021; 11:2148. [PMID: 33495513 PMCID: PMC7835240 DOI: 10.1038/s41598-021-81675-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/21/2020] [Accepted: 01/07/2021] [Indexed: 11/09/2022] Open
Abstract
Behavioural interventions tailored to psychological characteristics of an individual can effectively achieve risk-reducing behaviour. The impact of tailored interventions on population-level chlamydia prevalence is unknown. We aimed to assess the impact on overall chlamydia prevalence five years after the introduction of an intervention aimed at increasing self-efficacy, social norms, attitudes and intentions towards condom use (i.e., condom intervention), and an intervention aimed at increasing health goals and decreasing impulsiveness (i.e., impulsiveness intervention). A pair model, informed by longitudinal psychological and behavioural data of young heterosexuals visiting sexual health centers, with susceptible-infected-susceptible structure was developed. The intervention effect was defined as an increased proportion of each subgroup moving to the desired subgroup (i.e., lower risk subgroup). Interventions tailored to subgroup-specific characteristics, assuming differential intervention effects in each subgroup, more effectively reduced overall chlamydia prevalence compared to non-tailored interventions. The most effective intervention was the tailored condom intervention, which was assumed to result in a relative reduction in chlamydia prevalence of 18% versus 12% in the non-tailored scenario. Thus, it is important to assess multiple psychological and behavioural characteristics of individuals. Tailored interventions may be more successful in achieving risk-reducing behaviour, and consequently, reduce chlamydia prevalence more effectively.
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Affiliation(s)
- Daphne A van Wees
- Center for Infectious Disease Control, National Institute for Public Health and the Environment (RIVM), P.O. Box 1, 3720 BA, Bilthoven, The Netherlands.
| | - Chantal den Daas
- Center for Infectious Disease Control, National Institute for Public Health and the Environment (RIVM), P.O. Box 1, 3720 BA, Bilthoven, The Netherlands
- Department of Interdisciplinary Social Science, Faculty of Social and Behavioural Sciences, Utrecht University, Utrecht, The Netherlands
| | - Mirjam E E Kretzschmar
- Center for Infectious Disease Control, National Institute for Public Health and the Environment (RIVM), P.O. Box 1, 3720 BA, Bilthoven, The Netherlands
- Julius Center for Health Sciences and Primary Care, University Medical Center Utrecht, Utrecht University, Utrecht, The Netherlands
| | - Janneke C M Heijne
- Center for Infectious Disease Control, National Institute for Public Health and the Environment (RIVM), P.O. Box 1, 3720 BA, Bilthoven, The Netherlands
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Can Previous Associations of Single Nucleotide Polymorphisms in the TLR2, NOD1, CXCR5, and IL10 Genes in the Susceptibility to and Severity of Chlamydia trachomatis Infections Be Confirmed? Pathogens 2021; 10:pathogens10010048. [PMID: 33430411 PMCID: PMC7827792 DOI: 10.3390/pathogens10010048] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/16/2020] [Revised: 12/25/2020] [Accepted: 12/31/2020] [Indexed: 11/17/2022] Open
Abstract
Clear inter-individual differences exist in the response to C. trachomatis (CT) infections and reproductive tract complications in women. Host genetic variation like single nucleotide polymorphisms (SNPs) have been associated with differences in response to CT infection, and SNPs might be used as a genetic component in a tubal-pathology predicting algorithm. Our aim was to confirm the role of four genes by investigating proven associated SNPs in the susceptibility and severity of a CT infection. A total of 1201 women from five cohorts were genotyped and analyzed for TLR2 + 2477 G > A, NOD1 + 32656 T −> GG, CXCR5 + 10950 T > C, and IL10 − 1082 A > G. Results confirmed that NOD1 + 32656 T −>GG was associated with an increased risk of a symptomatic CT infection (OR: 1.9, 95%CI: 1.1–3.4, p = 0.02), but we did not observe an association with late complications. IL10 − 1082 A > G appeared to increase the risk of late complications (i.e., ectopic pregnancy/tubal factor infertility) following a CT infection (OR = 2.8, 95%CI: 1.1–7.1, p = 0.02). Other associations were not found. Confirmatory studies are important, and large cohorts are warranted to further investigate SNPs’ role in the susceptibility and severity of a CT infection.
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Balle C, Gill K, Konstantinus IN, Jaumdally SZ, Lennard K, Esra R, Happel AU, Barnabas SL, Gamieldien H, Pidwell T, Maseko V, Lesosky M, Myer L, Passmore JAS, Bekker LG, Jaspan HB. Hormonal contraception and risk of STIs and bacterial vaginosis in South African adolescents: secondary analysis of a randomised trial. Sex Transm Infect 2020; 97:112-117. [PMID: 32989170 DOI: 10.1136/sextrans-2020-054483] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/17/2020] [Revised: 07/30/2020] [Accepted: 08/29/2020] [Indexed: 12/11/2022] Open
Abstract
OBJECTIVES Young women in sub-Saharan Africa are at high risk of STIs and unintended pregnancies, yet hormonal contraceptive (HC) use may affect STI risk. We compared the influence of three HCs on the incidence and prevalence of STIs and bacterial vaginosis (BV) in South African adolescents. METHODS One hundred and thirty adolescents between 15 and 19 years were randomised to the injectable norethisterone enanthate (Net-En), combined oral contraceptives (COC) (Triphasil or Nordette) or a combined contraceptive vaginal ring (CCVR; NuvaRing) for 16 weeks (clinicaltrials.gov/NCT02404038). Vaginal samples were collected at baseline and 16 weeks post contraceptive initiation for STI and BV testing. RESULTS In an intention-to-treat analysis, no significant differences in BV prevalence were found between study arms. The overall incidence of any STI at follow-up was high: 16.2% in the COC arm; 25.7% in the Net-En arm; and 37.1% in the CCVR arm. The incidence rate (IR) of any STI was similar between Net-En (IR 0.74 (95% CI 0.34 to 1.41)) and the oestrogen-containing contraceptives (IR 0.78 (95% CI 0.47 to 1.22)). A lower IR of Chlamydia trachomatis (incidence rate ratio (IRR) 0.68 (95% CI 0.19 to 1.99)) and Neisseria gonorrhoeae (IRR 0.25 (95% CI 0.01 to 1.35)) but a higher IR of Mycoplasma genitalium (IRR 16.0 (95% CI 2.96 to 400)), was observed in the Net-En arm compared with the oestrogen-containing contraceptives, although the overall incidence of M. genitalium was low (4.7%). In an exploratory analysis, the risk of any STI and N. gonorrhoeae was lower in the COC arm compared with CCVR. A per-protocol analysis yielded similar results. CONCLUSION Our results suggest that use of Net-En may be associated with increased risk of M. genitalium compared with oestrogen-containing contraceptives but not with overall STI risk. COC use may decrease STI risk relative to CCVR.
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Affiliation(s)
- Christina Balle
- Department of Pathology, Institute of Infectious Disease and Molecular Medicine, University of Cape Town, Cape Town, Western Cape, South Africa
| | - Katherine Gill
- Desmond Tutu HIV Centre, University of Cape Town, Cape Town, Western Cape, South Africa
| | - Iyaloo N Konstantinus
- Department of Pathology, Institute of Infectious Disease and Molecular Medicine, University of Cape Town, Cape Town, Western Cape, South Africa
| | - Shameem Z Jaumdally
- Department of Pathology, Institute of Infectious Disease and Molecular Medicine, University of Cape Town, Cape Town, Western Cape, South Africa
| | - Katie Lennard
- Department of Integrative Biomedical Sciences, University of Cape Town, Cape Town, Western Cape, South Africa
| | - Rachel Esra
- Department of Pathology, Institute of Infectious Disease and Molecular Medicine, University of Cape Town, Cape Town, Western Cape, South Africa
| | - Anna-Ursula Happel
- Department of Pathology, Institute of Infectious Disease and Molecular Medicine, University of Cape Town, Cape Town, Western Cape, South Africa
| | - Shaun L Barnabas
- Department of Pathology, Institute of Infectious Disease and Molecular Medicine, University of Cape Town, Cape Town, Western Cape, South Africa.,Family Clinical Research Centre, Stellenbosch University, Stellenbosch, Western Cape, South Africa
| | - Hoyam Gamieldien
- Department of Pathology, Institute of Infectious Disease and Molecular Medicine, University of Cape Town, Cape Town, Western Cape, South Africa
| | - Tanya Pidwell
- Desmond Tutu HIV Centre, University of Cape Town, Cape Town, Western Cape, South Africa
| | - Venessa Maseko
- National Institute for Communicable Diseases, Johannesburg, Gauteng, South Africa
| | - Maia Lesosky
- Division of Epidemiology, Biostatistics, School of Public Health & Family Medicine, University of Cape Town, Cape Town, Western Cape, South Africa
| | - Landon Myer
- Division of Epidemiology, Biostatistics, School of Public Health & Family Medicine, University of Cape Town, Cape Town, Western Cape, South Africa
| | - Jo-Ann S Passmore
- Department of Pathology, Institute of Infectious Disease and Molecular Medicine, University of Cape Town, Cape Town, Western Cape, South Africa.,National Health Laboratory Service, Johannesburg, Gauteng, South Africa
| | - Linda-Gail Bekker
- Desmond Tutu HIV Centre, University of Cape Town, Cape Town, Western Cape, South Africa
| | - Heather B Jaspan
- Department of Pathology, Institute of Infectious Disease and Molecular Medicine, University of Cape Town, Cape Town, Western Cape, South Africa .,Center for Global Infectious Disease Research, Seattle Children's Research Institute, Seattle, Washington, DC, USA.,Pediatrics and Global Health, University of Washington, Seattle, WA, USA
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Effectiveness of Platelet-Rich Plasma in the Prevention of Chlamydia-Induced Hydrosalpinx in a Murine Model. Reprod Sci 2020; 28:1031-1040. [PMID: 32989630 DOI: 10.1007/s43032-020-00329-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/15/2020] [Accepted: 09/20/2020] [Indexed: 10/23/2022]
Abstract
Chlamydia trachomatis (C. trachomatis) is a major pathogen implicated in the formation of hydrosalpinx in the female reproductive tract. In mice, a related strain of Chlamydia, Chlamydia trachomatis (C. trachomatis) can induce almost 100% bilateral hydrosalpinx. This model was used as a hydrosalpinx induction model to test whether oviduct delivery of platelet-rich plasma (PRP) can attenuate chlamydia induction of hydrosalpinx in a mouse model. Mice were infected intravaginally with Chlamydia muridarum organisms, and 21 days after the infection, PRP was instilled into the lumen of one oviduct, and a sham instillation with phosphate buffer solution was performed on the contralateral oviduct. Mice were then sacrificed at designated time points after infection for oviduct pathologic evaluation including incidence, severity, and histopathologic grade of chronic inflammation. Oviduct instillation of PRP was associated with a 36% reduction in the incidence of hydrosalpinx and a 33% reduction in severity compared with sham. The median grade of chronic inflammation on histopathology was significantly lower with PRP instillation compared with sham and control. No differences were observed in vaginal or rectal shedding of C. muridarum between the test group and the control group. In short, the results suggest that oviduct instillation of PRP can significantly reduce the incidence and severity of C. muridarum-induced hydrosalpinx without affecting chlamydial infection courses in CBA/J mice.
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Lundy SR, Richardson S, Ramsey A, Ellerson D, Fengxia Y, Onyeabor S, Kirlin W, Thompson W, Black CM, DeBruyne JP, Davidson AJ, Immergluck LC, Blas-Machado U, Eko FO, Igietseme JU, He Q, Omosun YO. Shift work influences the outcomes of Chlamydia infection and pathogenesis. Sci Rep 2020; 10:15389. [PMID: 32958779 PMCID: PMC7505842 DOI: 10.1038/s41598-020-72409-5] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/05/2020] [Accepted: 08/28/2020] [Indexed: 12/16/2022] Open
Abstract
Shift work, performed by approximately 21 million Americans, is irregular or unusual work schedule hours occurring after 6:00 pm. Shift work has been shown to disrupt circadian rhythms and is associated with several adverse health outcomes and chronic diseases such as cancer, gastrointestinal and psychiatric diseases and disorders. It is unclear if shift work influences the complications associated with certain infectious agents, such as pelvic inflammatory disease, ectopic pregnancy and tubal factor infertility resulting from genital chlamydial infection. We used an Environmental circadian disruption (ECD) model mimicking circadian disruption occurring during shift work, where mice had a 6-h advance in the normal light/dark cycle (LD) every week for a month. Control group mice were housed under normal 12/12 LD cycle. Our hypothesis was that compared to controls, mice that had their circadian rhythms disrupted in this ECD model will have a higher Chlamydia load, more pathology and decreased fertility rate following Chlamydia infection. Results showed that, compared to controls, mice that had their circadian rhythms disrupted (ECD) had higher Chlamydia loads, more tissue alterations or lesions, and lower fertility rate associated with chlamydial infection. Also, infected ECD mice elicited higher proinflammatory cytokines compared to mice under normal 12/12 LD cycle. These results imply that there might be an association between shift work and the increased likelihood of developing more severe disease from Chlamydia infection.
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Affiliation(s)
- Stephanie R Lundy
- Department of Microbiology, Biochemistry & Immunology, Morehouse School of Medicine, 720 Westview Drive, S.W., Atlanta, GA, 30310, USA
| | - Shakyra Richardson
- Department of Microbiology, Biochemistry & Immunology, Morehouse School of Medicine, 720 Westview Drive, S.W., Atlanta, GA, 30310, USA
| | - Anne Ramsey
- Department of Neurobiology, Morehouse School of Medicine, Atlanta, GA, 30310, USA
| | - Debra Ellerson
- Centers for Disease Control & Prevention (CDC), Atlanta, GA, 30333, USA
| | - Yan Fengxia
- Department of Community Health and Preventive Medicine, Morehouse School of Medicine, Atlanta, GA, 30310, USA
| | - Sunny Onyeabor
- Department of Community Health and Preventive Medicine, Morehouse School of Medicine, Atlanta, GA, 30310, USA
| | - Ward Kirlin
- Department of Pharmacology, Morehouse School of Medicine, Atlanta, GA, 30310, USA
| | - Winston Thompson
- Department of Physiology, Morehouse School of Medicine, Atlanta, GA, 30310, USA
| | - Carolyn M Black
- Centers for Disease Control & Prevention (CDC), Atlanta, GA, 30333, USA
| | - Jason P DeBruyne
- Department of Pharmacology, Morehouse School of Medicine, Atlanta, GA, 30310, USA
| | - Alec J Davidson
- Department of Neurobiology, Morehouse School of Medicine, Atlanta, GA, 30310, USA
| | - Lilly C Immergluck
- Department of Microbiology, Biochemistry & Immunology, Morehouse School of Medicine, 720 Westview Drive, S.W., Atlanta, GA, 30310, USA
- Pediatric Clinical & Translational Research Unit, Clinical Research Center, Morehouse School of Medicine, Atlanta, GA, 30310, USA
| | - Uriel Blas-Machado
- Athens Veterinary Diagnostic Laboratory, Department of Pathology, College of Veterinary Medicine, University of Georgia, Athens, GA, 30602, USA
| | - Francis O Eko
- Department of Microbiology, Biochemistry & Immunology, Morehouse School of Medicine, 720 Westview Drive, S.W., Atlanta, GA, 30310, USA
| | - Joseph U Igietseme
- Department of Microbiology, Biochemistry & Immunology, Morehouse School of Medicine, 720 Westview Drive, S.W., Atlanta, GA, 30310, USA
- Centers for Disease Control & Prevention (CDC), Atlanta, GA, 30333, USA
| | - Qing He
- Department of Microbiology, Biochemistry & Immunology, Morehouse School of Medicine, 720 Westview Drive, S.W., Atlanta, GA, 30310, USA
- Centers for Disease Control & Prevention (CDC), Atlanta, GA, 30333, USA
| | - Yusuf O Omosun
- Department of Microbiology, Biochemistry & Immunology, Morehouse School of Medicine, 720 Westview Drive, S.W., Atlanta, GA, 30310, USA.
- Centers for Disease Control & Prevention (CDC), Atlanta, GA, 30333, USA.
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Ma L, Li Z, Xi S, Guo Q, Zhao P, Li W, Ai J, Chen X. Tubal ectopic pregnancy occurrence is associated with high expressions of prokineticin receptors and aberrant secretion of inflammatory cytokines. Am J Transl Res 2020; 12:5741-5751. [PMID: 33042453 PMCID: PMC7540125] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/27/2020] [Accepted: 07/28/2020] [Indexed: 06/11/2023]
Abstract
OBJECTIVE Tubal ectopic pregnancy (TEP) remains the most common cause of maternal morbidity and mortality in the early months of pregnancy. The aim of this study is to perform the correlation between PROKRs and pro-inflammatory genes and explore the role of novel genes in pathogenesis of TEP. METHODS Here, quantitative real time PCR and immunohistochemistry were used to assess the expression of the novel genes in 120 TEP patients and 30 age-matched non-TEP patients. The correlation between PROKRs and pro-inflammatory genes were analyzed by Pearson correlation coefficient. Univariate and multivariate Cox regression analyses were used to assess the risk prediction rate of novel genes. Receiver operating characteristic was used to assess the performance of our model. RESULTS PROKRs (PROKR1 and PROKR2) and pro-inflammatory genes (TNF-α, IL-6, and IL-8) expression levels significantly enhanced in TEP patients, and significantly positive correlation with pro-inflammatory genes for PROKRs. A multivariate Cox regression analysis demonstrated that 2 genes (PROKR2 and IL8) had significant diagnostic value, which were associated with the occurrence and development of TEP. CONCLUSION Our data further denote that dysregulation of PROKR2 and IL-8 were risk factor and played an important role in the pathogenesis of TEP.
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Affiliation(s)
- Lin Ma
- The Reproductive Medicine Center, The Seventh Affiliated Hospital, Sun Yat-sen UniversityShenzhen 510000, Guangdong Province, China
- The Reproductive Medicine Center, The Third Affiliated Hospital, Sun Yat-sen UniversityGuangzhou 510630, Guangdong Province, China
| | - Zaiyi Li
- The Reproductive Medicine Center, The Seventh Affiliated Hospital, Sun Yat-sen UniversityShenzhen 510000, Guangdong Province, China
| | - Sujuan Xi
- The Reproductive Medicine Center, The Seventh Affiliated Hospital, Sun Yat-sen UniversityShenzhen 510000, Guangdong Province, China
| | - Quan Guo
- Department of Gynaecology, Shengjing Hospital of China Medical UniversityShenyang, Liaoning Province, China
| | - Panlin Zhao
- Reproductive Medical Center, Beijing Baodao Obstetrics and Gynicology HospitalBeijing, China
| | - Weihao Li
- The Reproductive Medicine Center, The Seventh Affiliated Hospital, Sun Yat-sen UniversityShenzhen 510000, Guangdong Province, China
| | - Jing Ai
- The Reproductive Medicine Center, The Seventh Affiliated Hospital, Sun Yat-sen UniversityShenzhen 510000, Guangdong Province, China
| | - Xiaoxuan Chen
- The Reproductive Medicine Center, The Seventh Affiliated Hospital, Sun Yat-sen UniversityShenzhen 510000, Guangdong Province, China
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McQueen BE, Kiatthanapaiboon A, Fulcher ML, Lam M, Patton K, Powell E, Kollipara A, Madden V, Suchland RJ, Wyrick P, O'Connell CM, Reidel B, Kesimer M, Randell SH, Darville T, Nagarajan UM. Human Fallopian Tube Epithelial Cell Culture Model To Study Host Responses to Chlamydia trachomatis Infection. Infect Immun 2020; 88:e00105-20. [PMID: 32601108 PMCID: PMC7440757 DOI: 10.1128/iai.00105-20] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/20/2020] [Accepted: 06/23/2020] [Indexed: 12/20/2022] Open
Abstract
Chlamydia trachomatis infection of the human fallopian tubes can lead to damaging inflammation and scarring, ultimately resulting in infertility. To study the human cellular responses to chlamydial infection, researchers have frequently used transformed cell lines that can have limited translational relevance. We developed a primary human fallopian tube epithelial cell model based on a method previously established for culture of primary human bronchial epithelial cells. After protease digestion and physical dissociation of excised fallopian tubes, epithelial cell precursors were expanded in growth factor-containing medium. Expanded cells were cryopreserved to generate a biobank of cells from multiple donors and cultured at an air-liquid interface. Culture conditions stimulated cellular differentiation into polarized mucin-secreting and multiciliated cells, recapitulating the architecture of human fallopian tube epithelium. The polarized and differentiated cells were infected with a clinical isolate of C. trachomatis, and inclusions containing chlamydial developmental forms were visualized by fluorescence and electron microscopy. Apical secretions from infected cells contained increased amounts of proteins associated with chlamydial growth and replication, including transferrin receptor protein 1, the amino acid transporters SLC3A2 and SLC1A5, and the T-cell chemoattractants CXCL10, CXCL11, and RANTES. Flow cytometry revealed that chlamydial infection induced cell surface expression of T-cell homing and activation proteins, including ICAM-1, VCAM-1, HLA class I and II, and interferon gamma receptor. This human fallopian tube epithelial cell culture model is an important tool with translational potential for studying cellular responses to Chlamydia and other sexually transmitted pathogens.
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Affiliation(s)
- Bryan E McQueen
- Department of Pediatrics, University of North Carolina, Chapel Hill, North Carolina, USA
- Department of Microbiology and Immunology, University of North Carolina, Chapel Hill, North Carolina, USA
| | - Amy Kiatthanapaiboon
- Department of Pediatrics, University of North Carolina, Chapel Hill, North Carolina, USA
| | - M Leslie Fulcher
- Department of Cell Biology and Physiology, University of North Carolina, Chapel Hill, North Carolina, USA
| | - Mariam Lam
- Department of Cell Biology and Physiology, University of North Carolina, Chapel Hill, North Carolina, USA
| | - Kate Patton
- Department of Cell Biology and Physiology, University of North Carolina, Chapel Hill, North Carolina, USA
| | - Emily Powell
- Department of Cell Biology and Physiology, University of North Carolina, Chapel Hill, North Carolina, USA
| | - Avinash Kollipara
- Department of Pediatrics, University of North Carolina, Chapel Hill, North Carolina, USA
- Department of Microbiology and Immunology, University of North Carolina, Chapel Hill, North Carolina, USA
| | - Victoria Madden
- Department of Pathology and Laboratory Medicine, University of North Carolina, Chapel Hill, North Carolina, USA
| | - Robert J Suchland
- University of Washington, Division of Allergy and Infectious Diseases, Department of Medicine, Seattle, Washington, USA
| | - Priscilla Wyrick
- Department of Pediatrics, University of North Carolina, Chapel Hill, North Carolina, USA
| | - Catherine M O'Connell
- Department of Pediatrics, University of North Carolina, Chapel Hill, North Carolina, USA
| | - Boris Reidel
- Department of Pathology and Laboratory Medicine, University of North Carolina, Chapel Hill, North Carolina, USA
| | - Mehmet Kesimer
- Department of Pathology and Laboratory Medicine, University of North Carolina, Chapel Hill, North Carolina, USA
| | - Scott H Randell
- Department of Cell Biology and Physiology, University of North Carolina, Chapel Hill, North Carolina, USA
| | - Toni Darville
- Department of Pediatrics, University of North Carolina, Chapel Hill, North Carolina, USA
- Department of Microbiology and Immunology, University of North Carolina, Chapel Hill, North Carolina, USA
| | - Uma M Nagarajan
- Department of Pediatrics, University of North Carolina, Chapel Hill, North Carolina, USA
- Department of Microbiology and Immunology, University of North Carolina, Chapel Hill, North Carolina, USA
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38
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Dukers-Muijrers NHTM, Wolffs P, Lucchesi M, Götz HM, De Vries H, Schim van der Loeff M, Bruisten SM, Hoebe CJPA. Oropharyngeal Chlamydia trachomatis in women; spontaneous clearance and cure after treatment (FemCure). Sex Transm Infect 2020; 97:147-151. [PMID: 32737209 DOI: 10.1136/sextrans-2020-054558] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/22/2020] [Revised: 06/17/2020] [Accepted: 06/27/2020] [Indexed: 11/03/2022] Open
Abstract
OBJECTIVES Women attending STI clinics are not routinely tested for oropharyngeal Chlamydia trachomatis (CT) infections. We aimed to assess spontaneous clearance of oropharyngeal CT and cure after antibiotic treatment in women. METHODS Women with vaginal or rectal CT (n=560) were recruited at STI clinics in 2016-2017, as part of the FemCure study (prospective cohort study). We included participants' data from week -1, that is, the diagnosis at initial visit, when clinics applied selective oropharyngeal testing. At week -1, a total of 241 women were oropharyngeally tested (30 positive) and 319 were untested. All FemCure participants provided nurse-collected oropharyngeal samples at study enrolment, that is, week 0, just prior to treatment (n=560), and after treatment at weeks 4 (n=449), 8 (n=433) and 12 (n=427). Samples were tested by nucleic acid amplification test, and at week 0 also by viability testing by viability PCR. Proportions of oropharyngeal CT test results were presented to represent spontaneous clearance and cure. RESULTS Of 30 women diagnosed with oropharyngeal CT at week -1, fifteen (50%) were negative at week 0 after a median of 9 days, that is, 'spontaneous clearance'. At week 0, a total of 560 participants were tested, and 46 (8.8%) were oropharyngeal CT positive; 12 of them (26.1%) had viable CT. Of the 46 positive, 36 women had an oropharyngeal test after treatment; 97.2% (35/36) were negative at week 4, that is, 'cure'. Of all women with follow-up visits, the proportion of oropharyngeal CT positive was between 0.5% and 1.6% between weeks 4 and 12. Of those not tested at week -1 (n=319), 8.5% (n=27) were oropharyngeal positive at week 0. CONCLUSIONS The clinical importance of oropharyngeal CT in women is debated. We demonstrated that spontaneous clearance of oropharyngeal CT among women is common; of those who did not clear for CT, three-quarters had non-viable CT. After regular treatment with azithromycin or doxycycline, cure rate (97%) of oropharyngeal CT is excellent. TRIAL REGISTRATION NUMBER NCT02694497.
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Affiliation(s)
- Nicole H T M Dukers-Muijrers
- Department of Health Promotion, Care and Public Health Research Institute (CAPHRI), Maastricht University Medical Center (MUMC+), Maastricht, The Netherlands .,Department of Sexual Health, Infectious Diseases, and Environmental Health, Public Health Service South Limburg, Heerlen, Limburg, The Netherlands
| | - Petra Wolffs
- Department of Medical Microbiology, Care and Public Health Research Institute (CAPHRI), Maastricht University Medical Center (MUMC+), Maastricht, The Netherlands
| | - Mayk Lucchesi
- Department of Medical Microbiology, Care and Public Health Research Institute (CAPHRI), Maastricht University Medical Center (MUMC+), Maastricht, The Netherlands
| | - Hannelore M Götz
- Department of Public Health, Sexual Health Centre, Public Health Service Rotterdam-Rijnmond, Rotterdam, The Netherlands.,Department of Public Health, Erasmus MC-University Medical Center Rotterdam, Rotterdam, The Netherlands.,Epidemiology and Surveillance Unit, Centre for Infectious Disease Control, National Institute of Public Health and the Environment (RIVM), Bilthoven, The Netherlands
| | - Henry De Vries
- Department of Infectious Diseases, Public Health Service Amsterdam, Amsterdam, The Netherlands.,Department of Dermatology, Amsterdam Institute for Infection and Immunity (AI&II), location Academic Medical Centre, Amsterdam UMC, University of Amsterdam, Amsterdam, The Netherlands
| | - Maarten Schim van der Loeff
- Department of Infectious Diseases, Public Health Service Amsterdam, Amsterdam, The Netherlands.,Department of Internal Medicine, Amsterdam Institute for Infection and Immunity (AI&II), location Academic Medical Centre, Amsterdam UMC, University of Amsterdam, Amsterdam, The Netherlands
| | - Sylvia M Bruisten
- Department of Infectious Diseases, Public Health Service Amsterdam, Amsterdam, The Netherlands.,Department of Dermatology, Amsterdam Institute for Infection and Immunity (AI&II), location Academic Medical Centre, Amsterdam UMC, University of Amsterdam, Amsterdam, The Netherlands
| | - Christian J P A Hoebe
- Department of Sexual Health, Infectious Diseases, and Environmental Health, Public Health Service South Limburg, Heerlen, Limburg, The Netherlands.,Department of Medical Microbiology, Care and Public Health Research Institute (CAPHRI), Maastricht University Medical Center (MUMC+), Maastricht, The Netherlands.,Department of Social Medicine, University of Maastricht, Maastricht, The Netherlands
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39
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Egbe TO, Nana-Njamen T, Elong F, Tchounzou R, Simo AG, Nzeuga GP, Njamen Nana C, Manka’a E, Tchente Nguefack C, Halle-Ekane GE. Risk factors of tubal infertility in a tertiary hospital in a low-resource setting: a case-control study. FERTILITY RESEARCH AND PRACTICE 2020; 6:3. [PMID: 32161654 PMCID: PMC7059396 DOI: 10.1186/s40738-020-00073-4] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 09/16/2019] [Accepted: 02/21/2020] [Indexed: 12/25/2022]
Abstract
BACKGROUND Infertility is the inability to sustain a pregnancy in a woman with regular (2-3 times per week) unprotected sexual intercourse for a period of 1 year. This is a major public health problem that remains under-recognised in Cameroon and most countries in sub-Saharan Africa. This study aimed at identifying the risk factors associated with tubal infertility in a tertiary hospital in Douala, Cameroon. METHODS We conducted a case-control study at the Obstetrics, Gynaecology and Radiology Departments of the Douala Referral Hospital from October 1, 2016, to July 30, 2017. We recruited 77 women with tubal infertility diagnosed using hysterosalpingography and 154 unmatched pregnant women served as controls. Data on socio-demographic, reproductive and sexual health, and radiologic assessments were collected using a pretested questionnaire. The data were analysed using the Statistical Package for the Social Sciences (SPSS) software version 24.0. Logistic regression models were fitted to identify demographic, reproductive health factors, surgical, medical and toxicological factors associated with tubal infertility. The adjusted odds ratios (AOR) and their 95% confidence interval were interpreted. Statistical significance set at p < 0.05. RESULTS Sixty-one per cent of respondents had secondary infertility. Following multivariate logistic regression analysis, respondents who were housewives (AOR 10.7; 95% CI: 1.68-8.41, p = 0.012), self-employed (AOR 17.1; 95% CI: 2.52-115.8, p = 0.004), with a history of Chlamydia trachomatis infection (AOR 17.1; 95% CI: 3.4-85.5, p = 0.001), with Mycoplasma infection (AOR 5.1; 95% CI: 1.19-22.02, p = 0.03), with ovarian cyst (AOR 20.5; 95% CI: 2.5-168.7, p = 0.005), with uterine fibroid (AOR 62.4; 95% CI: 4.8-803.2, p = 0.002), have undergone pelvic surgery (AOR 2.3; 95% CI: 1.0-5.5, p = 0.05), have undergone other surgeries (AOR 49.8; 95% CI: 6.2-400, p = 0.000), diabetic patients (AOR 10.5; 95% CI 1.0-113.4, p = 0.05) and those with chronic pelvic pain (AOR 7.3; 95% CI: 3.2-17.1, p = 0.000) were significantly associated with tubal infertility while the young aged from 15 to 25 (AOR 0.07; 95% CI: 0.01-0.67, 0.021), those in monogamous marriages (AOR 0.05; 95% CI: 0.003-1.02, p = 0.05), as well as those with a history of barrier contraceptive methods (condom) (AOR 0.17; 95% CI: 0.03-1.1, p = 0.06) were less likely to have tubal infertility. CONCLUSION The following factors were independently associated with tubal infertility: being a housewife, self-employed, history of Chlamydia trachomatis, Mycoplasma infection, and uterine fibroid. Furthermore, a history of pelvic surgery and other surgeries, diabetes mellitus, and chronic pelvic pain were also associated with tubal infertility. Young age, persons in monogamous marriages and users of barrier methods of contraception (condom) were less likely to have tubal infertility. Identification of these factors will be a target of intervention to avoid tubal infertility.
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Affiliation(s)
- Thomas Obinchemti Egbe
- Department of Obstetrics and Gynecology, Douala Referral Hospital, Douala, Cameroon
- Faculty of Health Sciences, University of Buea, Buea, Cameroon
| | - Theophile Nana-Njamen
- Department of Obstetrics and Gynecology, Douala Referral Hospital, Douala, Cameroon
- Faculty of Health Sciences, University of Buea, Buea, Cameroon
| | - Felix Elong
- Faculty of Health Sciences, University of Buea, Buea, Cameroon
| | | | | | | | - Cedric Njamen Nana
- Department of Obstetrics and Gynecology, Douala Referral Hospital, Douala, Cameroon
| | | | - Charlotte Tchente Nguefack
- Department of Obstetrics and Gynecology, Douala Referral Hospital, Douala, Cameroon
- Faculty of Medicine and Pharmaceutical Sciences, University of Douala, Douala, Cameroon
| | - Gregory Edie Halle-Ekane
- Department of Obstetrics and Gynecology, Douala Referral Hospital, Douala, Cameroon
- Faculty of Health Sciences, University of Buea, Buea, Cameroon
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40
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Dukers-Muijrers NHTM, Janssen KJH, Hoebe CJPA, Götz HM, Schim van der Loeff MF, de Vries HJC, Bruisten SM, Wolffs PFG. Spontaneous clearance of Chlamydia trachomatis accounting for bacterial viability in vaginally or rectally infected women (FemCure). Sex Transm Infect 2020; 96:541-548. [PMID: 32066588 DOI: 10.1136/sextrans-2019-054267] [Citation(s) in RCA: 14] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/11/2019] [Revised: 01/23/2020] [Accepted: 01/28/2020] [Indexed: 11/04/2022] Open
Abstract
OBJECTIVES Spontaneous clearance of Chlamydia trachomatis (CT) infections can occur between diagnosis and treatment. We followed CT patients to assess clearance using a conventional definition (no total CT-DNA, assessed by routine quantitative PCR methods) and a definition accounting for viability, assessed by viability PCR testing. METHODS Three outpatient STI clinics included CT-diagnosed women (The Netherlands, 2016-2017, FemCure study); participants had vaginal CT (vCT) and rectal CT (rCT) (group A: n=155), vCT and were rectally untested (group B: n=351), single vCT (group C: n=25) or single rCT (group D: n=29). Follow-up (median interval 9 days) vaginal and rectal samples underwent quantitative PCR testing (detecting total CT-DNA). When PCR positive, samples underwent V-PCR testing to detect 'viable CT' (CT-DNA from intact CT organisms; V-PCR positive). 'Clearance' was the proportion PCR-negative patients and 'clearance of viable CT' was the proportion of patients testing PCR negative or PCR positive but V-PCR negative. We used multivariable logistic regression analyses to assess diagnosis group (A-D), age, days since initial CT test (diagnosis) and study site (STI clinic) in relation to clearance and clearance of viable CT. RESULTS Clearance and clearance of viable CT at both anatomic sites were for (A) 0.6% and 3.9%; (B) 5.4% and 9.4%; (C) 32.0% and 52.0% and (D) 27.6% and 41.4%, respectively. In multivariate analyses, women with single infections (groups C and D) had higher likelihood of clearance than women concurrently infected with vCT and rCT (p<0.001).Of rectally untested women (group B), 76.9% had total CT-DNA and 46.7% had viable CT (V-PCR positive) at the rectal site. CONCLUSIONS Of untreated female vCT patients who had CT also at the rectal site, or who were rectally untested, only a small proportion cleared CT (in fact many had viable CT) at their follow-up visit (median 9 days). Among single site infected women clearance was much higher. TRIAL REGISTRATION NUMBER NCT02694497.
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Affiliation(s)
- Nicole H T M Dukers-Muijrers
- Department of Sexual Health, Infectious Diseases, and Environmental Health, South Limburg Public Health Service, Heerlen, The Netherlands .,Department of Social Medicine and Medical Microbiology, Care and Public Health Research Institute (CAPHRI), Maastricht University Medical Center (MUMC+), Maastricht, The Netherlands
| | - Kevin J H Janssen
- Department of Social Medicine and Medical Microbiology, Care and Public Health Research Institute (CAPHRI), Maastricht University Medical Center (MUMC+), Maastricht, The Netherlands
| | - Christian J P A Hoebe
- Department of Sexual Health, Infectious Diseases, and Environmental Health, South Limburg Public Health Service, Heerlen, The Netherlands.,Department of Social Medicine and Medical Microbiology, Care and Public Health Research Institute (CAPHRI), Maastricht University Medical Center (MUMC+), Maastricht, The Netherlands
| | - Hannelore M Götz
- Department of Public Health, Sexual Health Centre, Public Health Service Rotterdam-Rijnmond, Rotterdam, The Netherlands.,National Institute of Public Health and the Environment (RIVM), Epidemiology and Surveillance Unit, Centre for Infectious Disease Control, Bilthoven, The Netherlands.,Department of Public Health, Erasmus MC-University Medical Center Rotterdam, Rotterdam, The Netherlands
| | - Maarten F Schim van der Loeff
- Department of Infectious Diseases, Public Health Service of Amsterdam (GGD Amsterdam), Amsterdam, The Netherlands.,Amsterdam UMC, University of Amsterdam, Department of Dermatology, Amsterdam Institute for Infection and Immunity (AI&II), Location Academic Medical Centre, Amsterdam, The Netherlands
| | - Henry J C de Vries
- Department of Infectious Diseases, Public Health Service of Amsterdam (GGD Amsterdam), Amsterdam, The Netherlands.,Amsterdam UMC, University of Amsterdam, Department of Dermatology, Amsterdam Institute for Infection and Immunity (AI&II), Location Academic Medical Centre, Amsterdam, The Netherlands
| | - Sylvia M Bruisten
- Department of Infectious Diseases, Public Health Service of Amsterdam (GGD Amsterdam), Amsterdam, The Netherlands.,Amsterdam UMC, University of Amsterdam, Department of Dermatology, Amsterdam Institute for Infection and Immunity (AI&II), Location Academic Medical Centre, Amsterdam, The Netherlands
| | - Petra F G Wolffs
- Department of Social Medicine and Medical Microbiology, Care and Public Health Research Institute (CAPHRI), Maastricht University Medical Center (MUMC+), Maastricht, The Netherlands
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Kayiira A, Zaake D, Lwetabe MW, Sekweyama P. Impact of genital Chlamydia trachomatis infection on reproductive outcomes among infertile women undergoing tubal flushing: a retrospective cohort at a fertility centre in Uganda. FERTILITY RESEARCH AND PRACTICE 2019; 5:16. [PMID: 31890236 PMCID: PMC6909488 DOI: 10.1186/s40738-019-0069-5] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 08/30/2019] [Accepted: 12/05/2019] [Indexed: 12/20/2022]
Abstract
BACKGROUND The impact of current C. trachomatis on clinical pregnancy and live birth rates among women undergoing tubal flushing is largely unknown. This study aimed to investigate whether current female genital C. trachomatis infection affects the chance of achieving a clinical pregnancy and a live birth, among infertile women undergoing tubal flushing, at a fertility centre in Uganda. METHODS A retrospective Cohort study at a peri-urban fertility centre. A total of 253 eligible women with tubal factor infertility, who underwent tubal flushing, were enrolled and categorised according to their exposure to current genital C. trachomatis infection. These women were followed up for a period of 12 months, with the primary outcome measure being clinical pregnancy and live birth. Secondary outcome measures included pregnancy loss and procedural related adverse events. RESULTS Exposure to current genital C. trachomatis infection reduced chance of clinical pregnancy (adjusted relative risk 0.42; 95% confidence interval, 0.18-0.96) and a live birth (adjusted relative risk 0.37; 95% confidence interval, 0.14-0.95) after tubal flushing. Women with current C. trachomatis infection had an increased risk of adverse events (adjusted relative risk, 1.20; 95% confidence interval, 1.08-1.34). However, current C. trachomatis infection did not affect the risk of spontaneous abortion and ectopic pregnancy. CONCLUSION Current genital C. trachomatis infection in women with tubal factor infertility, undergoing tubal flushing, lowers their chance of pregnancy and live birth.
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Affiliation(s)
- Anthony Kayiira
- Life Sure Fertility and Gynaecology centre, St. Francis Hospital Nsambya, postgraduate medical school, Uganda Martyr’s University Nkozi, Nsambya, Uganda
| | - Daniel Zaake
- Life Sure Fertility and Gynaecology centre, St. Francis Hospital Nsambya, postgraduate medical school, Uganda Martyr’s University Nkozi, Nsambya, Uganda
| | | | - Peter Sekweyama
- Life Sure Fertility and Gynaecology centre, St. Francis Hospital Nsambya, postgraduate medical school, Uganda Martyr’s University Nkozi, Nsambya, Uganda
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Effect of Time of Day of Infection on Chlamydia Infectivity and Pathogenesis. Sci Rep 2019; 9:11405. [PMID: 31388084 PMCID: PMC6684580 DOI: 10.1038/s41598-019-47878-y] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/12/2018] [Accepted: 07/09/2019] [Indexed: 01/11/2023] Open
Abstract
Genital chlamydia infection in women causes complications such as pelvic inflammatory disease and tubal factor infertility, but it is unclear why some women are more susceptible than others. Possible factors, such as time of day of chlamydia infection on chlamydial pathogenesis has not been determined. We hypothesised that infections during the day, will cause increased complications compared to infections at night. Mice placed under normal 12:12 light: dark (LD) cycle were infected intravaginally with Chlamydia muridarum either at zeitgeber time 3, ZT3 and ZT15. Infectivity was monitored by periodic vaginal swabs and chlamydiae isolation. Blood and vaginal washes were collected for host immunologic response assessments. The reproductive tracts of the mice were examined histopathologically, and fertility was determined by embryo enumeration after mating. Mice infected at ZT3 shed significantly more C. muridarum than mice infected at ZT15. This correlated with the increased genital tract pathology observed in mice infected at ZT3. Mice infected at ZT3 were less fertile than mice infected at ZT15. The results suggest that the time of day of infection influences chlamydial pathogenesis, it indicates a possible association between complications from chlamydia infection and host circadian clock, which may lead to a better understanding of chlamydial pathogenesis.
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