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PubMed1997

Reduced prevalence of cervical Chlamydia infection among women requesting termination.

BACKGROUND: The prevalence and pattern of Chlamydia trachomatis infection among women requesting induced abortion in the three year period 1992-95 was evaluated and compared to the results of a previous study in 1982-84, where the prevalence of chlamydial infection had been 13.5%. METHODS: A total of 1995 women requested termination, 1855 (93%) of whom were tested for Chlamydia and were included in the study. Two types of tests for chlamydial infection, ELISA and PCR, were used in two consecutive periods. In addition cultures for gonorrhea were done in each case. Information on age, marital status, parity, gestational age and the results of chlamydia and gonorrhea tests of the women and sexual partners were recorded. RESULTS: Chlamydia trachomatis positive women were 149 (8.0%), a significant reduction from the previous 1982-84 study (p<0.001). Women with positive tests were significantly younger (80% < or = 25 years of age; p<0.001) and more frequently single (86.6%; p<0.001), than those with negative tests, as in the previous period. Of the partners, 80.4% were contacted, and 52.1% presented for investigation. Of those tested 42.1% were Chlamydia positive. Four women (0.2%) had Neisseria gonorrhea but none of the partners. CONCLUSIONS: The prevalence of Chlamydia trachomatis is receding among women coming for termination of pregnancy. As treatment before or at operation has repeatedly been shown to be of benefit and since the prevalence is still considerable, continued screening of these women is justified.

Abortion, Legal↗
PubMed1998

[Treatment of chlamydial urogenital infections].

Chlamydia trachomatis is the most frequent sexually transmitted bacterial pathogen in developed countries [3, 12, 13]. The position is similar in the Czech Republic. Depending on the group of examined women active Chlamydia infection varies between 10 and 23%. The increasing incidence of urogenital Chlamydia infections and improving diagnostic possibilities call for adequate treatment. Correct treatment of urogenital infections caused by Chlamydia trachomatis is very important for the prevention of undesirable sequelae of inflammations of the lesser pelvis, subsequent risk of GEU, sterility, prevention of premature delivery and possible infection of the neonate. When starting treatment, selecting a suitable antibiotic and deciding on the therapeutic strategy it is important to select an antibiotic with regard to its efficacy, the epidemiological situation, regional sensitivity of the infectious agent, toxicity and tolerance of the antibiotic, to its bacteriostatic or bactericide action, and last not least, also its price. Despite selection of a suitable antibiotic sometimes treatment fails. For treatment of urogenital chlamydial infections tetracyclin and macrolid antibiotics are recommended or quinolone chemotherapeutic agents of the third generation. Tetracyclines are broad spectrum antibiotics with bacteriostatic action. As to oral forms doxycycline, tetracycline and oxytetracycline are used. The most frequent undesirable effects during treatment are nausea, vomiting, diarrhoea and abdominal pain. Tetracycline antibiotics are contraindicated in children under 8 years, during pregnancy and lactation and in case of sensitivity to this group of drugs. Macrolids are antibiotics with a medium broad antibacterial spectrum with bacteriostatic action. Macrolids of the first generation have a low antibacterial activity. They have a short biological half-life, not always a good tolerance, and serious clinically important drug interactions may develop. The most frequently used preparations of the first generation include erythromycin, josamycina and spiramycin. Macrolids of the second generation, azitromycin, roxitromycin and claritromycin lack the above negative properties. The most frequent undesirable effects after administration of macrolids include nausea and vomiting. Considerable differences were found in particular between different preparations containing erythromycin. Macrolids of the second generation have only slight undesirable gastrointestinal effects. Macrolid antibiotics are contraindicated in case of sensitization to this group, in severe hepatic disorders and great care must be taken in the treatment of pregnant women. Quinolone chemotherapeutic agents of the third generation, ciprofloxacine, enoxacine, ofloxacine and pefloxacine are synthetic drugs with a broad antibacterial spectrum which act on systemic infections. On oral administration they are rapidly absorbed and the blood and tissue concentrations are sufficiently effective. In the treatment of urogenital Chlamydia infections they are useful in the treatment of chronic infections after failure of previous macrolid and tetracycline therapy. The most frequent undesirable side-effects include nausea, vomiting, meteorism, diarrhoea, tinnitus, headache, changes of mood, allergic skin reaction. They are contraindicated in hypersensitivity to quinolone chemotherapeutic preparations, in children and adolescents under 18 years, during pregnancy and lactation. The objective of the present study was to evaluate different therapeutic patterns, their efficacy and tolerance.

Anti-Bacterial Agents↗
PubMedDate not supplied

[Local immunity factors in the reproductive system of women with Chlamydia infection].

A total of 50 healthy women and 184 women of reproductive age with Chlamidia infection, complicated by candidiasis, mycoplasmosis and bacterial vaginosis were under examination. The local infectious immunity indices of cervical mucous were detected. The investigation of cell-mediated and humoral factors of cervical secretions revealed the dysfunction of local infectious protection in women with Chlamydia infection.

Adult↗
PubMed2000

Opportunistic screening for chlamydia infection in general practice: can we reach young women?

OBJECTIVE: To study opportunistic screening in primary care, in such a way that would include teenage women. Setting-Screening for chlamydia infection was offered opportunistically in eight general practices in Edinburgh to women aged < or = 35 years attending for cervical smear, and women aged < or = 20 years attending for contraception. The numbers of women eligible to be offered screening were 901 in the cervical smear group, and 595 in the contraception group. RESULTS: Effective screening rate (offered test, consented, and urine sample returned) was 30% for the cervical smear group compared with 23% for the contraception group. Among those tested, chlamydia prevalence was strongly associated with young age, ranging from 11.8% in those <18 years, to 0% in those >25 years. Number of sexual partners in past year did not improve prediction of infection. CONCLUSION: These findings raise concerns regarding the feasibility of opportunistic screening in general practice, particularly for those with highest prevalence of chlamydia--teenage women.

Adolescent↗
PubMed2002

Outreach health adviser in a community clinic screening programme improves management of genital chlamydia infection.

OBJECTIVE: To assess the effectiveness of an outreach health adviser on treatment, partner notification and outcome for clients diagnosed with genital chlamydia (CT) infection at a community young people's clinic. METHODS: From August 1999 to March 2000, a genitourinary medicine (GUM) based health adviser helped to develop testing and undertook outreach management of clients aged under 26 years diagnosed with CT infection. In addition to facilitating referral to GUM, she gave antibiotic treatment based on a GUM derived patient group direction to those not wishing to travel to the GUM clinic. She also advised them on contact tracing and the need for a compliance check (CC). RESULTS: Chlamydia positive tests with ligase chain reaction (LCR), on first void urine, were obtained for 62 (12.9%) of 481 female clients, one (5%) of 20 male clients, and nine (53%) of 17 male contacts of female positive cases. All 72 testing positive received their result and were treated. Two urine samples positive for CT showed positive LCR tests for gonorrhoea. Proportions of named contacts seen (67%) and reattendances for compliance checks (60%) were similar to those for women seen in GUM services. CONCLUSIONS: Health adviser input with the ability to treat can be effective in reducing the growth of identified but untreated genital chlamydia infection consequent upon community based screening. Such a strategy appears comparable with, and can add to, GUM based treatment of infection. It helps to address the need for alternative management strategies in the light of the national sexual health strategy.

Adolescent↗
PubMed2004

Dendritic cells from Chlamydia-infected mice show altered Toll-like receptor expression and play a crucial role in inhibition of allergic responses to ovalbumin.

Our previous study has shown that Chlamydia lung infection can inhibit local eosinophilic inflammation induced by allergen sensitization and challenge, which is correlated with altered cytokine production. In the present study, we examined the role played by dendritic cells (DC) in chlamydial infection-mediated modulation of allergic responses. The results showed that DC freshly isolated from Chlamydia-infected mice (iIDC), unlike those from naive control mice (iNDC), could efficiently modulate immune responses to ovalbumin in vitro and in vivo. Co-culture of freshly isolated DC with naive CD4 cells from T cell receptor transgenic mice (DO11.10) showed that iIDC directed Th1-dominant, while iNDC directed Th2-dominant, allergen-specific CD4 T cell responses. Moreover, adoptive transfer of iIDC, but not iNDC, could inhibit systemic and local eosinophilia induced by allergen exposure. The reduction of eosinophilia was associated with a decrease in IL-5 receptor expression on bone marrow cells and the production of IL-5 and IL-13 by T lymphocytes. Analysis of the DC showed that iIDC expressed significantly higher levels of mRNA for Toll-like receptor 9 and produced more IL-12 compared to iNDC. The data demonstrate a critical role played by DC in infection-mediated inhibition of allergic responses.

Animals↗
PubMed1985

[Clinical aspects, diagnosis and therapy of ocular Chlamydia infection].

As reported in the recent literature, eye infections caused by Chlamydia trachomatis are increasing in number. Modern laboratory techniques were used in this study to scan a total of 114 patients with unilateral follicular conjunctivitis for these organisms. The authors describe the clinical picture, course, and results of therapy in a total of 6 (5.3%) young patients with chlamydial infections diagnosed by scraping and cell culture.

Administration, Topical↗
PubMed1991

Diagnosis and prevalence of persistent chlamydia infection in infertile women: tissue culture, direct antigen detection, and serology.

Specimens for chlamydial culture, direct fluorescent antibody (DFA) test, two enzyme immunoassays (EIA) for antigen detection, and serum for chlamydial antibodies were collected from 256 infertile women. Specimens were taken from the tubes during tuboplasty and from the cervix and endometrium during laparoscopy or tuboplasty. Antibodies to Chlamydia trachomatis were found four times more often in patients with signs of prior pelvic inflammatory disease (PID) than in infertile women with normal pelvic findings. Only 48 (37%) of 131 patients with signs of prior PID had a history of PID. Ten or more C. trachomatis elementary bodies (EBs) per smear were found in 21 (8.2%) of 256 patients. Six patients had a positive culture or a positive antigen EIA test. All six had high numbers of EBs in the DFA test. We conclude that routine culture and EIA antigen tests detect only a minority of persistent chlamydia infections in this population, but subjective factors in the interpretation of DFA methods must be considered.

Adult↗
PubMed1994

Management of genital Chlamydia trachomatis infections.

Chlamydia trachomatis is a common cause of genital infection and can give rise to urethritis and epididymitis in men and cervicitis and pelvic inflammatory disease in women. However, most genital chlamydial infections do not produce symptoms and so may be spread unknowingly. This article discusses the diagnosis and treatment of infection and how the risk of spread may be reduced.

Anti-Bacterial Agents↗
PubMed1988

Experimental chlamydial keratitis in rabbits. Correlation with chlamydia infected McCoy tissue culture cells.

Rabbit corneas were inoculated three times at weekly intervals with the agent of chlamydia trachomatis using the scratch method. Specimens of the corneal epithelium were obtained using the replica technique on the 1st, 2nd, 3rd and 4th day after each inoculation and at two weeks after the last inoculation. The development of chlamydial inclusions and the inflammatory cell response were monitored using Giemsa stain, acridine orange stain and direct immunofluorescent technique. Primary inoculation produced mild clinical disease associated cytologically with polymorphonuclear leucocytic cellular inflammatory response. Repeated inoculations produced more severe disease associated clinically with pannus formation and cytologically with the presence of lymphocytes and Leber cells in addition to polymorphonuclear leucocytes. Halberstaedter Prowazek inclusion bodies were detected in all the specimens. Additional intracytoplasmic and intranuclear inclusions of different morphological appearances were present. The cytological findings detected in the corneal epithelium of rabbits were correlated with the findings in McCoy tissue culture cells inoculated with chlamydia trachomatis.

Animals↗
PubMedDate not supplied

DFA, EIA, PCR, LCR and other technologies: what tests should be used for diagnosis of chlamydia infections?

For many years, isolation in tissue culture (TC) was considered the test of choice for diagnosis of Chlamydia trachomatis infection. Non-culture tests, such as direct fluorescent antibody (DFA) and enzyme immunoassay (EIA) which detected chlamydial antigens in clinical specimens, made chlamydia diagnostic tests more widely available. DFA and EIA were less sensitive than TC and had some false positive results which compromised our ability to use these tests in low prevalence settings. Direct nucleic acid probes are available, but do not appear to be more sensitive than EIA. It was only with the introduction of amplified DNA tests [polymerase chain reaction (PCR) and ligase chain reaction (LCR)] that non-culture tests became available that were actually more sensitive than TC. Unfortunately these tests are also more expensive than the antigen detection methods. Until there is a fairly sophisticated cost benefit analysis or a change in the pricing of these tests, it seems obvious that TC will remain, the best choice where medical/legal implications are important, DFA will probably remain a widely used tests for laboratories that process relatively small numbers of specimens and EIAs will play a role where cost is major factor and large numbers of specimens require bulk processing. Where they are affordable, the amplified DNA tests are to be preferred as they are far more sensitive than these other non-culture tests.

Bacterial Typing Techniques↗