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PubMed1997

Chlamydia screening practices of primary-care providers -- Wake County, North Carolina, 1996.

Genital chlamydial infection is the most commonly reported infectious disease in the United States, and the prevalence of Chlamydia trachomatis genital infections in sexually active adolescents is 5%-15%, regardless of socioeconomic status. Although chlamydial infections frequently are asymptomatic in women, untreated infections can cause extensive inflammation and scarring of the female reproductive tract. In addition, chlamydial infections may facilitate human immunodeficiency virus transmission. Because of the risks and complications associated with this infection, CDC and the U.S. Preventive Services Task Force have recommended that all sexually active adolescent women undergoing a pelvic examination receive routine screening for chlamydia. To characterize the chlamydia screening practices of primary-care providers in Wake County, North Carolina, a county with high reported rates of chlamydial genital infection, the Wake County Human Services Public Health Center conducted a survey of primary-care providers during August-October 1996. This report summarizes the results of that survey, which document missed opportunities for the detection of chlamydia infection by health-care providers in both public and private practices.

Adolescent↗
PubMed1997

[Direct and indirect detection of Chlamydia in infertile married couples in the assisted reproduction program].

The authors pay attention to the relationship of pregnancy in women enlisted in the IVF programme and the detection of Chlamydia infection. A group of 74 infertile couples were investigated. A significant relationship was found between confirmed Chlamydia infection in women and men. Moreover a significant relationship was found between Chlamydia infection confirmed by immunofluorescence in men and impregnation in women in the IVF programme. This means that in female partners of men with acute Chlamydia infection the results of IVF are less successful. The authors recommend that all couples enlisted in the IVF programme should be examined for this infection and if it is positive given adequate treatment.

Chlamydia Infections↗
PubMed1998

Apoptosis of epithelial cells and macrophages due to infection with the obligate intracellular pathogen Chlamydia psittaci.

We have characterized the cytotoxic activity of the obligate intracellular bacterium Chlamydia psittaci, which resides within a membrane-bound vacuole during the 2-day infection cycle. We have established that infected epithelial cells and macrophages die through apoptosis, which is measurable within 1 day of infection and requires productive infection by the bacteria. Inhibition of host cell protein synthesis has no effect on cell death, but blocking bacterial entry or bacterial protein synthesis prevents apoptosis, implying that bacterial growth is required for death of the host cell. Apoptosis was confirmed through the use of electron microscopy, terminal deoxynucleotidyl transferase-mediated dUTP nick end labeling, gel agarose electrophoresis of fragmented DNA, and propidium-iodide labeling of host cell nuclei. Although infected cells died preferentially, both infected and uninfected cells became apoptotic, suggesting that the infected cells may secrete proapoptotic factors. Inhibition of either of two proapoptotic enzymes, caspase-1 or caspase-3, did not significantly affect Chlamydia-induced apoptosis. These results suggest that, as in the case of apoptosis due to Bax expression or oncogene dysregulation, which initiate the apoptotic program within the cell interior, the Chlamydia infection may trigger an apoptotic pathway that is independent of known caspases. As apoptotic cells secrete proinflammatory cytokines, Chlamydia-induced apoptosis may contribute to the inflammatory response of the host.

Apoptosis↗
PubMed1998

[Chlamydia pneumoniae infection and cardiac ischemic syndromes].

The aim of this study was to assess the presence of Chlamydia pneumoniae antibodies in patients with angiographically verified atherosclerotic coronary artery disease. A total of 114 consecutive patients were investigated between April 1995 and June 1996. Patients were divided into two groups: 72 patients with acute myocardial infarction (AMI; 53 men, 19 women, mean age 62.27 +/- 10.1 years), and 42 patients with chronic ischemic heart disease (CAD; 37 men, 5 women, mean age 62.75 +/- 9.2 years). A control group of 50 normal subjects matched for age (mean 62 +/- 9 years), sex, social status and geographical area was used. Identification of Chlamydia pneumoniae was carried out with the microimmunofluorescence method, on two serum samples taken from patients on admission and after 15 days. The IgM, IgG and IgA anti-Chlamydia pneumoniae titers were assessed, values > or = 1:16, > or = 1:32 and > or = 1:8 being respectively considered positive. Acute (IgM > or = 16 or four fold rise of IgG titer) and chronic (IgG > or = 128 e IgA > or = 32 or only elevated IgA titer) infections were analyzed. IgM antibodies were not found in AMI, CAD and control groups. IgG positivity (IgG > or = 32) was found in 38% of the control group, in 58.3% of the AMI group (p < 0.05) and 42.8% of the CAD group (p < 0.01). IgA positivity > or = 8) was found in 22% of the control group, in 31.9% of the AMI group (NS) and in 33.3% of the CAD group (p < or = 0.05). Acute infection was observed in 5.5% of AMI patients and in 12% of CAD patients (NS), whereas no subject of the control group showed these values. Chronic infection was observed in 9.7% of AMI patients and in 16.6% of CAD patients (NS) whereas nobody of the control group showed these values. In conclusion, our results suggest that Chlamydia pneumoniae infection is present only in the AMI and CAD groups. It is possible to suppose that this infection may be linked to atherosclerosis through an endothelial damage or a systemic endogenous procoagulant and inflammatory activity.

Aged↗
PubMed1999

Frequency of apolipoprotein E (APOE) allele types in patients with Chlamydia-associated arthritis and other arthritides.

Genetic background is important in determining whether certain infecting bacteria disseminate to the joint and cause arthritis. We assessed whether APOE genotype is associated with the presence of DNA from Chlamydia or other bacteria in synovial tissues of patients with various arthritides. Nucleic acids from synovial tissues of 135 patients were screened by PCR for DNA from Chlamydia trachomatis, C. pneumoniae and other bacteria (pan-bacteria). APOE genotype was determined by a PCR-based method for all patients in each of four resulting groups comprised of about 35 individuals each, positive for C. trachomatis only, C. pneumoniae only, other bacteria, or no bacteria. RT-PCR was used to assess synovial APOE expression. The latter assays confirmed that APOE mRNA is present in synovial tissue. Determination of APOE genotype showed that patients PCR-negative in all assays, and those positive in the C. trachomatis - and pan-bacteria- (excluding Chlamydia) directed assays, had distributions of the APOE epsilon2, epsilon3 and epsilon4 alleles mirroring those of the general population (i.e. about 8%, 79% and 13%, respectively). In contrast, 68% of patients with C. pneumoniae DNA in synovium possessed a copy of the epsilon4 allele. These results indicate that no association exists between APOE genotype and synovial presence of C. trachomatis or other bacteria. However, individuals bearing at least one copy of the APOE epsilon4 allele may be at increased risk for synovial infection by C. pneumoniae.

Alleles↗
PubMed1988

The incidence of urogenital Chlamydia trachomatis infections among patients in Kumasi, Ghana.

The incidence of urogenital chlamydia infections among selected patients in Kumasi, Ghana was evaluated using an immunofluorescent monoclonal antibody technique. Chlamydia trachomatis was identified in 4 of 110 patients presenting for prenatal care, 2 of 55 female patients with infertility and 6 of 15 males with acute urethritis. The findings demonstrate that C. trachomatis is a frequently identified pathogen among male patients presenting with symptoms of acute urethritis; however, the incidence of chlamydia infections among asymptomatic patients is relatively low.

Acute Disease↗
PubMed2002

CADD, a Chlamydia protein that interacts with death receptors.

We report here the identification of a bacterial protein capable of interacting with mammalian death receptors in vitro and in vivo. The protein is encoded in the genome of Chlamydia trachomatis and has homologues in other Chlamydia species. This protein, which we refer to as "Chlamydia protein associating with death domains" (CADD), induces apoptosis in a variety of mammalian cell lines when expressed by transient gene transfection. Apoptosis induction can be blocked by Caspase inhibitors, indicating that CADD triggers cell death by engaging the host apoptotic machinery. CADD interacts with death domains of tumor necrosis factor (TNF) family receptors TNFR1, Fas, DR4, and DR5 but not with the respective downstream adaptors. In infected epithelial cells, CADD is expressed late in the infectious cycle of C. trachomatis and co-localizes with Fas in the proximity of the inclusion body. The results suggest a role for CADD modulating the apoptosis pathways of cells infected, revealing a new mechanism of host-pathogen interaction.

Amino Acid Sequence↗
PubMedDate not supplied

Screening for Chlamydia trachomatis infection in pregnant women in Martinique.

GOAL OF THIS STUDY: To determine the prevalence of Chlamydia trachomatis urogenital infection and to identify behavioral, demographic, and clinical factors associated with the infection in pregnant women in Martinique. STUDY DESIGN: One-thousand-four-hundred-eleven patients 15-39 years old, at 10-16 weeks of gestation and attending the prenatal clinic at Lamentin Hospital, were tested for Chlamydia trachomatis infection of the cervix and urethra using tissue culture. RESULTS: Chlamydia trachomatis was isolated from 375 (26.7%) women; 34% of them were positive in the cervix and urethra, 58% in the cervix only, and 8% in the urethra only. Factors found by multivariate analysis to be significantly associated with chlamydial infection were age less than 25 years, first intercourse at less than 18 years old, previous induced abortions, mucopurulent cervicitis, and repeated candidiasis. CONCLUSIONS: None of the factors associated with chlamydial infection was sensitive enough to permit efficient selective screening. It is cost effective to recommend a routine screening for chlamydial infection together with an educational program.

Abortion, Induced↗
PubMed1999

Subsequent sexually transmitted infections among adolescent women with genital infection due to Chlamydia trachomatis, Neisseria gonorrhoeae, or Trichomonas vaginalis.

OBJECTIVE: To identify factors associated with subsequent sexually transmitted infection (STI) (within 1 year of initial infection) due to Chlamydia trachomatis, Neisseria gonorrhoeae or Trichomonas vaginalis. DESIGN: Prospective cohort study. SETTING: A sexually transmitted diseases clinic and four community-based primary care clinics for adolescents. PARTICIPANTS: Female patients (ages 15 to 19 years) with initial diagnosis of chlamydia, gonorrhea, or trichomonas. MAIN OUTCOME MEASURES: Subsequent infection by chlamydia, gonorrhea, or trichomonas. RESULTS: More than 40% of subjects were subsequently infected by at least one STI. Reinfection was common, but infections with sexually transmitted organisms other than the initial infecting organism were also common. Predictors of subsequent infection were black race, gonorrhea as the initial infection, two or more sex partners in the previous 3 months, and inconsistent condom use. CONCLUSIONS: Subsequent STI frequently follow an initial STI, but there is substantial variation in the causal organism. These data suggest the importance of comprehensive STI prevention programs for adolescents rather than organism-specific interventions.

Adolescent↗
PubMed1990

Postabortal pelvic sepsis in association with Chlamydia trachomatis.

Cervical swabs for Chlamydia trachomatis culture were taken from 527 women presenting for elective termination of pregnancy. Twenty-six patients (4.9%) harboured C. trachomatis; 21 (81%) of these were less than 25-years-old and 21 (81%) were nulliparas. Postoperative pelvic sepsis developed in 11.5% of chlamydia-positive women, in contrast to 3.6% of chlamydia-negative women. Consequently it is suggested that all patients, especially those younger than 25 years, presenting for termination of pregnancy or in whom an intrauterine device is to be inserted should be screened and have treatment commenced for C. trachomatis prior to the operative procedure.

Abortion, Induced↗
PubMed2001

Recombination in the ompA gene but not the omcB gene of Chlamydia contributes to serovar-specific differences in tissue tropism, immune surveillance, and persistence of the organism.

Sequences of the major outer membrane protein (MOMP) gene (ompA) and the outer membrane complex B protein gene (omcB) from Chlamydia trachomatis, Chlamydia pneumoniae, and Chlamydia psittaci were analyzed for evidence of intragenic recombination and for linkage equilibrium. The Sawyer runs test, compatibility matrices, and index of association analyses provided substantial evidence that there has been a history of intragenic recombination at ompA including one instance of interspecies recombination between the C. trachomatis mouse pneumonitis strain and the C. pneumoniae horse N16 strain. Although none of these methods detected intragenic recombination within omcB, differences in divergence reported in earlier studies suggested that there has been intergenic recombination involving omcB, and the analyses presented in this study are consistent with this. For C. trachomatis, index-of-association analyses suggested a higher degree of recombination for C class than for B class strains and a higher degree of recombination in the downstream half of ompA. In concordance with these findings, many significant breakpoints were found in variable segments 3 and 4 of MOMP for the recombinant strains D/B120, G/UW-57, E/Bour, and LGV-98 identified in this study. We provide examples of how genetic diversity generated by repeated recombination in these regions may be associated with evasion of immune surveillance, serovar-specific differences in tissue tropism, and persistence.

Animals↗
PubMed2006

Vulvovaginal-swab or first-catch urine specimen to detect Chlamydia trachomatis in women in a community setting?

Screening for chlamydia in women is widely recommended. We evaluated the performance of two nucleic acid amplification tests for detecting Chlamydia trachomatis in self-collected vulvovaginal-swab and first-catch urine specimens from women in a community setting and a strategy for optimizing the sensitivity of an amplified enzyme immunoassay on vulvovaginal-swab specimens. We tested 2,745 paired vulvovaginal-swab and urine specimens by PCR (Roche Cobas) or strand displacement amplification (SDA; Becton Dickinson). There were 146 women infected with chlamydia. The assays detected 97.3% (95% confidence interval [CI], 93.1 to 99.2%) of infected patients with vulvovaginal-swab specimens and 91.8% (86.1 to 95.7%) with urine specimens. We tested 2,749 vulvovaginal-swab specimens with both a nucleic acid amplification test and a polymer conjugate-enhanced enzyme immunoassay with negative-gray-zone testing. The relative sensitivities obtained after retesting specimens in the negative gray zone were 74.3% (95% CI, 62.8 to 83.8%) with PCR and 58.3% (95% CI, 46.1 to 69.8%) with SDA. In community settings, both vulvovaginal-swab and first-catch urine specimens from women are suitable substrates for nucleic acid amplification tests, but enzyme immunoassays, even after negative-gray-zone testing, should not be used in screening programs.

Adolescent↗
PubMed1975

Minocycline in the treatment of nongonococcal urethritis: its effect on Chlamydia trachomatis.

The effect of minocycline on nongonococcal urethritis (NGU) was investigated, with particular reference to its action against Chlamydia trachomatis. Preliminary laboratory studies showed that the drug was active against a laboratory chlamydial strain (Lb4f) in vitro. A group of 133 men with first attacks of NGU was then treated with minocycline, 100 mg twice daily for 3 weeks. Isolates of C trachomatis were obtained from 33 of these men before treatment; all of them gave negative results on cell culture after therapy. Of the 133 patients, 119 (90%) had symptoms on their first attendance, but after one week's treatment only 16 of the 133 (12%) and after 3 weeks 6 of the 133 (5%) had symptoms. All 133 men had demonstrable urethritis initially; by the end of the first week of treatment only 43 of the 133 (32%) and by the end of the third week 32 of the 133 (24%) had evidence of urethritis. There were no differences in clinical response between the Chlamydia-positive and Chlamydia-negative groups. A group of 24 female sexual contacts of men with NGU yielded C trachomatis on cell culture. After 3 weeks' therapy with minocycline all these women gave negative results on cell culture. It is concluded that minocycline is a useful addition to existing remedies for NGU. The future structure of treatment trials for NGU is discussed.

Animals↗
PubMed1992

[Chlamydia trachomatis and Neisseria gonorrhoeae among women seeking abortion in Norway. Results from a nationwide study].

In April and May 1991 all women requesting abortion in Norway were screened for Chlamydia trachomatis and Neisseria gonorrhoeae. During the study period 2,194 abortions were carried out. The study included 2,110 women with representative tests for C trachomatis from the cervix uteri. Only 1,702 women were tested for N gonorrhoeae. The prevalence of N gonorrhoeae was 0.5% (8:1,702), and of C trachomatis 5.4% (113:2,100). The prevalence of C trachomatis decreased from 9.1% among women less than or equal to 19 years to 2.0% among women greater than or equal to 35 years of age. Prevalence of C trachomatis was significantly lower among subjects resident in health region no. IV (mid-western part of Norway) than among candidates for abortion from the other four health regions. Being less than 25 years of age was the best single parameter for identifying chlamydia-positive cases. The prevalence of N gonorrhoeae among women seeking abortion in Norway is so low that screening is not recommended. However, the prevalence of C trachomatis is still high enough to recommend screening of all women less than 25 years of age who request abortion. Chlamydia-positive cases should be tested for N gonorrhoeae.

Abortion Applicants↗
PubMed1991

[Serology of Chlamydia and ectopic pregnancies. Incidence of Fitz-Hugh-Curtis syndrome].

The authors report a prospective study of anti-chlamydia trachomatis serology in extra-uterine pregnancies, which happened to coincide with an increase in the ectopic rate during the year 1989 (p less than 1.10(-6]. The subjects of the study were those patients operated on for ectopic pregnancy between the 1st January and the 31st May 1989. There were two control groups: the first were those that were delivered and the second were those pregnant women who were at risk of ectopic pregnancy because of their age, or the number of pregnancies they had had and their parity, without taking any account of the duration of the pregnancy. The level for sero-positive reading was 1 in 64 using an indirect immunofluorescent method (Spot IF, Bio Merieux). The results showed 81% sero-positive in those who had had ectopic pregnancies as against 63% in the control groups. The two control groups had identical readings. There was a significant difference statistically (p less than 0.01). There was no statistical difference in the incidence of HIV (human immunodeficiency virus) in the two groups (3% and 1%). The clinical study of the other tube showed no particular lesions. On the other hand, adhesions between the liver and the diaphragm (Fitz-Hugh-Curtis Syndrome) were demonstrated in 34% of those with ectopic pregnancy with a statistical significant level of igG above or equal to 1:128 (p 0.02). Perisplenitis was rare (3 cases). Histological finding of salpingitis isthmica nodosa in 49% of cases raises the problem of the pathology of chlamydial lesions being due to a host invader reaction. The increase in the incidence of ectopic pregnancy (1 in 44 deliveries) was accompanied by an increase in the prevalence of chlamydia trachomatis in the group with ectopics and the control groups. If the frequency of ectopics creates a major problem of public hygiene, the prevalence of chlamydia in the female population, apart from its effect on fertility, explains the action of sexually transmitted diseases as a factor in the heterosexual transmission of HIV in Africa.

Adolescent↗
PubMedDate not supplied

The incidence of Chlamydia trachomatis-induced infection in women suffering from cervicovaginitis.

The results of a research on Chlamydia T. (direct survey of both the antigen in the uterine cervix and plasmatic antibodies) in a group of subjects suffering for cervico-vaginitis are provided. The incidence of the Chlamydia infection (proved by either the presence of this bacterium or antibody positivity) is not different from the values reported in literature. Conversely, the presence of neither specific cytological or colposcopic patterns nor of priviledged comites at vaginal level could be demonstrated. Our data, however, confirm a greater incidence of this infection in women reporting early sexual life and a high number of partners. As for the relationship between Chlamydia and contraceptives a slightly higher incidence of positivity in the cervix of patients using oestro-progestinics was registered, whereas no significant difference was noted in the use of other contraceptives IUD included.

Adult↗
PubMed1996

Incidence of pelvic inflammatory disease among women treated for gonorrhea or chlamydia.

BACKGROUND: No estimate exists of the incidence of pelvic inflammatory disease (PID) after the occurrence of a recent bout of sexually transmitted disease (STD). METHODS: We used a computerized data file of prescriptions and medical encounters from the Fallon Community Health Plan to estimate the incidence rate of pelvic inflammatory disease (PID) among women with a recently treated episode of gonorrhea or chlamydia (STD). First we identified women with presumed gonorrhea or chlamydia on the basis of a combination of diagnostic codes for cervicitis, vulvovaginitis or Bartholin's abscess, and a computer record of a prescription for doxycycline. We then followed these women to estimate the incidence rate of PID after their treatment for gonorrhea or chlamydia. We estimated the number of cases of pelvic inflammatory disease in this cohort by selecting all women with an International Classification of Diseases (ICD) code of 614.9 entered for either an outpatient or inpatient diagnosis. RESULTS: We estimated the overall risk of PID to be about 9% during the 1-year period following treatment for gonorrhea or chlamydia, with a steep rise in risk coming within the first 45 days. CONCLUSION: The risk of PID in the year after an episode of treated STD is high, but the highest period of risk is in the first few weeks. The shape of the risk curve indicates that some PID cases may result from treatment-resistant infections, or possibly from untreated reinfections.

Journal Article↗
PubMed1997

Heparin-mediated inhibition of Chlamydia psittaci adherence to HeLa cells.

The adherence of human strains of Chlamydia trachomatis has been recently shown to be inhibitable by heparin and heparitinase, leading to the proposal that Chlamydia binding to host cells may be mediated by a glycosaminoglycan (GAG)-dependent mechanism. We here describe the adherence of the guinea-pig pathogen, Chlamydia psittaci GPIC, to HeLa cells, which was measured by cytofluorometry with chlamydiae whose DNA was fluorescently labelled. Adherence could be inhibited by heat or trypsin pretreatment of the bacteria, and binding was much faster at 37 degrees C (reaching a plateau within 1 h) than 4 degrees C. Little binding remained when host cells were pre-fixed with paraformaldehyde, suggesting that host cell receptor mobility may be required for effective adherence. Visualization by confocal microscopy confirmed that the bacteria were at or near the host cell surface during the entire time-course of these experiments. Adherence increased as a function of pH between pH 6 and pH 8.0-8.5. Both adherence and infection of HeLa cells could be inhibited with heparin when the adherence step was performed at 4 degrees C, but only infection was inhibited when the adherence step was performed at 37 degrees C, even though heparitinase could block adherence at either 4 degrees C or 37 degrees C. Even at 4 degrees C, heparin-mediated inhibition was significantly lower at pH 8 than pH 7.4, suggesting that GAG-independent mechanisms may play a role in the higher adherence observed at basic pH. These results therefore demonstrate that a GAG-dependent adherence step may be operative in C. psittaci, and raise the possibility that other adherence mechanisms may also contribute to binding by this chlamydial strain. Furthermore, they suggest that there may not be a strict correlation between C. psittaci adherence and the ability to cause productive infections.

Bacterial Adhesion↗