Sexually transmitted chlamydia trachomatis infection: management of the most common venereal disease

Cytokine profile in Nigerians with tubal infertility

INTRODUCTION

Immune response to genital Chlamydia trachomatis infection is involved in both immunity and pathology. The cytokine profile during infection has been implicated in the disease outcome, either resolution or severe sequelae. Serum cytokines of Chlamydia positive Nigerian women with tubal infertility were assessed to determine their possible relationship with tubal occlusion.

MATERIAL AND METHODS

One hundred and fifty age-matched consenting women (100 fertile and 50 with tubal infertility) were recruited based on C. trachomatis antibody positivity and grouped into infertile Chlamydia positive (CTpos) women (n = 50), fertile Chlamydia positive women (n = 50) and fertile Chlamydia negative (CTneg) women as controls (n = 50). High vaginal swabs and endo-cervical swabs were collected for microscopy, culture and gram staining. Cytokines [transforming growth factor β1 (TGF-β1), interferon γ (IFN-γ), tumor necrosis factor α (TNF-α), interleukin (IL)-4, IL-10 and IL-17A] were estimated by ELISA in sera. Data were analyzed using ANOVA, χ (2) and Spearman's correlation at p = 0.05.

RESULTS

Lower IFN-γ levels were observed in infertile women compared to fertile women. Fertile CTneg women had significantly higher TNF-α, and TGF-β1 compared to fertile and infertile CTpos women, respectively. Lower IL-10 levels were seen in fertile CTpos women compared to the infertile CTpos group. Vaginal discharge was negatively correlated with TNF-α and IFN-γ and positively with IL-4 in Chlamydia positive women.

CONCLUSIONS

Chlamydia positive women with tubal infertility have higher IL-10 and lower IFN-γ levels than controls, which may contribute to their development of tubal pathology.

TestPack Chlamydia, a new rapid assay for the direct detection of Chlamydia trachomatis

TestPack Chlamydia (Abbott Laboratories) is a rapid enzyme immunoassay for the direct antigen detection of Chlamydia trachomatis in endocervical specimens. The assay is self-contained, requires no specialized equipment, and yields results in less than 30 min. The clinical performance of TestPack Chlamydia versus chlamydial cell culture was evaluated with a total of 1,694 paired endocervical specimens. Discordant samples were further investigated by immunofluorescent staining and by Chlamydiazyme immunoassay, with confirmatory procedures. The sensitivity of TestPack Chlamydia with less-than-48-h-old specimens was 76.5%, while culture sensitivity was 86.7%. TestPack Chlamydia specificity was determined to be 99.5%. These results indicate that TestPack Chlamydia is an accurate test for chlamydial infection, with a positive predictive value of 96.2%. This assay is suitable for low-volume chlamydial testing in physician offices, clinics, and smaller laboratories.

Chlamydia trachomatis infections

The diversity in chlamydial syndromes and their consequences especially the impact on human reproduction and fertility, the asymptomatic characteristics of infections and the ever-increasing incidence have been the focus of considerable attention in the 1980s. The current status of the clinical spectrum of ocular-genital infections due to Chlamydia trachomatis and the laboratory tests for accurate, rapid diagnosis and effective treatment are reviewed.

Serologic diagnosis of Chlamydia trachomatis infections

The serology of various infections often caused by Chlamydia trachomatis including complications such as pelvic inflammatory disease (PID) and infertility was investigated comprehensively among diverse patient groups in a developing country using initially an indirect immunofluorescent antibody test (IFA). Any positives detected were further examined by a micro-immunofluorescence (MIF) method for the presence of type specific anti-chlamydial IgG/IgM antibodies. Conventional cell culture was carried out concurrently to compare culture results with serologic results. Among 416 patients (107 males and 309 females) C. trachomatis D-K antibodies to IgG were identified in 87 (20.9%) and to type specific IgM were identified in 11(2.6%) patients. Cell culture identified C. trachomatis in 60 patients (14.4%). C. trachomatis IgG antibodies were detectable in 6.4% of chlamydia culture negative patients.

Chlamydial infections

Chlamydiae are small bacteria that have a unique life cycle. There are two species, Chlamydia psittaci and C. trachomatis, which cause a wide spectrum of clinical disease, including neonatal conjunctivitis and pneumonia, sexually transmitted disease, psittacosis, and trachoma. The importance of chlamydial disease in public health is being increasingly recognized, and the incidence in developed countries seems to be increasing. An understanding of chlamydial disease, its prevention and treatment, is essential for the infection control practitioner, who can play a significant role in patient education.

Pelvic inflammatory disease, intrauterine contraception, and the conduct of epidemiologic studies

Pelvic inflammatory disease (PID) has been described in the medical literature for more than a century as a specific entity. Neisseria gonorrhoeae, Chlamydia trachomatis, and Mycoplasma hominis, along with Bacteroides fragilis and other anaerobic bacteria, have been most frequently associated with PID. Factors affecting the occurrence of PID have been extensively studied during the past two decades and include number of sexual partners, age, race, socioeconomic status, education, and contraceptive method. As knowledge concerning factors that contribute to PID increases, epidemiologic studies addressing such issues must become increasingly sophisticated, and the literature needs to be re-evaluated in light of present knowledge. Various risk factors for PID, types of epidemiologic studies, methods for conducting such studies, and data interpretation are reviewed.