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Nguyen PTT, Pham HV, Van DH, Pham LV, Nguyen HT, Nguyen HV. Randomized controlled trial of the relative efficacy of high-dose intravenous ceftriaxone and oral cefixime combined with doxycycline for the treatment of Chlamydia trachomatis and Neisseria gonorrhoeae co-infection. BMC Infect Dis 2022; 22:607. [PMID: 35810277 PMCID: PMC9270733 DOI: 10.1186/s12879-022-07595-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/25/2022] [Accepted: 06/08/2022] [Indexed: 11/10/2022] Open
Abstract
OBJECTIVES Chlamydia trachomatis (CT) and Neisseria gonorrhoeae (NG) are the commonest bacterial causes of sexually transmitted infections in humans with high incidence of co-infection. Treatment with high doses of ceftriaxone (CRO) and cefixime (CFM) is strongly recommended due to the reduced drug susceptibility of NG. However, their safety and efficacy have not been confirmed. We compared the safety and efficacy of a single 1 g intravenous (IV) dose of ceftriaxone (CRO) plus doxycycline (DOX) versus a single 800 mg oral dose of cefixime (CFM) plus DOX for the treatment of NG-CT co-infection. METHODS An open-label randomized controlled trial was conducted on 125 individuals aged > 18 years with untreated gonorrhea and chlamydia to compare a single 1 g intravenous dose of CRO + DOX and a single 800 mg oral dose of CFM + DOX. The primary outcome was the clearance of NG from all the initially infected sites. Secondary outcomes included symptom resolution, changes in the serum clearance levels, glomerular filtration rate, and antibiotic minimum inhibitory concentrations. RESULTS Both regimens were highly effective in treating gonorrhea with success rates of 96.7% (95% confidence interval [CI] 88.8-99.1%) for CRO and 95.3% (95% CI 87.1-98.4%) for CFM. However, CRO + DOX was superior to CFM + DOX for the treatment of NG-CT co-infection (odds ratio 4.41, 95% CI 1.11-25.7). The safety profiles of the two regimens were similar. CONCLUSIONS CRO + DOX was superior to CFM + DOX for the treatment of NG-CT co-infection. CFM + DOX may be indicated in patients with CRO allergy and in settings where CRO is unavailable. Trial registration ClinicalTrials.gov (NCT05216744) on 31/01/22.
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Affiliation(s)
- Phuong Thi Thu Nguyen
- Hai Phong University of Medicine and Pharmacy, 72A Nguyen Binh Khiem, Dang Giang, Ngo Quyen, Hai Phong, Vietnam.,Hai Phong International Hospital, 124 Nguyen Duc Canh, Cat Dai, Le Chan, Hai Phong, Vietnam
| | - Ha Viet Pham
- Hai Phong International Hospital, 124 Nguyen Duc Canh, Cat Dai, Le Chan, Hai Phong, Vietnam
| | - Dung Hoang Van
- Hai Phong University of Medicine and Pharmacy, 72A Nguyen Binh Khiem, Dang Giang, Ngo Quyen, Hai Phong, Vietnam.,Hai Phong International Hospital, 124 Nguyen Duc Canh, Cat Dai, Le Chan, Hai Phong, Vietnam
| | - Linh Van Pham
- Hai Phong University of Medicine and Pharmacy, 72A Nguyen Binh Khiem, Dang Giang, Ngo Quyen, Hai Phong, Vietnam
| | - Hoi Thanh Nguyen
- Hai Phong University of Medicine and Pharmacy, 72A Nguyen Binh Khiem, Dang Giang, Ngo Quyen, Hai Phong, Vietnam.,Hai Phong International Hospital, 124 Nguyen Duc Canh, Cat Dai, Le Chan, Hai Phong, Vietnam
| | - Hung Van Nguyen
- Hai Phong University of Medicine and Pharmacy, 72A Nguyen Binh Khiem, Dang Giang, Ngo Quyen, Hai Phong, Vietnam.
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Filardo S, Di Pietro M, Pasqualetti P, Manera M, Diaco F, Sessa R. In-cell western assay as a high-throughput approach for Chlamydia trachomatis quantification and susceptibility testing to antimicrobials. PLoS One 2021; 16:e0251075. [PMID: 33974662 PMCID: PMC8112659 DOI: 10.1371/journal.pone.0251075] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/22/2020] [Accepted: 04/19/2021] [Indexed: 11/24/2022] Open
Abstract
Chlamydia trachomatis, the leading cause of bacterial sexually transmitted diseases in developed countries, with around 127 million new cases per year, is mainly responsible for urethritis and cervicitis in women, and urethritis and epididymitis in men. Most C. trachomatis infections remain asymptomatic (>50%) and, hence, untreated, leading to severe reproductive complications in both women and men, like infertility. Therefore, the detection of C. trachomatis as well as the antimicrobial susceptibility testing becomes a priority, and, along the years, several methods have been recommended, like cell culture and direct immunofluorescence (DFA) on cell cultures. Herein, we described the application of In-Cell Western assay (ICW) via Odyssey CLx as a fast, more accessible, and high-throughput platform for the quantification of C. trachomatis and the screening of anti-chlamydial drugs. As a first step, we set up a standard curve by infecting cell monolayers with 2-fold serial dilutions of C. trachomatis Elementary Body (EB) suspension. Then, different unknown C. trachomatis EB suspensions were quantified and the chlamydial susceptibility testing to erythromycin was performed, using the DFA as comparison. Our results showed a very high concordance between these two assays, as evidenced by the enumeration of chlamydial IFUs as well as the determination of erythromycin Minimum Inhibitory Concentration (MIC). In conclusion, the ICW assay may be a promising candidate as an accurate and accessible methodology for C. trachomatis antimicrobial susceptibility testing.
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Affiliation(s)
- Simone Filardo
- Department of Public Health and Infectious Diseases, Section of Microbiology, University of Rome “Sapienza”, Rome, Italy
- * E-mail:
| | - Marisa Di Pietro
- Department of Public Health and Infectious Diseases, Section of Microbiology, University of Rome “Sapienza”, Rome, Italy
| | - Patrizio Pasqualetti
- Department of Public Health and Infectious Diseases, Section of Health Statistics and Biometry, University of Rome “Sapienza”, Rome, Italy
| | - Martina Manera
- Department of Public Health and Infectious Diseases, Section of Microbiology, University of Rome “Sapienza”, Rome, Italy
| | - Fabiana Diaco
- Department of Public Health and Infectious Diseases, Section of Microbiology, University of Rome “Sapienza”, Rome, Italy
| | - Rosa Sessa
- Department of Public Health and Infectious Diseases, Section of Microbiology, University of Rome “Sapienza”, Rome, Italy
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Ma C, Du J, He W, Chen R, Li Y, Dou Y, Yuan X, Zhao L, Gong H, Liu P, Liu H. Rapid and accurate diagnosis of Chlamydia trachomatis in the urogenital tract by a dual-gene multiplex qPCR method. J Med Microbiol 2019; 68:1732-1739. [PMID: 31613208 DOI: 10.1099/jmm.0.001084] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022] Open
Abstract
Introduction. Chlamydia trachomatis (C. trachomatis, CT) is an obligatory intracellular bacterium that causes urogenital tract infections and leads to severe reproductive consequences. Therefore, a rapid and accurate detection method with high sensitivity and specificity is an urgent requirement for the routine diagnosis of C. trachomatis infections.Aim. In this study, we aimed to develop a multiplex quantitative real-time PCR (qPCR) assay based on two target regions for accurate detection of C. trachomatis in urogenital tract infections.Methodology. Primers and probes based on the conserved regions of the cryptic plasmid and 23S rRNA gene were designed. Then, two qPCR assays were established to screen for the optimal probe and primers for each of the two target regions. Subsequently, the multiplex qPCR method was developed and optimized. For the diagnostic efficiency evaluation, 1284 urogenital specimens were tested by the newly developed multiplex qPCR method, an immunological assay and a singleplex qPCR assay widely used in hospitals.Results. The multiplex qPCR method could amplify both target regions in the range of 1.0×102-1.0×108 copies ml-1 with a strong linear relationship, and lower limits of detection (LODs) for both targets reached 2 copies PCR-1. For the multiplex qPCR method, the diagnostic sensitivity and specificity was 100.0 % (134/134) and 99.3 % (1142/1150), respectively. For the singleplex qPCR assay, the diagnostic sensitivity and specificity was 88.8 % (119/134) and 100.0 % (1150/1150), respectively. For the immunological assay, the diagnostic sensitivity and specificity was 47.0 % (63/134) and 100.0 % (1150/1150), respectively.Conclusion. In this study, a multiplex qPCR assay with high sensitivity and specificity for rapid (≤2.0 h) and accurate diagnosis of C. trachomatis was developed. The qPCR assay has the potential to be used as a routine diagnostic method in clinical microbiology laboratories.
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Affiliation(s)
- Caifeng Ma
- Department of Clinical Laboratory, Central Research Laboratory, The Second People's Hospital of Bao'an Shenzhen (Group), Shajing People's Hospital of Bao'an Shenzhen, Shenzhen Shajing Hospital affiliated to Guangzhou Medical University, Shenzhen, PR China
| | - Jikun Du
- Department of Clinical Laboratory, Central Research Laboratory, The Second People's Hospital of Bao'an Shenzhen (Group), Shajing People's Hospital of Bao'an Shenzhen, Shenzhen Shajing Hospital affiliated to Guangzhou Medical University, Shenzhen, PR China
| | - Weina He
- Department of Clinical Laboratory, Central Research Laboratory, The Second People's Hospital of Bao'an Shenzhen (Group), Shajing People's Hospital of Bao'an Shenzhen, Shenzhen Shajing Hospital affiliated to Guangzhou Medical University, Shenzhen, PR China
| | - Rui Chen
- Department of Clinical Laboratory, The Second People's Hospital of Futian District, Shenzhen, PR China
| | - Yuxia Li
- Department of Clinical Laboratory, Central Research Laboratory, The Second People's Hospital of Bao'an Shenzhen (Group), Shajing People's Hospital of Bao'an Shenzhen, Shenzhen Shajing Hospital affiliated to Guangzhou Medical University, Shenzhen, PR China
| | - Yuhong Dou
- Department of Clinical Laboratory, Central Research Laboratory, The Second People's Hospital of Bao'an Shenzhen (Group), Shajing People's Hospital of Bao'an Shenzhen, Shenzhen Shajing Hospital affiliated to Guangzhou Medical University, Shenzhen, PR China
| | - Xiaoxue Yuan
- Department of Clinical Laboratory, Central Research Laboratory, The Second People's Hospital of Bao'an Shenzhen (Group), Shajing People's Hospital of Bao'an Shenzhen, Shenzhen Shajing Hospital affiliated to Guangzhou Medical University, Shenzhen, PR China
| | - Lijun Zhao
- Department of Clinical Laboratory, Central Research Laboratory, The Second People's Hospital of Bao'an Shenzhen (Group), Shajing People's Hospital of Bao'an Shenzhen, Shenzhen Shajing Hospital affiliated to Guangzhou Medical University, Shenzhen, PR China
| | - Huijiao Gong
- Department of Clinical Laboratory, Central Research Laboratory, The Second People's Hospital of Bao'an Shenzhen (Group), Shajing People's Hospital of Bao'an Shenzhen, Shenzhen Shajing Hospital affiliated to Guangzhou Medical University, Shenzhen, PR China
| | - Ping Liu
- Department of Clinical Laboratory, Central Research Laboratory, The Second People's Hospital of Bao'an Shenzhen (Group), Shajing People's Hospital of Bao'an Shenzhen, Shenzhen Shajing Hospital affiliated to Guangzhou Medical University, Shenzhen, PR China
| | - Helu Liu
- Department of Clinical Laboratory, Central Research Laboratory, The Second People's Hospital of Bao'an Shenzhen (Group), Shajing People's Hospital of Bao'an Shenzhen, Shenzhen Shajing Hospital affiliated to Guangzhou Medical University, Shenzhen, PR China
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Dubbink JH, Verweij SP, Struthers HE, Ouburg S, McIntyre JA, Morré SA, Peters RP. Genital Chlamydia trachomatis and Neisseria gonorrhoeae infections among women in sub-Saharan Africa: A structured review. Int J STD AIDS 2018; 29:806-824. [PMID: 29486628 DOI: 10.1177/0956462418758224] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
Chlamydia trachomatis and Neisseria gonorrhoeae constitute major public health problems among women, but the burden of infection in sub-Saharan Africa is poorly documented. We conducted a structured review of the prevalence and incidence of genital, oral and anal C. trachomatis and N. gonorrhoeae infection in women in sub-Saharan Africa. We searched Medline, EMBASE and Web of Science over a 10-year period for studies on epidemiology of genital, oral and anal chlamydial infection and gonorrhoea in women in all countries of sub-Saharan Africa. We assessed geographic and demographic differences in prevalence and incidence of infection; weighted mean prevalence estimates were calculated with a random-effect model. A total of 102 study results were included, with data available for 24/49 of sub-Saharan countries. The weighted prevalence of chlamydial infection was lower among women in community-based studies (3.9%; 95% CI: 2.9-5.1%) than for women recruited at primary healthcare facilities (6.0%; 95% CI: 4.2-8.4%, p < 0.001); the same was observed for gonorrhoea (2.2%; 95% CI: 1.2-4.0% vs. 4.2%; 95% CI: 3.2-5.6%, p < 0.001). Prevalence of Chlamydia among sex workers was 5.5% (95% CI: 4.2-7.3%) and gonorrhoea 7.6% (95% CI: 5.4-11%). Seven studies reported on incidence which varied between 0.75-28 and 2.8-17 per 100 person-years-at-risk for chlamydial infection and gonorrhoea, respectively. Only two studies reported on anal infections and one on oral infection. This overview underscores the considerable incidence and prevalence of genital C. trachomatis and N. gonorrhoeae in women in different settings in sub-Saharan Africa. Better control strategies are warranted to reduce the burden of infection and to prevent long-term complications of these infections.
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Affiliation(s)
- Jan Henk Dubbink
- 1 Anova Health Institute, Johannesburg, South Africa.,2 Department of Medical Microbiology & Infection Control, Laboratory of Immunogenetics, VU University Medical Center, Amsterdam, the Netherlands.,3 Faculty of Health, Medicine & Life Sciences, Department of Genetics and Cell Biology, Institute for Public Health Genomics (IPHG), Research School GROW (School for Oncology & Developmental Biology), University of Maastricht, Maastricht, the Netherlands
| | - Stephan P Verweij
- 2 Department of Medical Microbiology & Infection Control, Laboratory of Immunogenetics, VU University Medical Center, Amsterdam, the Netherlands
| | - Helen E Struthers
- 1 Anova Health Institute, Johannesburg, South Africa.,4 Division of Infectious Diseases & HIV Medicine, Department of Internal Medicine, University of Cape Town, Cape Town, South Africa
| | - Sander Ouburg
- 2 Department of Medical Microbiology & Infection Control, Laboratory of Immunogenetics, VU University Medical Center, Amsterdam, the Netherlands
| | - James A McIntyre
- 1 Anova Health Institute, Johannesburg, South Africa.,5 School of Public Health and Family Medicine, University of Cape Town, Cape Town, South Africa
| | - Servaas A Morré
- 2 Department of Medical Microbiology & Infection Control, Laboratory of Immunogenetics, VU University Medical Center, Amsterdam, the Netherlands.,3 Faculty of Health, Medicine & Life Sciences, Department of Genetics and Cell Biology, Institute for Public Health Genomics (IPHG), Research School GROW (School for Oncology & Developmental Biology), University of Maastricht, Maastricht, the Netherlands
| | - Remco Ph Peters
- 1 Anova Health Institute, Johannesburg, South Africa.,6 Department of Medical Microbiology, University of Pretoria, Pretoria, South Africa
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Abstract
BACKGROUND Genital Chlamydia trachomatis (C.trachomatis) infection may lead to pregnancy complications such as miscarriage, preterm labour, low birthweight, preterm rupture of membranes, increased perinatal mortality, postpartum endometritis, chlamydial conjunctivitis and C.trachomatis pneumonia.This review supersedes a previous review on this topic. OBJECTIVES To establish the most efficacious and best-tolerated therapy for treatment of genital chlamydial infection in preventing maternal infection and adverse neonatal outcomes. SEARCH METHODS We searched the Cochrane Pregnancy and Childbirth Group's Trials Register, ClinicalTrials.gov, the WHO International Clinical Trials Registry Platform (ICTRP) (26 June 2017) and reference lists of retrieved studies. SELECTION CRITERIA Randomised controlled trials (RCTs) as well as studies published in abstract form assessing interventions for treating genital C.trachomatis infection in pregnancy. Cluster-RCTs were also eligible for inclusion but none were identified. Quasi-randomised trials and trials using cross-over design are not eligible for inclusion in this review. DATA COLLECTION AND ANALYSIS Two review authors independently assessed studies for inclusion, assessed trial quality and extracted the data using the agreed form. Data were checked for accuracy. Evidence was assessed using the GRADE approach. MAIN RESULTS We included 15 trials (involving 1754 women) although our meta-analyses were based on fewer numbers of studies/women. All of the included studies were undertaken in North America from 1982 to 2001. Two studies were low risk of bias in all domains, all other studies had varying risk of bias. Four other studies were excluded and one study is ongoing.Eight comparisons were included in this review; three compared antibiotic (erythromycin, clindamycin, amoxicillin) versus placebo; five compared an antibiotic versus another antibiotic (erythromycin, clindamycin, amoxicillin, azithromycin). No study reported different antibiotic regimens. Microbiological cure (primary outcome) Antibiotics versus placebo: Erythromycin (average risk ratio (RR) 2.64, 95% confidence interval (CI) 1.60 to 4.38; two trials, 495 women; I2 = 68%; moderate-certainty evidence), and clindamycin (RR 4.08, 95% CI 2.35 to 7.08; one trial, 85 women;low-certainty evidence) were associated with improved microbiological cure compared to a placebo control. In one very small trial comparing amoxicillin and placebo, the results were unclear, but the evidence was graded very low (RR 2.00, 95% CI 0.59 to 6.79; 15 women). One antibiotic versus another antibiotic: Amoxicillin made little or no difference in microbiological cure in comparison to erythromycin (RR 0.97, 95% CI 0.93 to 1.01; four trials, 466 women; high-certainty evidence), probably no difference compared to clindamycin (RR 0.96, 95% CI 0.89 to 1.04; one trial, 101 women; moderate-quality evidence), and evidence is very low certainty when compared to azithromycin so the effect is not certain (RR 0.89, 95% CI 0.71 to 1.12; two trials, 144 women; very low-certainty evidence). Azithromycin versus erythromycin (average RR 1.11, 95% CI 1.00 to 1.23; six trials, 374 women; I2 = 53%; moderate-certainty evidence) probably have similar efficacy though results appear to favour azithromycin. Clindamycin versus erythromycin (RR 1.06, 95% CI 0.97 to 1.15; two trials, 173 women; low-certainty evidence) may have similar numbers of women with a microbiological cure between groups.Evidence was downgraded for design limitations, inconsistency, and imprecision in effect estimates. Side effects of the treatment (maternal) (secondary outcome) Antibiotics versus placebo: side effects including nausea, vomiting, and abdominal pain, were reported in two studies (495 women) but there was no clear evidence whether erythromycin was associated with more side effects than placebo and a high level of heterogeneity (I2 = 78%) was observed (average RR 2.93, 95% CI 0.36 to 23.76). There was no clear difference in the number of women experiencing side effects when clindamycin was compared to placebo in one small study (5/41 versus 1/44) (RR 6.35, 95% CI 0.38 to 107.45, 62 women). The side effects reported were mostly gastrointestinal and also included resolving skin rashes. One antibiotic versus another antibiotic: There was no clear difference in incidence of side effects (including nausea, vomiting, diarrhoea and abdominal pain) when amoxicillin was compared to azithromycin based on data from one small study (36 women) (RR 0.56, 95% CI 0.24 to 1.31).However, amoxicillin was associated with fewer side effects compared to erythromycin with data from four trials (513 women) (RR 0.31, 95% CI 0.21 to 0.46; I2 = 27%). Side effects included nausea, vomiting, diarrhoea, abdominal cramping, rash, and allergic reaction.Both azithromycin (RR 0.24, 95% CI 0.17 to 0.34; six trials, 374 women) and clindamycin (RR 0.44, 95% CI 0.22 to 0.87; two trials, 183 women) were associated with a lower incidence of side effects compared to erythromycin. These side effects included nausea, vomiting, diarrhoea and abdominal cramping.One small study (101 women) reported there was no clear difference in the number of women with side effects when amoxicillin was compared with clindamycin (RR 0.57, 95% CI 0.14 to 2.26; 107 women). The side effects reported included rash and gastrointestinal complaints. Other secondary outcomes Single trials reported data on repeated infections, preterm birth, preterm rupture of membranes, perinatal mortality and low birthweight and found no clear differences between treatments.Many of this review's secondary outcomes were not reported in the included studies. AUTHORS' CONCLUSIONS Treatment with antibacterial agents achieves microbiological cure from C.trachomatis infection during pregnancy. There was no apparent difference between assessed agents (amoxicillin, erythromycin, clindamycin, azithromycin) in terms of efficacy (microbiological cure and repeat infection) and pregnancy complications (preterm birth, preterm rupture of membranes, low birthweight). Azithromycin and clindamycin appear to result in fewer side effects than erythromycin.All of the studies in this review were conducted in North America, which may limit the generalisability of the results. In addition, study populations may differ in low-resource settings and these results are therefore only applicable to well-resourced settings. Furthermore, the trials in this review mainly took place in the nineties and early 2000's and antibiotic resistance may have changed since then.Further well-designed studies, with appropriate sample sizes and set in a variety of settings, are required to further evaluate interventions for treating C.trachomatis infection in pregnancy and determine which agents achieve the best microbiological cure with the least side effects. Such studies could report on the outcomes listed in this review.
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Affiliation(s)
- Catherine Cluver
- Stellenbosch University and Tygerberg HospitalDepartment of Obstetrics and Gynaecology, Faculty of Health SciencesPO Box 19063TygerbergWestern CapeSouth Africa7505
| | - Natalia Novikova
- Stellenbosch University and Tygerberg HospitalDepartment of Obstetrics and Gynaecology, Faculty of Health SciencesPO Box 19063TygerbergWestern CapeSouth Africa7505
| | | | | | - Göran K Lingman
- Lund UniversityDepartment of Obstetrics and GynecologySkanes Universitetssjukhus/LundLundSweden22185
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Santos CGD, Sabidó M, Leturiondo AL, Ferreira CDO, da Cruz TP, Benzaken AS. Development, validation and testing costs of an in-house real-time PCR assay for the detection of Chlamydia trachomatis. J Med Microbiol 2017; 66:312-317. [PMID: 28141509 DOI: 10.1099/jmm.0.000443] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022] Open
Abstract
PURPOSE To improve the screening of Chlamydia trachomatis(C. trachomatis) in Brazil, an accurate and affordable method is needed. The objective of this study was to develop and assess the performance and costs of a new in-house real-time PCR (qPCR) assay for the diagnosis of C. trachomatis infection. METHODOLOGY Asymptomatic women aged 14-25 years who attended primary health services in Manaus, Brazil, were screened for C. trachomatis using the Digene Hybrid Capture II CT-ID (HCII CT-ID) DNA test. A subset of cervical specimens were tested using an in-house qPCR and a commercial qPCR, ArtusC. trachomatis Plus RG PCR 96 CE (Artus qPCR) kit, as a reference test. A primer/probe based on the sequence of cryptic plasmid (CP) was designed. An economic evaluation was conducted from the provider's perspective. RESULTS The primers were considered specific for C. trachomatis because they did not amplify any product from non-sexually transmitted bacterial species tested. Overall, 292 specimens were tested by both the commercial kit (Artus qPCR) and the in-house qPCR. Of those, one resulted in no amplification and was excluded from the analysis. The sensitivity, specificity, and positive and negative predictive values of the in-house qPCR were 99.5 % [95 % confidence interval (CI): 97.1-100], 95.1 % (95 % CI: 89-98.4), 97.4 % (95 % CI: 94-99.1) and 99.0 % (95 % CI: 94.5-100), respectively. The cost per case of C. trachomatis was £0.44 ($0.55) for HCII CT-ID, £1.16 ($1.45) for Artus qPCR and £1.06 ($1.33) for in-house qPCR. CONCLUSION We have standardized an in-house qPCR to detect cervical C. trachomatis targeting CP. The in-house qPCR showed excellent accuracy and was more affordable than the commercial qPCR kit.
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Affiliation(s)
- Camila Gurgel Dos Santos
- Programa de Pós-graduação em Medicina Tropical, Universidade do Estado do Amazonas, Manaus, Amazonas, Brazil.,Fundação Alfredo da Matta, Manaus, Amazonas, Brazil
| | - Meritxell Sabidó
- Fundação de Medicina Tropical Doutor Heitor Vieira Dourado (FMT-HVD), Manaus, Amazonas, Brazil.,TransLab, Departament of Medical Sciences, Universitat de Girona, Catalunya, Spain.,CIBER de Epidemiologia y Salud Pública, CIBERESP, Spain
| | | | | | | | - Adele Schwartz Benzaken
- Fundação Alfredo da Matta, Manaus, Amazonas, Brazil.,Fundação de Medicina Tropical Doutor Heitor Vieira Dourado (FMT-HVD), Manaus, Amazonas, Brazil.,Departamento de IST, Aids e Hepatites Virais, Secretaria de Vigilância em Saúde, Ministério da Saúde, Brasília, Brazil
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Sangkomkamhang US, Lumbiganon P, Prasertcharoensuk W, Laopaiboon M. Antenatal lower genital tract infection screening and treatment programs for preventing preterm delivery. Cochrane Database Syst Rev 2015; 2015:CD006178. [PMID: 25922860 PMCID: PMC8498019 DOI: 10.1002/14651858.cd006178.pub3] [Citation(s) in RCA: 33] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/11/2023]
Abstract
BACKGROUND Genital tract infection is associated with preterm birth (before 37 weeks' gestation). Screening for infections during pregnancy may therefore reduce the numbers of babies being born prematurely. However, screening for infections may have some adverse effects, such as increased antibiotic drug resistance and increased cost of treatment. OBJECTIVES To assess the effectiveness of antenatal lower genital tract infection screening and treatment programs for reducing preterm birth and subsequent morbidity. SEARCH METHODS We searched the Cochrane Pregnancy and Childbirth Group's Trials Register (30 November 2014), the Cochrane Central Register of Controlled Trials (The Cochrane Library 2014, Issue 7) and reference lists of retrieved reports. SELECTION CRITERIA We included all published and unpublished randomised controlled trials in any language that evaluated any described methods of antenatal lower genital tract infection screening compared with no screening. DATA COLLECTION AND ANALYSIS Two review authors independently assessed trials for inclusion and risk of bias, extracted data and checked for accuracy. MAIN RESULTS One study (4155 women at less than 20 weeks' gestation) met the inclusion criteria. The intervention group (2058 women) received infection screening and treatment for bacterial vaginosis, trichomonas vaginalis and candidiasis; the control group (2097 women) also received screening, but the results of the screening program were not revealed and women received routine antenatal care. The rate of preterm birth before 37 weeks' gestation was significantly lower in the intervention group (3% versus 5% in the control group) with a risk ratio (RR) of 0.55 (95% confidence interval (CI) 0.41 to 0.75; the evidence for this outcome was graded as of moderate quality). The incidence of preterm birth for infants with a weight equal to or below 2500 g (low birthweight) and infants with a weight equal to or below 1500 g (very low birthweight) were significantly lower in the intervention group than in the control group (RR 0.48, 95% CI 0.34 to 0.66 and RR 0.34; 95% CI 0.15 to 0.75, respectively; both graded as moderate quality evidence). Based on a subset of costs for preterm births of < 1900 g, the authors reported that for each of those preterm births averted, EUR 60,262 would be saved. AUTHORS' CONCLUSIONS There is evidence from one trial that infection screening and treatment programs for pregnant women before 20 weeks' gestation reduce preterm birth and preterm low birthweight. Infection screening and treatment programs are associated with cost savings when used for the prevention of preterm birth. Future trials should evaluate the effects of different types of infection screening programs.
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Affiliation(s)
- Ussanee S Sangkomkamhang
- Khon Kaen HospitalDepartment of Obstetrics and GynaecologySrichan RoadMaungKhon KaenThailand40000
| | - Pisake Lumbiganon
- Khon Kaen UniversityDepartment of Obstetrics and Gynaecology, Faculty of Medicine123 Mitraparb RoadAmphur MuangKhon KaenThailand40002
| | - Witoon Prasertcharoensuk
- Khon Kaen UniversityDepartment of Obstetrics and Gynaecology, Faculty of Medicine123 Mitraparb RoadAmphur MuangKhon KaenThailand40002
| | - Malinee Laopaiboon
- Khon Kaen UniversityDepartment of Biostatistics and Demography, Faculty of Public Health123 Mitraparb RoadAmphur MuangKhon KaenThailand40002
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Novikova N, Cluver C. Interventions for treating genitalChlamydia trachomatisinfection in pregnancy. THE COCHRANE DATABASE OF SYSTEMATIC REVIEWS 2013. [DOI: 10.1002/14651858.cd010485] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/10/2022]
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Abstract
Chlamydia trachomatis (CT) is the most common bacterial cause of sexually transmitted infections. CT infections are strongly associated with risk-taking behavior. Recommendations for testing have been implemented in many countries. The effectiveness of the screening programs has been questioned since chlamydia rates have increased. However, the complication rates including pelvic inflammatory disease, tubal factor infertility, and tubal pregnancy have been decreasing, which is good news. The complication rates associated with CT infection have clearly been over-estimated. Genetic predisposition and host immune response play important roles in the pathogenesis of long-term complications. CT plays a co-factor role in the development of cervical neoplasia caused by high-risk human papillomavirus (HPV) types. The evidence linking CT and other adverse pregnancy outcomes is weak. The current nucleic acid amplification tests perform well. A new genetic variant of CT was discovered in Sweden but has only rarely been detected elsewhere. Single-dose azithromycin remains effective against CT. Secondary prevention by screening is still the most important intervention to limit the adverse effects of CT on reproductive health.
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Affiliation(s)
- Jorma Paavonen
- Department of Obstetrics and Gynecology, University Hospital, Helsinki, Finland.
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Vazquez F, Otero L, Melón S, de Oña M. Overview of molecular biological methods for the detection of pathogens causing sexually transmitted infections. Methods Mol Biol 2012; 903:1-20. [PMID: 22782808 DOI: 10.1007/978-1-61779-937-2_1] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/01/2023]
Abstract
We review here different state-of-the-art molecular methods currently used in the diagnosis of sexually transmitted infections.
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Affiliation(s)
- Fernando Vazquez
- Servicio de Microbiología, Hospital Monte Naranco, Oviedo, Spain.
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Dean D. Chlamydia trachomatis today: treatment, detection, immunogenetics and the need for a greater global understanding of chlamydial disease pathogenesis. Drugs Today (Barc) 2009; 45 Suppl B:25-31. [PMID: 20011691 PMCID: PMC3278962] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/28/2023]
Abstract
Chlamydia trachomatis is an important human pathogen causing a myriad of severe and debilitating diseases. While antibiotics have been a mainstay of treatment, there is increasing evidence for potential drug resistance, reinfection and persistent infections that require a reevaluation of treatment strategies. A critical need to address these issues will be a rapid, sensitive and cost-effective diagnostic that can be used for global screening, treatment and test-of-cure of infected individuals instead of empirical therapy that not only drives drug resistance but is not costeffective. This type of diagnostic would allow clinicians and researchers to evaluate the true incidence and prevalence of chlamydial infections in both developed and developing countries. There are extremely limited data on chlamydial sexually transmitted diseases (STDs) in many developing countries, including those in Central and South America. In addition, advancing our understanding of chlamydial disease pathogenesis will require an evaluation of host genetic susceptibility to infection and sequelae. We provide preliminary data on rates of chlamydial STDs and host genetic factors that predispose to infection among adolescent pregnant and nonpregnant commercial sex worker populations residing in Quito, Ecuador.
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Affiliation(s)
- D Dean
- Children's Global Health Initiative, University of California at San Francisco, San Francisco, USA.
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Land JA, Van Bergen JEAM, Morré SA, Postma MJ. Epidemiology of Chlamydia trachomatis infection in women and the cost-effectiveness of screening. Hum Reprod Update 2009; 16:189-204. [PMID: 19828674 DOI: 10.1093/humupd/dmp035] [Citation(s) in RCA: 118] [Impact Index Per Article: 7.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
BACKGROUND The majority of Chlamydia trachomatis infections in women are asymptomatic, but may give rise to pelvic inflammatory disease (PID) and tubal infertility. Screening programmes aim at reducing morbidity in individuals by early detection and treatment, and at decreasing the overall prevalence of infection in the population. A number of modelling studies have tried to calculate the threshold prevalence of chlamydia lower genital tract infection above which screening becomes cost-effective. There is considerable debate over the exact complication rates after chlamydia infections, and more precise estimates of PID and tubal infertility are needed, for instance to be inserted in economic models. METHODS With reference to key studies and systematic reviews, an overview is provided focusing on the epidemiology of chlamydia infection and the risk-estimates of its late complications. RESULTS In the literature, the generally assumed risk of developing PID after lower genital tract chlamydia infection varies considerably, and is up to 30%. For developing tubal infertility after PID the risks are 10-20%. This implies that the risk of test-positive women of developing tubal infertility would range between 0.1 and 6%. We included chlamydia IgG antibody testing in a model and estimated a risk of tubal infertility up to 4.6%. CONCLUSION The risk of developing late complications after chlamydia lower genital tract infection appears low. High quality RCTs dealing with the transition from cervicitis to infertility are needed to broaden the evidence. In screening programmes, chlamydia antibody testing, as an intermediate marker for potential adverse sequelae, might enable more precise estimates.
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Affiliation(s)
- J A Land
- Department of Obstetrics and Gynaecology, University Medical Center Groningen, Groningen, The Netherlands.
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Otero Guerra L, Lepe Jiménez JA, Blanco Galán MA, Aznar Martín J, Vázquez Valdés F. [Utility of molecular biology techniques in the diagnosis of sexually transmitted diseases and genital infections]. Enferm Infecc Microbiol Clin 2008; 26 Suppl 9:42-9. [PMID: 19195446 DOI: 10.1016/s0213-005x(08)76540-6] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
Abstract
Historically, the diagnosis of sexually transmitted diseases (STDs) has been difficult. The introduction of molecular biology techniques in microbiological diagnosis and their application to non-invasive samples has produced significant advances in the diagnosis of these diseases. Overall, detection of Neisseria gonorrhoeae by molecular biology techniques provides a presumptive diagnosis and requires confirmation by culture in areas with a low prevalence. For Chlamydia trachomatis infections, these techniques are considered to be the most sensitive and specific procedures for mass screening studies, as well as for the diagnosis of symptomatic patients. Diagnosis of Mycoplasma genitalium infection by culture is very slow and consequently molecular techniques are the only procedures that can provide relevant diagnostic information. For Treponema pallidum, molecular techniques can provide direct benefits in the diagnosis of infection. Molecular techniques are not established for the routine diagnosis of donovanosis, but can be recommended when performed by experts. Molecular methods are advisable in Haemophilus ducreyi, because of the difficulties of culture and its low sensitivity. In genital herpes, molecular techniques have begun to be recommended for routine diagnosis and could soon become the technique of choice. For other genital infections, bacterial vaginosis, vulvovaginal candidosis and trichomoniasis, diagnosis by molecular methods is poorly established. With genital warts, techniques available for screening and genotyping of endocervical samples could be used for certain populations, but are not validated for this purpose.
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Swadpanich U, Lumbiganon P, Prasertcharoensook W, Laopaiboon M. Antenatal lower genital tract infection screening and treatment programs for preventing preterm delivery. Cochrane Database Syst Rev 2008:CD006178. [PMID: 18425940 DOI: 10.1002/14651858.cd006178.pub2] [Citation(s) in RCA: 25] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/12/2022]
Abstract
BACKGROUND Preterm birth is birth before 37 weeks' gestation. Genital tract infection is one of the causes of preterm birth. Infection screening during pregnancy has been used to reduce preterm birth. However, infection screening may have some adverse effects, e.g. increased antibiotic drug resistance, increased costs of treatment. OBJECTIVES To assess the effectiveness and complications of antenatal lower genital tract infection screening and treatment programs in reducing preterm birth and subsequent morbidity. SEARCH STRATEGY We searched the Cochrane Pregnancy and Childbirth Group's Trials Register (January 2008) and the Cochrane Central Register of Controlled Trials (The Cochrane Library 2007, Issue 2). SELECTION CRITERIA We included all published and unpublished randomised controlled trials in any language that evaluated any described methods of antenatal lower genital tract infection screening compared with no screening. Preterm births have been reported as an outcome. DATA COLLECTION AND ANALYSIS Two review authors independently assessed eligibility, trial quality and extracted data. MAIN RESULTS One study (4155 women) met the inclusion criteria. This trial is of high methodological quality. In the intervention group (2058 women), the results of infection screening and treatment for bacterial vaginosis, trichomonas vaginalis and candidiasis were reported; in the control group (2097 women), the results of the screening program for the women allocated to receive routine antenatal care were not reported. Preterm birth before 37 weeks was significantly lower in the intervention group (3% versus 5% in the control group) with a relative risk (RR) of 0.55 (95% confidence interval (CI) 0.41 to 0.75). The incidence of preterm birth for low birthweight preterm infants with a weight equal to or below 2500 g and very low birthweight infants with a weight equal to or below 1500 g were significantly lower in the intervention group than in the control group (RR 0.48, 95% CI 0.34 to 0.66 and RR 0.34; 95% CI 0.15 to 0.75, respectively). AUTHORS' CONCLUSIONS There is evidence that infection screening and treatment programs in pregnant women may reduce preterm birth and preterm low birthweights. Future trials should evaluate the effects of types of infection screening program, gestational ages at screening test and the costs of introducing an infection screening program.
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Affiliation(s)
- Ussanee Swadpanich
- Division of Obstetrics and Gynecology, Khon Kaen Hospital, Srichan Road, Maung, Khon Kaen, Thailand, 40000.
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Jalal H, Al-Suwaine A, Stephen H, Carne C, Sonnex C. Comparative performance of the Roche COBAS Amplicor assay and an in-house real-time PCR assay for diagnosis of Chlamydia trachomatis infection. J Med Microbiol 2007; 56:320-322. [PMID: 17314360 DOI: 10.1099/jmm.0.46762-0] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022] Open
Abstract
This study investigated the comparative performance of the Amplicor assay and an in-house semi-automated, multiplex real-time PCR for the diagnosis of genital chlamydial infection. Four different assays, the COBAS Amplicor CT test (Amplicor PCR), in-house real-time PCR (IHRT-PCR), in-house nested cryptic plasmid PCR and in-house nested major outer membrane protein PCR, were performed on genital swabs from 1000 consecutive patients attending a genitourinary medicine clinic. The samples were designated true positive if Chlamydia trachomatis DNA was detected by at least two of the four above-mentioned assays while a sample was defined as true negative if C. trachomatis DNA was detected in only one or none of the assays. By this criterion, there were 129 true positive and 871 true negative samples for C. trachomatis DNA in this cohort. Amplicor PCR designated 144 samples positive: 128 (89%) of 144 samples were true positive and 16 (11%) were false positive. IHRT-PCR detected 126 of 129 true positive samples and did not generate any false positive results. The sensitivity of IHRT-PCR was comparable with, and specificity was higher than, Amplicor PCR for the diagnosis of genital chlamydial infection.
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Affiliation(s)
- Hamid Jalal
- Clinical Microbiology and Public Health Laboratory, Box 236, Addenbrooke's Hospital, Hills Road, Cambridge CB2 2QW, UK
| | | | - Hannah Stephen
- Clinical Microbiology and Public Health Laboratory, Box 236, Addenbrooke's Hospital, Hills Road, Cambridge CB2 2QW, UK
| | - Christopher Carne
- Department of Genitourinary Medicine, Clinic 1A, Box 38, Addenbrooke's Hospital, Hills Road, Cambridge CB2 2QQ, UK
| | - Christopher Sonnex
- Department of Genitourinary Medicine, Clinic 1A, Box 38, Addenbrooke's Hospital, Hills Road, Cambridge CB2 2QQ, UK
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Abstract
PURPOSE OF REVIEW This review will highlight the recent literature findings regarding urine-based Chlamydia and gonorrhea testing in adolescents. RECENT FINDINGS Rates of Chlamydia trachomatis are increasing, likely due to increased detection efficiency, but have not yet begun to decrease. Neisseria gonorrhoeae is at an all-time low. Urine-based testing for sexually transmitted infections is readily available and convenient but underutilized. Interesting approaches to a more universal screening program, including self-collected, mail-in urine samples, have been shown to be effective. SUMMARY In spite of recommendations urging universal screening for C. trachomatis and N. gonorrhoeae and the availability of highly accurate and convenient tests, screening rates for adolescents and young adults remain below the universal recommendations. Strategies to improve screening rates should take advantage of urine-based screening methodologies for sexually transmitted infections because of their cost-effectiveness as well as the convenience for patient and provider.
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Affiliation(s)
- Michael G Spigarelli
- Division of Adolescent Medicine, Cincinnati Children's Hospital Medical Center, University of Cincinnati, Cincinnati, OH 45229-3039, USA.
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Current World Literature. Curr Opin Obstet Gynecol 2006; 18:575-580. [DOI: 10.1097/01.gco.0000242963.55738.b6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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