Chlamydia trachomatis in the Pharynx and Rectum of Heterosexual Patients at Risk for Genital Infection

Jones, Robert B.; Rabinovitch, Ruth A.; Katz, Barry P.; Batteiger, Byron E.; Quinn, Timothy S.; Terho, P; Lapworth, Mary A.

doi:10.7326/0003-4819-102-6-757

Cited by 99 publications

(45 citation statements)

References 19 publications

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“…Early studies of the presence of C. trachomatis in specimens from the tonsillar area and throat secretions were equivocal [10,27]. A 1985 study of C. trachomatis from posterior pharyngeal and tonsillar areas in men and women at risk for genital infection found 3.7% of men and 3.2% of women positive by culture technique [37]. The authors stated that they had difficulty with recovery of C. trachomatis from the oropharynx and suggested that perhaps C. trachomatis was present in low numbers at that location or that unknown factors of pharyngeal secretions interfered with detection [37].…”

Section: Collection Methods and Detection Techniquementioning

confidence: 99%

Oral Chlamydia trachomatis in patients with established periodontitis

Reed

Lopatin

Foxman

et al. 2000

Clinical Oral Investigations

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Periodontitis is considered a consequence of a pathogenic microbial infection at the periodontal site and host susceptibility factors. Periodontal research supports the association of Actinobacillus actinomycetemcomitans, Porphyromonas gingivalis, Prevotella intermedia, and Bacteroides forsythus, and periodontitis; however causality has not been demonstrated. In pursuit of the etiology of periodontitis, we hypothesized that the intracellular bacteria, Chlamydia trachomatis, may play a role. As a first step, a cross-sectional study of dental school clinic patients with established periodontitis were assessed for the presence of C. trachomatis in the oral cavity, and in particular from the lining epithelium of periodontal sites. C. trachomatis was detected using a direct fluorescent monoclonal antibody (DFA) in oral specimens from 7% (6/87) of the patients. Four patients tested positive in specimens from the lining epithelium of diseased periodontal sites, one patient tested positive in healthy periodontal sites, and one patient tested positive in the general mucosal specimen. In conclusion, this study provides preliminary evidence of C. trachomatis in the periodontal sites. Planned studies include the use of a more precise periodontal epithelial cell collection device, the newer nucleic acid amplification techniques to detect C. trachomatis, and additional populations to determine the association of C. trachomatis and periodontitis.

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Section: Collection Methods and Detection Techniquementioning

confidence: 99%

Oral Chlamydia trachomatis in patients with established periodontitis

Reed

Lopatin

Foxman

et al. 2000

Clinical Oral Investigations

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“…Whether they directly pass through the GI tract or establish transitory infection in the pharynx or small intestine prior to reaching the cecum is not known. Pharyngeal infections have been well documented (37).…”

Section: Chlamydial Gi Infection In Humansmentioning

confidence: 99%

“…They collected pharyngeal swabs from 706 heterosexual men and 686 women and rectal specimens from 1,223 women at risk for chlamydial infection (37). C. trachomatis was isolated from the pharynx of 3.7% of men and 3.2% of women.…”

Section: Chlamydial Gi Infection In Humansmentioning

confidence: 99%

Hidden in Plain Sight: Chlamydial Gastrointestinal Infection and Its Relevance to Persistence in Human Genital Infection

2014

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Although the concept of persistence in chlamydial infections has been recognized for about 80 years, there is still very little known about the mechanism by which this occurs. In this review, we revisit an old paradigm, long known to chlamydiologists and veterinarians, that in virtually all hosts of chlamydiae, including mammals and birds, chlamydiae reside in the gastrointestinal tract for long periods of time in the absence of clinical disease. Thus, if gastrointestinal infection occurs in most hosts, then it is very likely that gastrointestinal infection occurs in humans as well. We demonstrate that gastrointestinal infection does indeed occur in humans and propose that this anatomical site is the source of persistent infection in humans. The data in ruminants and animal models demonstrate that the immune system is unable to clear chlamydiae from the gut, so they can remain indefinitely, with continual shedding in feces. Clearly, many women become reinfected from an untreated partner; however, we propose that women, cured of genital infection, remain at risk for autoinoculation from the lower gastrointestinal tract. Moreover, there are substantial data demonstrating treatment failure of chlamydial infections, particularly with azithromycin. New data in the mouse model have shown that azithromycin is far less effective against chlamydial gastrointestinal infection than against genital infections. Therefore, it is possible that women cured of genital infection by antibiotics remain infected in the gastrointestinal tract and can become reinfected by autoinoculation from that site.

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“…In addition, among men who have sex with men (MSM), there is evidence that nongenital sites may serve as (often asymptomatic) reservoirs of gonococcal and chlamydial infection, with one study demonstrating infection rates of 7% for gonorrhea and 8% for chlamydia; among men with urethral, pharyngeal, and rectal exposures, 54% of chlamydial infections and 21% of gonococcal infections involved only the rectum (10). In an earlier study utilizing chlamydia culture techniques, Jones and colleagues found that 6.4% (24 of 373) of women with chlamydial infection harbored the organism at the rectal site only and therefore would have been missed in the absence of rectal chlamydia testing (9).…”

mentioning

confidence: 99%

Nucleic Acid Amplification Tests for Diagnosis of Neisseria gonorrhoeae and Chlamydia trachomatis Rectal Infections

et al. 2010

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It is uncertain which methods for the diagnosis of rectal gonococcal and chlamydial infection are optimal. This study evaluated the performance of culture and nucleic acid amplification tests (NAATs) for rectal chlamydial and gonococcal diagnosis. From July 2003 until February 2007, 441 rectal test sets were collected from individuals attending a sexually transmitted disease clinic and three HIV clinics who gave a history of anal intercourse or were women at high risk for Neisseria gonorrhoeae or Chlamydia trachomatis infections. Rectal swab specimens were tested using culture and commercial NAATs employing transcription-mediated amplification (TMA), strand displacement amplification (SDA), and PCR amplification. Test performance was evaluated using a rotating standard by which patients were classified as infected if either two or three comparator tests were positive. Test sensitivities for the detection of N. gonorrhoeae ranged from 66.7% to 71.9% for culture to 100% for TMA. Specificities were 99.7% to 100% for culture and greater than 95.5% for all three NAATs. Test sensitivities for C. trachomatis ranged from 36.1% to 45.7% for culture and among NAATS from 91.4% to 95.8% for PCR to 100% for TMA. Specificities of the NAATs ranged from 95.6% to 98.5% (two-of-three standard) and from 88.8% to 91.8% (three-of-three standard). Over 60% and 80% of gonococcal and chlamydial infections, respectively, among men who have sex with men and over 20% of chlamydial infections in women would have been missed if the rectal site had not been tested. Currently available NAATs are more sensitive for the detection of chlamydial and gonococcal infection at the rectal site than is culture.Historically, the focus of sexually transmitted disease (STD) diagnostic testing has been on the development and evaluation of tests for diagnosis of genital infections. However, a substantial proportion of the population engages in nongenital (e.g., oral or anal) sexual activity. For instance, a recent study conducted at three U.S. STD clinics found that 37% of heterosexual clients reported having practiced anal intercourse and over a quarter (28.9%) reported this activity with at least one of their last three sexual partners (4). These clinic-based findings are consistent with results of population-based studies indicating that 30% to 40% of U.S. men and women had ever engaged in anal sex with an opposite-sex partner (11, 13). In addition, among men who have sex with men (MSM), there is evidence that nongenital sites may serve as (often asymptomatic) reservoirs of gonococcal and chlamydial infection, with one study demonstrating infection rates of 7% for gonorrhea and 8% for chlamydia; among men with urethral, pharyngeal, and rectal exposures, 54% of chlamydial infections and 21% of gonococcal infections involved only the rectum (10). In an earlier study utilizing chlamydia culture techniques, Jones and colleagues found that 6.4% (24 of 373) of women with chlamydial infection harbored the organism at the rectal site only and therefore would hav...

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Chlamydia trachomatis in the Pharynx and Rectum of Heterosexual Patients at Risk for Genital Infection

Cited by 99 publications

References 19 publications

Oral Chlamydia trachomatis in patients with established periodontitis

Oral Chlamydia trachomatis in patients with established periodontitis

Hidden in Plain Sight: Chlamydial Gastrointestinal Infection and Its Relevance to Persistence in Human Genital Infection

Nucleic Acid Amplification Tests for Diagnosis of Neisseria gonorrhoeae and Chlamydia trachomatis Rectal Infections

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