Cross-Sectional Study of Genital, Rectal, and Pharyngeal Chlamydia and Gonorrhea in Women in Rural South Africa

Peters, Remco P. H.; Dubbink, Jan Henk; Eem, Lisette van der; Verweij, Stephan P.; Bos, Myrte L. A.; Ouburg, Sander; Lewis, David A.; Struthers, Helen; McIntyre, James; Morré, Servaas A.

doi:10.1097/olq.0000000000000175

Cited by 92 publications

(99 citation statements)

References 26 publications

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“…These observations have led to the hypothesis that long-lasting chlamydial infection in the GI tract may serve as a reservoir for reinfecting the genital tract (18). Consistent with this hypothesis are the findings that GI tract infection with Chlamydia trachomatis has been detected not only in men having sex with men (MSM) (19,20) but also in women (21).…”

supporting

confidence: 65%

“…For example, a positive diagnosis for C. trachomatis in rectal swabs has been reported among diverse woman populations, some of whom may not necessarily practice oral or anal intercourse. A recent crosssectional study of 604 adult women visiting 25 primary health care facilities in rural South Africa revealed a 7.1% rate of rectal chlamydial infection (21). A separate study reported a Ͼ10% prevalence rate for rectal chlamydial infection among 3,055 women who attended 2 Canadian provincial sexually transmitted infection (STI) clinics (27).…”

Section: Figmentioning

confidence: 99%

“…Thus, the C. trachomatis organisms likely use the ocular or urogenital tract tissues as their primary sites for adapting to the human host. However, the high rates of positive detection of C. trachomatis in the rectal swabs taken from women (21,27,28) indicate that C. trachomatis organisms can also infect the GI tract. The widespread GI tract infection in humans has prompted modification of chlamydial treatment guidelines and stimulated the investigation of the transmission pathways and the effects of the chlamydial GI tract infection on chlamydial pathogenesis in the genital tract.…”

Section: Figmentioning

confidence: 99%

“…Chlamydia trachomatis antigens have been detected in enteroendocrine cells and macrophages of the small bowel in patients with severe irritable bowel syndrome (24), although the association of chlamydial infection in the GI tract with intestinal inflammatory diseases remains unclear (25,26). The high prevalence of C. trachomatis infection in the GI tract (21,27,28) has prompted screening for chlamydial infection in both cervicovaginal and rectal swabs from both sexually active men and women (29,30). Large-scale screenings of both cervicovaginal and rectal swabs not only will provide information for treatment and follow-up but may also aid in our understanding of the exact relationships between the vaginal and rectal C. trachomatis organisms in humans.…”

mentioning

confidence: 99%

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In VivoandEx VivoImaging Reveals a Long-Lasting Chlamydial Infection in the Mouse Gastrointestinal Tract following Genital Tract Inoculation

et al. 2015

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Intravaginal infection with Chlamydia muridarum in mice can ascend to the upper genital tract, resulting in hydrosalpinx, a pathological hallmark for tubal infertility in women infected with C. trachomatis. Here, we utilized in vivo imaging of C. muridarum infection in mice following an intravaginal inoculation and confirmed the rapid ascent of the chlamydial organisms from the lower to upper genital tracts. Unexpectedly, the C. muridarum-derived signal was still detectable in the abdominal area 100 days after inoculation. Ex vivo imaging of the mouse organs revealed that the long-lasting presence of the chlamydial signal was restricted to the gastrointestinal (GI) tract, which was validated by directly measuring the chlamydial live organisms and genomes in the same organs. The C. muridarum organisms spreading from the genital to the GI tracts were detected in different mouse strains and appeared to be independent of oral or rectal routes. Mice prevented from orally taking up excretions also developed the long-lasting GI tract infection. Inoculation of C. muridarum directly into the upper genital tract, which resulted in a delayed vaginal shedding of live organisms, accelerated the chlamydial spreading to the GI tract. Thus, we have demonstrated that the genital tract chlamydial organisms may use a systemic route to spread to and establish a long-lasting infection in the GI tract. The significance of the chlamydial spreading from the genital to GI tracts is discussed.

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supporting

confidence: 65%

Section: Figmentioning

confidence: 99%

Section: Figmentioning

confidence: 99%

mentioning

confidence: 99%

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In VivoandEx VivoImaging Reveals a Long-Lasting Chlamydial Infection in the Mouse Gastrointestinal Tract following Genital Tract Inoculation

et al. 2015

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“…Extra-genital CT infections are often asymptomatic or characterized by nonspecific symptoms, acting as an important reservoir for further transmission and potentially leading to sequelae both in men having sex with men (MSM) and in women (van Liere et al, 2013(van Liere et al, , 2014Peters et al, 2014;Patton et al, 2014).…”

Section: Introductionmentioning

confidence: 99%

Chlamydia trachomatis infection prevalence and serovar distribution in a high-density urban area in the north of Italy

Foschi

Nardini

Banzola

et al. 2016

Journal of Medical Microbiology

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The aim of this study was to assess Chlamydia trachomatis (CT) infection prevalence and serovar distribution in a high-density urban area in the north of Italy, by comparing different groups of subjects divided on the basis of the type of care provider they referred to (STI Clinic, gynaecologists or general practitioners). From January 2011 to May 2014, all the specimens submitted to the Microbiology Laboratory of St Orsola Hospital in Bologna for CT detection were tested by PCR assay. For positive specimens, molecular genotyping based on RFLP analysis was performed. Total prevalence of CT infection was 8.1 %, with significant differences between subgroups (P<0.01) but stable during the study period. The STI Clinic was mainly responsible for CT diagnosis, whereas the lowest infection prevalence was detected in gynaecological clinics, despite the high number of tests performed. Extra-genital samples were almost exclusively collected from males at the STI Clinic. Interestingly, 13.3 % of patients providing extra-genital specimens were positive for CT on rectal and/or pharyngeal swabs, and 4.4 % of cases would have been missed if extra-genital sites had not been tested. The most common serovar was E, and serovar distribution was influenced by gender (P<0.01), age (P<0.01), care provider (P=0.01) and anatomical site (P<0.01). The L2 serovar was detected only in extragenital samples from males at the STI Clinic. Knowledge about care providers' contributions in CT testing and diagnosis is essential for infection control. CT typing is crucial for appropriate management of specific infections, such as lymphogranuloma venereum in extra-genital samples of high-risk populations.

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Chlamydia trachomatis as the Cause of Infectious Infertility: Acute, Repetitive or Persistent Long-Term Infection?

Schuchardt

Rupp

2016

Current Topics in Microbiology and Immunology

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Chlamydia trachomatis is the most frequently detected agent of sexually transmitted infections worldwide. Infection of the lower female genital tract (FGT) can cause cervicitis and if ascending to the upper FGT may result in serious sequelae such as pelvic inflammatory disease (PID), salpingitis and tubal factor infertility (TFI). The factors leading to this complication are still not completely understood. We elaborate four different models for host-pathogen interactions in C. trachomatis infections that may promote disease development: (1) acute infection, (2) repeated infections, (3) chronic/persistent infections and (4) non-inflammatory colonization. Whereas experimental data exist for all of these models in vitro, ex vivo and in vivo, we were interested in seeing what clinical evidence we have supporting one or the other model. We particularly focused on data that favour the one or the other model for TFI development in C. trachomatis infection and speculate on future studies that could integrate in vitro findings for a better characterization of the situation in vivo.

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Cross-Sectional Study of Genital, Rectal, and Pharyngeal Chlamydia and Gonorrhea in Women in Rural South Africa

Abstract: Genital and rectal, but not pharyngeal, chlamydia and gonorrhea are highly prevalent and frequently asymptomatic in women in rural South Africa. Young women attending health care facilities for antenatal care or family planning should be prioritized in control efforts.

Cited by 92 publications

References 26 publications

In VivoandEx VivoImaging Reveals a Long-Lasting Chlamydial Infection in the Mouse Gastrointestinal Tract following Genital Tract Inoculation

In VivoandEx VivoImaging Reveals a Long-Lasting Chlamydial Infection in the Mouse Gastrointestinal Tract following Genital Tract Inoculation

Chlamydia trachomatis infection prevalence and serovar distribution in a high-density urban area in the north of Italy

Chlamydia trachomatis as the Cause of Infectious Infertility: Acute, Repetitive or Persistent Long-Term Infection?

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