Evidence for Increased Chlamydia Case Finding After the Introduction of Rectal Screening Among Women Attending 2 Canadian Sexually Transmitted Infection Clinics

Gratrix, Jennifer; Singh, Ameeta E.; Bergman, Joshua; Egan, Caroline; Plitt, Sabrina S.; McGinnis, Justin M.; Bell, Christopher; Drews, Steven J.; Read, Ron

doi:10.1093/cid/ciu831

Cited by 94 publications

(82 citation statements)

References 29 publications

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“…C. trachomatis has been detected in the GI tract of humans (29)(30)(31)(32). However, the mechanisms by which the host subjects acquire chlamydial infection in the GI tract remain unclear.…”

Section: Discussionmentioning

confidence: 99%

“…Although C. trachomatis is a sexually transmitted bacterial pathogen that causes pathologies in the genital tract (27,28), it has also been detected in the gastrointestinal (GI) tract of humans (29)(30)(31)(32). C. muridarum colonized the mouse GI tract when it was introduced to multiple mucosae (33) and established a long-lasting infection when directly inoculated into the mouse GI tract (34,35).…”

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confidence: 99%

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Intravenous Inoculation with Chlamydia muridarum Leads to a Long-Lasting Infection Restricted to the Gastrointestinal Tract

et al. 2016

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cChlamydia has been detected in the gastrointestinal tracts of both animals and humans. However, it remains unclear whether the chlamydial organisms can be introduced into the gastrointestinal tract via pathways independent of the oral and anal routes. We have recently shown that Chlamydia muridarum spreads from the genital tract to the gastrointestinal tract potentially via the circulatory system. To test whether hematogenous C. muridarum can spread to and establish a long-lasting colonization in the mouse gastrointestinal tract, we inoculated mice intravenously with a luciferase-expressing C. muridarum strain and monitored its distribution. After tail vein inoculation, most luciferase-generated bioluminescence signals were detected in the mouse abdominal area throughout the experiment. The ex vivo imaging revealed that the abdominal signals came from the gastrointestinal tract tissues. Simultaneous monitoring of chlamydial organisms in individual organs or tissues revealed an initial stage of systemic spreading followed by a long-lasting infection in the gastrointestinal tract. A retro-orbital vein inoculation of the C. muridarum organisms at a lower dose in a different mouse strain also led to colonization of the gastrointestinal tract. We have demonstrated that intravenous C. muridarum inoculation can result in colonization of the gastrointestinal tract, suggesting that the chlamydial organisms may use the sexual behavior-independent circulation pathway to infect the gastrointestinal tract.C hlamydia muridarum infection in the mouse genital tract model has been used for investigation of the mechanisms of Chlamydia trachomatis pathogenesis and immune responses (1-6). This is because a single inoculation of C. muridarum organisms in the mouse lower genital tract can cause hydrosalpinx and infertility (7-9), closely mimicking the tubal adhesion, hydrosalpinx, and infertility observed in women urogenitally infected with C. trachomatis (10-12). Although C. muridarum is not a natural sexually transmitted agent of mice, chlamydiologists have used this model not only to identify both chlamydial (13-17) and host (1, 5, 18-24) pathogenic determinants but also to define the roles of ascending infection and tubal inflammation in chlamydial induction of hydrosalpinx (9,16,25,26). Nevertheless, questions such as how a self-limited infection with C. muridarum in the mouse genital tract can trigger tubal fibrosis or hydrosalpinx that lasts long after the tubal infection is resolved (9, 25) remain unanswered.Although C. trachomatis is a sexually transmitted bacterial pathogen that causes pathologies in the genital tract (27, 28), it has also been detected in the gastrointestinal (GI) tract of humans (29-32). C. muridarum colonized the mouse GI tract when it was introduced to multiple mucosae (33) and established a long-lasting infection when directly inoculated into the mouse GI tract (34,35). The question is whether persistent colonization of the mouse GI tract can fill in the temporal gap between the self-limited infection...

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Section: Discussionmentioning

confidence: 99%

mentioning

confidence: 99%

Intravenous Inoculation with Chlamydia muridarum Leads to a Long-Lasting Infection Restricted to the Gastrointestinal Tract

et al. 2016

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“…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). Sexual behaviors were not considered in either study.…”

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.…”

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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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Chlamydia Trachomatis Urogenital Infections

Armitage

Carey

Hickey

et al. 2018

Diagnostics to Pathogenomics of Sexually Transmitted Infections

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Quantitative evaluation of the cells involved in the immune system, such as lymphocytes, plasma cells, macrophages, dendritic cells, and epithelial cells, together with their products, including antibodies, cytokines, and humoral factors of innate immunity, convincingly revealed that the immune system associated with the mucosae is greater than its systemic counterpart (Russell et al. 2015a). This fact should not be surprising, as the development of the entire immune system during evolution and continuously in everyday life is driven by stimulation with commensal microbiota, antigens present in food and inhaled air, as well as pathogens throughout the enormous surface area of mucosal sites, which far exceeds the skin surface. The mucosal immune system comprises anatomically remote and physiologically distinct compartments that provide protection at various mucosal sites. Although the genital tract shares some common features with other mucosae, including the presence of humoral factors and cells of innate immunity, and the origin of cells involved in antibody production and T cell-mediated immunity, there are also many distinct features characteristic of the genital tract (Russell and Mestecky 2002, 2010; Mestecky et al. 2005). The spectrum of antigens including commensal or pathogenic microorganisms, and sperm is different from those at other mucosal sites. Furthermore, the primary physiological role of the genital tract is reproduction, which involves the acceptance of allogeneic sperm and semi-allogeneic offspring. This distinct physiological role influences the immune system of the genital tract with respect to the induction or suppression of immune responses, which must be considered in the development and application of vaccines against infectious agents of sexually transmitted diseases.

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Evidence for Increased Chlamydia Case Finding After the Introduction of Rectal Screening Among Women Attending 2 Canadian Sexually Transmitted Infection Clinics

Abstract: Our findings add to the growing body of evidence supporting universal rectal screening in high-risk women such as those undergoing pelvic exams at STI clinics.

Cited by 94 publications

References 29 publications

Intravenous Inoculation with Chlamydia muridarum Leads to a Long-Lasting Infection Restricted to the Gastrointestinal Tract

Intravenous Inoculation with Chlamydia muridarum Leads to a Long-Lasting Infection Restricted to the Gastrointestinal Tract

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

Chlamydia Trachomatis Urogenital Infections

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