<i>Chlamydia trachomatis</i>
            Load at Matched Anatomic Sites: Implications for Screening Strategies

Michel, C; Sonnex, C; Carne, Christopher; White, John Albert; Magbanua, Jose Paolo V.; Nadala, Cesar; Lee, Helen H.

doi:10.1128/jcm.00100-07

Cited by 95 publications

(100 citation statements)

References 31 publications

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“…Given that salpingitis is a necessary condition for TFI (6,32,42), it seems reasonable to regard the CT+++ group, which is observed in cases only, as representing a causal mechanism linked to CTrelated TFI. It is tempting to attribute this to a greater inflammatory response possibly due to a higher infectious load in those who develop TFI, as has been observed at the lower genital tract and in PID (43,44). The 28.0% (6.9, 50.0) estimate of PEF based on the CT+++ distribution alone can be regarded as a lower bound because it ignores the excess CT++ observed in the cases.…”

Section: Discussionmentioning

confidence: 99%

Proportion of Tubal Factor Infertility due toChlamydia: Finite Mixture Modeling of Serum Antibody Titers

Ades¹,

Price²,

Kounali³

et al. 2017

Am. J. Epidemiol.

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General rightsThis document is made available in accordance with publisher policies. Please cite only the published version using the reference above. Full terms of use are available: http://www.bristol.ac.uk/pure/about/ebr-terms estimates based on the standard PEF formula from case-control studies were 0% and over 65%.Finite mixture modeling can be applied to serological data to obtain estimates of the proportion of reproductive damage attributable to Chlamydia trachomatis. Further studies should be undertaken using modern assays in contemporary, representative populations. <198 words>

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Section: Discussionmentioning

confidence: 99%

Proportion of Tubal Factor Infertility due toChlamydia: Finite Mixture Modeling of Serum Antibody Titers

Ades¹,

Price²,

Kounali³

et al. 2017

Am. J. Epidemiol.

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“…This finding was supported by the results of the present study, as demonstrated by the similar PCR positivity rates for the matched CS and VS specimens (Table 1). For women infected with C. trachomatis, CS specimens contain the highest organism load, followed in decreasing order by VS specimens, urethral swabs, and first-void urine (23). However, despite their lower organism load than CS specimens, VS specimens are gaining acceptance as the specimen of choice for screening and diagnostic purposes because their collection is noninvasive, easier, and less expensive and their chlamydial load is sufficient for most tests to maintain sensitivity (33).…”

Section: Discussionmentioning

confidence: 99%

Prevalence of Chlamydia trachomatis Infection among Low- and High-Risk Filipino Women and Performance of Chlamydia Rapid Tests in Resource-Limited Settings

et al. 2007

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The prevalence of urogenital Chlamydia trachomatis infection was determined with a PCR-based test of women from low-and high-risk populations in Iloilo City, Philippines, between August 2002 and March 2006. Two rapid tests for C. trachomatis, Clearview Chlamydia MF and the Chlamydia Rapid Test (CRT), were also evaluated in these resource-limited settings. Specimens were obtained from female sex workers (FSWs; n ‫؍‬ 1,484) attending a social hygiene clinic (SHC) and from women (n ‫؍‬ 838) attending an obstetrics-gynecology (OB-GYN) clinic. The sensitivity, specificity, positive predictive value (PPV), and negative predictive value (NPV) of the rapid tests were determined, with PCR as the gold standard. The PCR positivity rate for SHC participants (72% asymptomatic) ranged from 17.9 to 32.0% during the study period. Compared with those of PCR, the sensitivities and specificities of the Clearview test were 53.5 and 99.1%, respectively, with endocervical swab specimens (CS; n ‫؍‬ 822) from the FSWs and 31.1 and 95.2%, respectively, with vaginal swab specimens (VS; n ‫؍‬ 333) from these women. The sensitivity, specificity, PPV, and NPV of the CRT with VS from the FSWs were 71.0, 99.0, 97.1, and 87.9%, respectively. At the OB-GYN site, the PCR positivity rate with VS was 6.3%. The sensitivity, specificity, PPV, and NPV of the CRT with these specimens were 86.8, 99.6, 93.9, and 99.1%, respectively. The performance of the Clearview test at the SHC was thus markedly lower with VS than with CS, whereas the CRT performed well with VS from both populations.Chlamydia trachomatis is responsible for the most common sexually transmitted bacterial infection and the leading cause of pelvic inflammatory disease in women (34,38). In 1999, the World Health Organization (WHO) estimated that 92 million new chlamydial infections occur worldwide annually, with the largest proportion (43 million) of these infections being contracted in south and Southeast Asia (38), a region that is mostly resource limited with respect to infectious disease diagnosis and management.Although up to 94% of women with urogenital chlamydial infections do not manifest obvious symptoms (20, 28), the consequences of such untreated infections, including pelvic inflammatory disease, ectopic pregnancy, and infertility (27), generate a global financial burden of billions of dollars annually. Because most infected individuals are either asymptomatic or have mild, nonspecific symptoms, C. trachomatis infection poses a problem for health control programs. National screening and prevention programs for C. trachomatis infection have been implemented, usually among young adults, in industrialized countries (11,14,16). With the exception of sporadic testing of commercial sex workers, Chlamydia screening is rare in developing countries, which have the highest incidence of new chlamydial infections (7,9,17,25). The major barriers to screening programs in the developing world include the high cost of testing and the lack of appropriate staff and diagnostic tools. Such countri...

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“…Urine specimens have lower sensitivity than vaginal and endocervical specimens. [32][33][34] Hence, false negative results for urogenital infection could lead to an overestimate in the number of women who are positive only for rectal infection. Fourth, utilizing clinic billing records to identify patients for the retrospective review may raise a concern about selection bias.…”

Section: Discussionmentioning

confidence: 99%

High Prevalence of Rectal Gonorrhea and Chlamydia Infection in Women Attending a Sexually Transmitted Disease Clinic

Bazan

Reese

Esber

et al. 2015

Journal of Women's Health

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Background: Testing women for urogenital Neisseria gonorrhoeae (GC) and Chlamydia trachomatis (CT) is common in sexually transmitted disease (STD) clinics. However, women may not be routinely tested for rectal GC/CT. This may lead to missed infections in women reporting anal intercourse (AI). Methods: This was a retrospective review of all women who underwent rectal GC/CT testing from August 2012 to June 2013 at an STD clinic in Columbus, Ohio. All women who reported AI in the last year had a rectal swab collected for GC/CT nucleic acid amplification testing (n = 331). Using log-binomial regression models, we computed unadjusted and adjusted associations for demographic and behavioral factors associated with rectal GC/CT infection. Results: Participants (n = 331) were 47% African-American, with median age of 29 years. Prevalence of rectal GC was 6%, rectal CT was 13%, and either rectal infection was 19%. Prevalence of urogenital GC and CT was 7% and 13% respectively. Among women with rectal GC, 14% tested negative for urogenital GC. Similarly, 14% of women with rectal CT tested negative for urogenital CT. In unadjusted analyses, there was increased rectal GC prevalence among women reporting sex in the last year with an injection drug user, with a person exchanging sex for drugs or money, with anonymous partners, and while intoxicated/high on alcohol or illicit drugs. After multivariable adjustment, no significant associations persisted, but a trend of increased rectal GC prevalence was observed for women < 26 years of age ( p = 0.06) and those reporting sex while intoxicated/high on alcohol or drugs ( p = 0.05). For rectal CT, only age < 26 years was associated with prevalent infection in unadjusted models; this association strengthened after multivariable adjustment (prevalence ratio: 6.03; 95% confidence interval: 2.29-15.90). Conclusion: Nearly one in five women who reported AI in the last year had rectal GC or CT infection. Urogenital testing alone would have missed 14% of rectal infections. Standardized guidelines would increase rectal GC/CT testing in women and help detect missed infections.

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Chlamydia trachomatis Load at Matched Anatomic Sites: Implications for Screening Strategies

Cited by 95 publications

References 31 publications

Proportion of Tubal Factor Infertility due toChlamydia: Finite Mixture Modeling of Serum Antibody Titers

Proportion of Tubal Factor Infertility due toChlamydia: Finite Mixture Modeling of Serum Antibody Titers

Prevalence of Chlamydia trachomatis Infection among Low- and High-Risk Filipino Women and Performance of Chlamydia Rapid Tests in Resource-Limited Settings

High Prevalence of Rectal Gonorrhea and Chlamydia Infection in Women Attending a Sexually Transmitted Disease Clinic

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