Is There a Hidden Burden of Disease as a Result of Epigenetic Epithelial-to-Mesenchymal Transition Following Chlamydia trachomatis Genital Tract Infection?

Abstract

Chlamydia trachomatis (CT), the most common bacterial sexually transmitted infection worldwide, has been widely researched for its involvement in many disease pathologies in the reproductive tract, including pelvic inflammatory disease, ectopic pregnancy, and tubal factor infertility. Recent findings, through the efforts to understand the pathogenesis of CT, suggest that CT can induce the process of epithelial-to-mesenchymal transition (EMT) through epigenetic changes in the epithelium of the female reproductive tract. This literature review aims to analyze the evidence for CT’s ability to promote EMT and to pinpoint the areas that merit further investigation.

What Do Diagnoses of Pelvic Inflammatory Disease in Specialist Sexual Health Services in England Tell Us About Chlamydia Control?

“…One explanation as discussed by Horner et al in a separate paper in this special supplement is that CT infection of the fallopian tubes can result in a persistent epithelial-to-mesenchymal transition (EMT) state as a result of epigenetic changes. [27] Such a state is pro-inflammatory and could increase the risk of non-specific PID developing in females whose upper genital tract is colonised by bacterial vaginosis associated bacteria (BVAB). [27,28] EMT reduces the integrity of the epithelium potentially making it more susceptible to invasion and disease from BVAB .…”

“…[27] Such a state is pro-inflammatory and could increase the risk of non-specific PID developing in females whose upper genital tract is colonised by bacterial vaginosis associated bacteria (BVAB). [27,28] EMT reduces the integrity of the epithelium potentially making it more susceptible to invasion and disease from BVAB . [27] BVAB are the most common cause of non-specific PID.…”

“…[27,28] EMT reduces the integrity of the epithelium potentially making it more susceptible to invasion and disease from BVAB . [27] BVAB are the most common cause of non-specific PID. [1,2,27] It is likely if CT-PID rates decreased so did upper genital tract CT infection which is not always symptomatic.…”

“…[27] BVAB are the most common cause of non-specific PID. [1,2,27] It is likely if CT-PID rates decreased so did upper genital tract CT infection which is not always symptomatic. [6,27] This would then reduce the subsequent risk of developing PID from any cause.…”

“…[1,2,27] It is likely if CT-PID rates decreased so did upper genital tract CT infection which is not always symptomatic. [6,27] This would then reduce the subsequent risk of developing PID from any cause. [18,19,27] Horner et al argue that this hypothesis merits further investigation as it would increase our understanding of the risks of sequelae associated with chlamydial genital tract infection and thus better inform public health interventions and cost effectiveness models of interventions such as screening and vaccination.…”