The Natural History of Untreated Chlamydia trachomatis Infection in the Interval Between Screening and Returning for Treatment

Geisler, William M.; Wang, Chengbin; Morrison, Sandra G.; Black, Carolyn M.; Bandea, Claudiu I.; Hook, Edward W.

doi:10.1097/olq.0b013e318151497d

Cited by 146 publications

(126 citation statements)

References 11 publications

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“…Those with a positive CT screening test but negative CT test at follow-up are classified as having spontaneous resolution, which studies report occurs in 11% to 44% of individuals within a few weeks to several months of a positive screening CT NAAT [3]. We found a spontaneous resolution frequency of ~20% in subjects studied at a STD Clinic in Birmingham, AL [4].…”

Section: Persisting Genital Chlamydia Trachomatis (Ct) Infection Can mentioning

confidence: 74%

Immunoglobulin-Based Investigation of Spontaneous Resolution of Chlamydia trachomatis Infection

Bakshi

Gupta

Jordan

et al. 2017

The Journal of Infectious Diseases

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Section: Persisting Genital Chlamydia Trachomatis (Ct) Infection Can mentioning

confidence: 74%

Immunoglobulin-Based Investigation of Spontaneous Resolution of Chlamydia trachomatis Infection

Bakshi

Gupta

Jordan

et al. 2017

The Journal of Infectious Diseases

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“…Human subjects can resolve acute infection, resist infection upon reexposure, and develop immunity to repeated infections over time (15,16). However, at the same time, the immune response is also thought to contribute to enhanced pathology in the form of heightened inflammation and tubal scarring in the female reproductive tract, potentially leading to infertility (17).…”

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confidence: 99%

Resolution of Chlamydia trachomatis Infection Is Associated with a Distinct T Cell Response Profile

Picard

Bodmer

Gierahn

et al. 2015

Clin Vaccine Immunol

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dChlamydia trachomatis is the causative agent of the most frequently reported bacterial sexually transmitted infection, the total burden of which is underestimated due to the asymptomatic nature of the infection. Untreated C. trachomatis infections can cause significant morbidities, including pelvic inflammatory disease and tubal factor infertility (TFI). The human immune response against C. trachomatis, an obligate intracellular bacterium, is poorly characterized but is thought to rely on cell-mediated immunity, with CD4؉ and CD8 ؉ T cells implicated in protection. In this report, we present immune profiling data of subjects enrolled in a multicenter study of C. trachomatis genital infection. CD4؉ and CD8 ؉ T cells from subjects grouped into diseasespecific cohorts were screened using a C. trachomatis proteomic library to identify the antigen specificities of recall T cell responses after natural exposure by measuring interferon gamma (IFN-␥) levels. We identified specific T cell responses associated with the resolution of infection, including unique antigens identified in subjects who spontaneously cleared infection and different antigens associated with C. trachomatis-related sequelae, such as TFI. These data suggest that novel and unique C. trachomatis T cell antigens identified in individuals with effective immune responses can be considered as targets for vaccine development, and by excluding antigens associated with deleterious sequelae, immune-mediated pathologies may be circumvented.

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“…This is likely to influence the performance of different nucleic acid amplification tests, which do not routinely distinguish between people with high and low chlamydial loads (4,8). Differences in chlamydial load have been reported to be associated with the presence of clinical symptoms (2,8), the transmissibility and persistence of infection (3,10), and the risk of developing chronic sequelae (2). Studies investigating the relevance of chlamydial load so far have been conducted only with patients attending health care settings (2,4,8).…”

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Real-Time Quantitative PCR To Determine Chlamydial Load in Men and Women in a Community Setting

et al. 2009

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We used a PCR method to quantify the loads of Chlamydia trachomatis organisms in self-collected urine and vulvovaginal swab (VVS) samples from 93 women and 30 men participating in the Chlamydia Screening Studies Project, a community-based study of individuals not seeking health care. For women, self-collected VVS had a higher mean chlamydial load (10,405 organisms/ml; 95% confidence interval [95% CI], 5,167 to 21,163 organisms/ml) than did first-void urines (FVU) (503 organisms/ml; 95% CI, 250 to 1,022 organisms/ml; P < 0.001). Chlamydial loads in female and male self-collected FVU specimens were similar (P ‫؍‬ 0.634). The mean chlamydial load in FVU specimens decreased with increasing age in females and males. There was no strong statistical evidence of differences in chlamydial load in repeat male and female FVU specimens taken when patients attended for treatment a median of 23.5 (range, 14 to 62) and 28 (range, 13 to 132) days later, respectively, or in VVS taken a median of 35 (range, 14 to 217) days later. In this study, chlamydial load values for infected persons in the community who were not seeking treatment were lower than those published in other studies involving symptomatic patients attending clinical settings. This might have implications for estimates of the infectiousness of chlamydia. The results of this study provide a scientific rationale for preferring VVS to FVU specimens from women.Nucleic acid amplification tests to detect Chlamydia trachomatis have revolutionized the diagnosis and management of this common treatable sexually transmitted infection (6). Increased test sensitivity has enabled the use of noninvasive specimens, such as first-void urine specimens for men and women and vulvovaginal swabs for women, thus dispensing with the need for a genital examination and making it easier to perform screening tests on people without symptoms suggestive of chlamydial infection.The burden of C. trachomatis organisms in the genital tract (chlamydial load) can vary from 10 to over a million organisms per milliliter of genital tract secretions (4,8). This is likely to influence the performance of different nucleic acid amplification tests, which do not routinely distinguish between people with high and low chlamydial loads (4, 8). Differences in chlamydial load have been reported to be associated with the presence of clinical symptoms (2, 8), the transmissibility and persistence of infection (3, 10), and the risk of developing chronic sequelae (2). Studies investigating the relevance of chlamydial load so far have been conducted only with patients attending health care settings (2,4,8). The objectives of this study were to measure chlamydial loads in individuals in a community setting and to investigate factors associated with chlamydial load. MATERIALS AND METHODSWe used specimens from people participating in the Chlamydia Screening Studies (ClaSS) project, which has been described in detail elsewhere (5, 7, 11). In brief, specimens were collected at home from February 2000 to August 2001 by women...

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The Natural History of Untreated Chlamydia trachomatis Infection in the Interval Between Screening and Returning for Treatment

Abstract: Our findings demonstrate that although spontaneous resolution of chlamydia is common, many persons with persisting chlamydia progress to develop signs of infection and some develop complications.

Cited by 146 publications

References 11 publications

Immunoglobulin-Based Investigation of Spontaneous Resolution of Chlamydia trachomatis Infection

Immunoglobulin-Based Investigation of Spontaneous Resolution of Chlamydia trachomatis Infection

Resolution of Chlamydia trachomatis Infection Is Associated with a Distinct T Cell Response Profile

Real-Time Quantitative PCR To Determine Chlamydial Load in Men and Women in a Community Setting

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