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Spontaneous resolution of asymptomatic Chlamydia trachomatis in pregnancy.

AbstractOBJECTIVE:
We sought to estimate the rate of spontaneous resolution of asymptomatic Chlamydia trachomatis in pregnancy and to evaluate factors associated with its resolution.
METHODS:
A cohort of women enrolled in a large multicenter randomized bacterial vaginosis antibiotic trial (metronidazole versus placebo) that, when randomly allocated, had asymptomatic C trachomatis diagnosed by urine ligase chain reaction (from frozen archival specimens) between 16(0/7) and 23(6/7) weeks were included. The urine ligase chain reaction is a highly accurate predictor of genital tract chlamydial infection. A follow-up ligase chain reaction was performed between 24(0/7) and 29(6/7) weeks.
RESULTS:
A total of 1,953 women were enrolled in the original antibiotic trial; 1,547 (79%) had ligase chain reaction performed both at randomization and follow-up. Women receiving antibiotics effective against Chlamydia between randomization and follow-up or having symptomatic Chlamydia infection were excluded (26 women). Of the 140 women (9%) who were diagnosed as positive via the initial ligase chain reaction assay, 61 (44%) had spontaneous resolution of Chlamydia by the follow-up ligase chain reaction assay. Factors associated with spontaneous resolution included older age (P = .02), more than 5 weeks from randomization to follow-up (P = .02), and a greater number of lifetime sexual partners (P = .02). Using a logistic regression model, maternal age and a greater-than-5-week follow-up interval remained significant; for every 5-year increase in maternal age, the odds of a positive result on the ligase chain reaction test at follow-up decreased by 40% (odds ratio 0.6; 95% confidence interval 0.4-0.9). Race, substance abuse, parity, and treatment with metronidazole were not associated with spontaneous resolution. Gram stain score and vaginal pH at randomization and follow-up also were not associated.
CONCLUSION:
The prevalence of asymptomatic C trachomatis in pregnancy was 9%; infection resolved spontaneously in almost half of these women. The association of older age and increasing time interval to spontaneous resolution of Chlamydia is consistent with a host immune-response mechanism.
AuthorsJeanne S Sheffield, Williams W Andrews, Mark A Klebanoff, Cora Macpherson, J Christopher Carey, J M Ernest, Ronald J Wapner, Wayne Trout, Atef Moawad, Menachem Miodovnik, Baha Sibai, Michael W Varner, Steve N Caritis, Mitchell Dombrowski, Oded Langer, Mary J O'Sullivan, National Institute for Child Health and Human Development Maternal-Fetal Medicine Units Network
JournalObstetrics and gynecology (Obstet Gynecol) Vol. 105 Issue 3 Pg. 557-62 (Mar 2005) ISSN: 0029-7844 [Print] United States
PMID15738024 (Publication Type: Clinical Trial, Journal Article, Multicenter Study, Randomized Controlled Trial, Research Support, U.S. Gov't, P.H.S.)
Chemical References
  • Anti-Infective Agents
  • Metronidazole
Topics
  • Adult
  • Anti-Infective Agents (therapeutic use)
  • Chlamydia Infections (complications, diagnosis)
  • Chlamydia trachomatis
  • Double-Blind Method
  • Female
  • Humans
  • Ligase Chain Reaction
  • Metronidazole (therapeutic use)
  • Pregnancy
  • Pregnancy Complications, Infectious (diagnosis)
  • Remission, Spontaneous
  • Vaginosis, Bacterial (complications, diagnosis, drug therapy)

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