Long-term eradication of Chlamydia trachomatis genital infection after antimicrobial therapy. Evidence against persistent infection.

Abstract

OBJECTIVE:

To determine whether Chlamydia trachomatis urogenital infections persist or relapse after antimicrobial therapy by serial measurement of chlamydial-specific DNA using the polymerase chain reaction (PCR), cell cultures, and serological studies.

DESIGN:

Prospective evaluation of an inception cohort.

SETTING:

University student health clinic.

PARTICIPANTS:

Twenty women with culture-proven and PCR-proven C trachomatis urogenital infections.

MEASUREMENTS:

Incidence of persistent infection as determined by PCR, culture, and serial measurement of local and systemic antibody to C trachomatis for 5 months after doxycycline therapy.

RESULTS:

Prior to therapy, C trachomatis was isolated in cell culture from the cervix in 19 of 20 women, from the urethra in 13 women, and from the rectum in 13 women. All culture-positive specimens were also PCR-positive. Immediately after completion of antimicrobial therapy, all women had negative cell cultures for chlamydia. Ten of 20 culture-negative cervical specimens and two culture-negative urethral specimens had chlamydial DNA present immediately after treatment. In addition, three women had detectable DNA from cervical specimens 1 week after treatment. The presence of cervicitis (P = .01), high inclusion counts (P = .004), and serological evidence of recent infection (P = .0004) were each significantly associated with PCR positivity after treatment. All 384 subsequent cervical, rectal, and urethral specimens collected over 5 months were negative by both PCR and culture with the exception of one woman who was reinfected. Serum immunoglobulin M (IgM) titers, geometric mean serum immunoglobulin G (IgG) titers, and prevalence of local antibody to chlamydia progressively declined after treatment.

CONCLUSIONS:

Standard antimicrobial therapy is effective in the long-term microbiologic eradication of uncomplicated C trachomatis urogenital infections. The presence of chlamydial DNA after antimicrobial therapy is of short duration and reflects excretion of nonviable organisms rather than persistent infection.

• Authors: K A Workowski, M F Lampe, K G Wong, M B Watts, W E Stamm
• Journal: JAMA (JAMA) Vol. 270 Issue 17 Pg. 2071-5 (Nov 03 1993) ISSN: 0098-7484 [Print] United States
• PMID: 8305018 (Publication Type: Journal Article, Research Support, U.S. Gov't, P.H.S.)

Chemical References

• Antibodies, Fungal
• DNA, Fungal
• Doxycycline

Topics

• Adult
• Antibodies, Fungal (blood)
• Chlamydia Infections (diagnosis, drug therapy, immunology)
• Chlamydia trachomatis (isolation & purification)
• Cohort Studies
• DNA, Fungal (analysis)
• Doxycycline (therapeutic use)
• Female
• Female Urogenital Diseases (diagnosis, drug therapy, microbiology)
• Humans
• Polymerase Chain Reaction
• Prospective Studies
• Recurrence