Long-term Eradication of Chlamydia trachomatis Genital Infection After Antimicrobial Therapy

Publisher Website
Google Scholar
Abstract
Objective. —To determine whetherChlamydia trachomatisurogenital 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-provenC trachomatisurogenital infections. Measurements. —Incidence of persistent infection as determined by PCR, culture, and serial measurement of local and systemic antibody toC trachomatisfor 5 months after doxycycline therapy. Results. —Prior to therapy,C trachomatiswas 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 uncomplicatedC trachomatisurogenital infections. The presence of chlamydial DNA after antimicrobial therapy is of short duration and reflects excretion of nonviable organisms rather than persistent infection. (JAMA. 1993;270:2071-2075)