Chlamydia trachomatis infections of the female genital tract: State of the art

Figures & data

Table I. Chlamydia trachomatis revisited: Major discoveries.

1950s

First isolation from genital tract

1960s

Cell culture to isolate C. trachomatis was introduced

1970s

Wide spectrum of clinical manifestations described Early prevalence data

1980s

Rapid tests (DFA, EIA, slide tests) emerged National surveillance systems Major role of chlamydia in tubal factor infertility and adverse pregnancy outcome

1990s

Most women and men with chlamydial infection are asymptomatic NAATs - First void urine (FVU) testing - Self-sampling (vulva, vagina) Single-dose therapy Patient-delivered partner therapy Guidelines for screening

2000s

Reported case rates are on the rise again Self-sampling and FVU testing emerge - Gynecologic examination not necessary Home sampling—a new innovation - Better compliance Re-screening of chlamydia-positive individuals - Core group with high risk for reinfection Discovery of a new variant of C. trachomatis Upper genital tract complication rates have been over-estimated

Figure 1. Rate of reported chlamydia cases per 100,000 population: 1998–2007.

Reproduced from Chlamydia trachomatis seroprevalence atlas of Finland 1983 – 2003, Lyytikä i nen E, Kaasila M, Koskela P, Lehtinen M, Patama T, Pukkala E, et al. volume 84, pages 19 – 22, Sex Transm Infect, 2008 with permission from BMJ Publishing Ltd.

Figure 2. Chlamydia trachomatis seroprevalence (%) in Finnish women. C. trachomatis IgG antibodies were determined in a random sample of sera from 14–22 and 23–28-year-old women in three consecutive periods (20).

Table II. Meta-analysis of longitudinal studies on Chlamydia trachomatis infection and cervical neoplasia (43).

	Women years	Cases (pos/all)	Controls (pos/all)	Mean follow-up time	Odds ratio (95% CI)	Reference
CC	2 500 000	120/181	290/533	5.0 yrs	1.6 (1.1–2.2)	(39)
	8 780 000	244/530	705/2568	9.4 yrs	2.3 (1.9–2.7)	(85)
	190 000	31/72	44/143	10 yrs	1.8 (1.0–3.5)	(86)
	122 000	15/35	29/144	9.0 yrs	2.9 (1.2–7.4)	(87)
Total	11 592 000	410/818	1068/3388	7.9 yrs	2.0 (1.5–2.5)
CIN	500	21/28	118/213	2.1 yrs	2.4 (1.0–5.9)	(88)
	29 600	32/365	322/8229	3.4 yrs	1.8 (1.3–2.6)	(89)
	700	25/76	22/105	1.3 yrs	1.9 (0.9–3.6)	(90)
	10 160	42/60	44/104	1.6 yrs	3.1 (1.6–6.3)	(91)
Total	40 960	120/529	506/8651	2.8 yrs	2.0 (1.4–3.1)

CC = cervical carcinoma; CIN = cervical intraepithelial neoplasia grade 2 or worse.

Figure 3. Hypothetical model of an interaction between Chlamydia trachomatis, PID, and epithelial ovarian cancer.

Figure 4. Chlamydia trachomatis screening program flow chart (modified from (2)).

Table III. Treatment for Chlamydia trachomatis: current recommendations.

Recommended regimens

Azithromycin: single dose of 1 g Doxycycline: 100 mg twice daily for 7 days

Alternative regimens

Ofloxacin: 200 mg twice daily or 400 mg once daily for 7 days Erythromycin: 500 mg twice daily for 14 days or 500 mg four times daily for 7 days Amoxicillin: 500 mg three times daily for 7 days

Pregnant women

Erythromycin: 500 mg four times daily for 7 days, or 500 mg twice daily for 14 days Amoxicillin: 500 mg three times daily for 7 days Azithromycin: single dose of 1 g

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