Journal of Chemotherapy

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Epidemiology and Therapy of Chlamydia trachomatis Genital Infection in Women C. De Punzio, E. Neri, P. Metelli, M.S. Bianchi, M. Campa & P. Fioretti To cite this article: C. De Punzio, E. Neri, P. Metelli, M.S. Bianchi, M. Campa & P. Fioretti (1992) Epidemiology and Therapy of Chlamydia�trachomatis Genital Infection in Women, Journal of Chemotherapy, 4:3, 163-166, DOI: 10.1080/1120009X.1992.11739157 To link to this article:

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Journal of Chemotherapy

Epidemiology and Therapy of Chlamydia trachomatis Genital Infection in Women C. DE PUNZIO * - E. NERI * P. METELLI * - M.S . BIANCHI * M. CAMPA** - P. FIORETTI *

Summary ------------------------------Out of 1172 females recruited in a screening program for genital infections, 144 (12.2896) were cervical and/or urethral positive for Clamydia trachomatis (Ct) by enzyme immunoassay (EIA). Patients positive for Ct showed no significant differences in terms of demography, sexual practices and clinical evidence as compared to a control group formed by Ctnegative females randomly selected. Historical data showed a higher frequency of previous pelvic inflammatory disease (PID) in patients as compared to controls. 11 of the 94 patients' partners tested were sperm positive for Ct. Of the 63 patients for whom therapeutic data were available, 38 were treated with josamycin, 16 with tetracycline and the others with different drugs. After treatment, EIA for Ct was nega· tive for 92.196 of the patients treated with josamycin and for 68.7 96 of those treated with tetracycline. The results of this study confirm a high prevalence of asymptomatic Ct infection which may be correctly diagnosed by EIA performed on cervical and urethral samples. They also indicate that negative test results can be obtained by an appropriate antibiotic treat· ment. Key words: Chlamydia trachomatis infection, epidemiology, EIA, josamycin, tetracycline.

* Institute of Obstetrics and Gynecology ** Department of Biomedicine, University of Pisa, Italy. Correspondence: Prof. C. De Punzio, Via Cag!iari 6, 56100 Pisa {Italy). © Edizioni Riviste Scientifiche - Firenze

Vol. 4 - n. 3 (163-166) - 1992


Currently, Chlamydia trachomatis (Ct) infection is the most widespread sexually-transmitted disease in the world. Seven million new cases of C t infections are reported every year in the USA out of twelve million sexually transmitted diseases. The actual extent of Ct infection cannot be measured as many asymptomatic and latent cases are not identified and treated 2 • Furthermore, 15% of the males with Ct infection of the anterior urethra are asymptomatic 3 • Because of the lack of clinical manifestation, Ct infection is not diagnosed and treated and can, therefore, spread widely with possible complications such as acute epididymitis, wich may lead to sterility and chronic prostatitis 4 • 5 • 6 • 7 • Symptoms of Ct infection in women are bartholinitis and, more often, mucopurulent cervicitis or leukorrhea 8 • In about 8% of cases involving cervicitis, C t infection spreads along the ascending canal to the uterus (endometritis) 9 • 10 and/or uterine tubes (salpingitis) 11 • 1 2 and to the peritoneum causing the development of pelvic inflammatory disease (PID). PID is directly responsible for complications such as infertility (20%), spontaneous abortion (18% ), premature delivery (40%), extrauterine pregnancy and increased perinatal death rate (33 % ) and sterility, which may develop in about 12 % of the cases with a single PID episode, and about 50% of the women with 3 PID episodes 13 • Costa estimated that the incidence of Ct infection is 1 to 5% among "normal" women but 20% among women who are infertile or sterile 14 • The presence of specific antibodies to Ct was found in 20 to 25 % of " normal" women, in 57 % of infertile women and finally in ISSN 1120-009X



90% of women with sterility and bilateral tubal obliteration 13 • 15 • This study was undertaken to assess the prevalence of Ct infection and to attempt to develop a profile of this infection to aid in the identification of potential infection in other women. PATIENTS AND METHODS

1172 women were screened for genital infection at the Colposcopic Unit of the Institute of Gynecology and Obstetrics and at the Department of Biomedicine, Clinical Microbiology Division, of the University of Pisa. Patients were assessed for Ct by EIA (Chlamydiazyme, Abbott, Rome, Italy), with detection by a Quantum II spectrophotometer at 492 nm wavelength. The study considered only 133 women for whom complete data were available. The semen of 94 male patners was also tested for the presence of Ct. Another 13 3 women selected at random among those undergoing colposcopy were used as controls (Table 1) . The physiological and pathological histories and sexual practices of all the patients and controls were carefully studied. In addition to EIA for Ct, a PAP test, a bacteriological examination of vaginal smear and a colposcopic examination were performed in all patients. 63 Ct-positive women were treated for 10 to 20 days (modal value 20 days; mean value 15 days) with josamycin (Schering, Milan, Italy) (n = 38), doxycycline (n = 16), amoxicillin (amox) + clavulanic acid (clavul ac) (n = 7), clindamycin (clindam) + gentamicin (gentam) (n=2). All Ct positive patients were again tested for Ct both 1 and 4 weeks after interruption of the treatment. Statistical analysis was made using the x-squared test and Wilcoxon signed rank test. RESULTS

144 women (12.28%) were positive for Ct. No differences were found between the Ct positive group and controls with respect to sexual practices and physiological and pathological histories (Table 1). Unmarried women. were more numerous in the Ct positive group (unmarried 38.4%, married 21 %; p < 0.01). As for work-


1 - Patients.





Age (years) (mean±sd) (range)

31.7 ± 10.5 18-67

32.7±8.9 19-64

Menarche (years) (mean±sd) (range)

12.4 ± 1.5 8- 17

12.5 ± 1.6 8-17






Nulliparas Multiparas

89 44

67.3 32.7

76 57

57.1 42.9











ing activities, housewives were as numerous in either group, while students were in a larger number in the Ct positive group than in controls (22.3% vs 9.5%; p< 0.007). 13 patients were pregnant as opposed to 4 controls (Table 1). In order to ascertain any correlation between the number of legal abortions and Ct infection, the number of legal abortions was compared for both groups. A comparable low abortion rate was found in both groups (1 legal abortion: 9.35% patients vs 13.53% controls; > 1 legal abortion: 3.74% vs 6.72%, respectively). No differences were found with regard to the age of the first sexual intercourse, the number of partners (most women had a single partner, 54.2% patients vs 68.4% controls) and the pattern of sexual intercourse comparable in both groups. Several women in either group used no contraceptives (3 7. 7% patients vs 41.3% controls). Only the frequency of coitus interruptus was rather different in the two groups (16.7% vs 28.6%; p

Epidemiology and therapy of Chlamydia trachomatis genital infection in women.

Out of 1172 females recruited in a screening program for genital infections, 144 (12.28%) were cervical and/or urethral positive for Chlamydia trachom...
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