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Female genital Chlamydia trachomatis infection: where are we heading?

  • General Gynecology
  • Published:
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Abstract

Introduction

Urogenital infection by Chlamydia trachomatis is the most common bacterial sexually transmitted disease in the world. C. trachomatis is the etiologic agent of several common genital tract syndromes such as urethritis, cervicitis, and pelvic inflammatory disease in women.

Materials and methods

In this review, the pathophysiology of a chlamydial infection as well as diagnosis, therapy and prevention strategies regarding female chlamydial infection are reviewed.

Results

A chlamydial infection results in minimal or even no symptoms in approximately two-thirds of women, remaining therefore clinically apparent and undiagnosed. C. trachomatis infections are of great socioeconomic and public health concern due to the potential for severe long-term consequences in women, including an increased risk of ectopic pregnancy, tubal infertility and chronic pelvic pain. Moreover, if the bacterium is transmitted during labor to a newborn, it can cause ophthalmia neonatorum and atypical neonatal pneumonia. Due to the documented increased risk of morbidity, several national guidelines are available, including a routine screening for young women and screening during pregnancy that is recommended in several countries.

Discussion

A routine screening for young women and screening during pregnancy is recommended in several countries. However, additional prospective studies of the effectiveness of chlamydia screening are warranted and might be feasible within established screening programs. Moreover, the transition from cervicitis to infertility should be also evaluated in future controlled studies to underline the existing evidence. Additionally, there is an urgent need to educate and inform health-care providers about implementation of screening programs to reduce the spread of chlamydial infection. Moreover, awareness and use of screening programs by the public is needed, which requires informational campaigns for the general public using different media. For improved screening strategies and public awareness, novel approaches have to be developed and evaluated. Finally, guidelines should be actively disseminated to all medical practitioners to increase their use in daily practice. Although the major socioeconomic and public health concerns of C. trachomatis infection are recognized, several considerations and additional measures for addressing this increasingly urgent health problem remain.

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References

  1. Witkin SS (2002) Immunological aspects of genital chlamydia infections. Best Pract Res Clin Obstet Gynaecol 16:865–874. pii: S1521693402903263

    Google Scholar 

  2. Schachter J, Stephens RS (2008) Biology of Chlamydia trachomatis. In: Holmes KK, Parling PF, Stamm WE, et al (eds) Sexually transmitted diseases, McGraw Hill, NewYork, pp 555–574

  3. Stamm WE (2008) Chlamydia trachomatis infections of the adult. In: Holmes KK, Parling PF, Stamm WE et al (eds) Sexually transmitted diseases. McGraw Hill, New York, pp 575–593

  4. Eksi F, Dikensoy E, Gayyurhan ED, Balci I, Balat O, Karsligil T, Bayram A, Komurcu O (2011) The prevalence of Chlamydia trachomatis and Neisseria gonorrhoeae in the endocervical swab specimens of symptomatic, asymptomatic and infertile women in Turkey. Arch Gynecol Obstet 283:1349–1355. doi:10.1007/s00404-010-1694-8

    PubMed  Google Scholar 

  5. van de Laar M, Ison C (2007) Europe-wide investigation to assess the presence of new variant of Chlamydia trachomatis in Europe. Euro Surveill 12:E070208 070204. pii: 2135

    Google Scholar 

  6. van de Laar MJ, Fontaine J (2009) ECDC guidance on chlamydia control in Europe: next steps. Euro Surveill 14(26). pii: 19260

    Google Scholar 

  7. Sekkides O (2009) ECDC issues chlamydia control guidance. Lancet Infect Dis 9:530

    Google Scholar 

  8. Unemo M, Seth-Smith HM, Cutcliffe LT, Skilton RJ, Barlow D, Goulding D, Persson K, Harris SR, Kelly A, Bjartling C, Fredlund H, Olcen P, Thomson NR, Clarke IN (2010) The Swedish new variant of Chlamydia trachomatis: genome sequence, morphology, cell tropism and phenotypic characterization. Microbiology 156:1394–1404. doi:10.1099/mic.0.036830-0

    PubMed  CAS  Google Scholar 

  9. Ripa T, Nilsson P (2006) A variant of Chlamydia trachomatis with deletion in cryptic plasmid: implications for use of PCR diagnostic tests. Euro Surveill 11(11):E061109.2

    Google Scholar 

  10. Unemo M, Clarke IN (2011) The Swedish new variant of Chlamydia trachomatis. Curr Opin Infect Dis 24:62–69. doi:10.1097/QCO.0b013e32834204d5

    PubMed  Google Scholar 

  11. Gottlieb SL, Martin DH, Xu F, Byrne GI, Brunham RC (2010) Summary: the natural history and immunobiology of Chlamydia trachomatis genital infection and implications for Chlamydia control. J Infect Dis 201(Suppl 2):S190–S204

    PubMed  CAS  Google Scholar 

  12. Beatty WL, Byrne GI, Morrison RP (1994) Repeated and persistent infection with Chlamydia and the development of chronic inflammation and disease. Trends Microbiol 2:94–98

    PubMed  CAS  Google Scholar 

  13. Brunham RC, Rey-Ladino J (2005) Immunology of Chlamydia infection: implications for a Chlamydia trachomatis vaccine. Nat Rev Immunol 5:149–161. doi:10.1038/nri1551

    PubMed  CAS  Google Scholar 

  14. Arno JN, Katz BP, McBride R, Carty GA, Batteiger BE, Caine VA, Jones RB (1994) Age and clinical immunity to infections with Chlamydia trachomatis. Sex Transm Dis 21:47–52

    PubMed  CAS  Google Scholar 

  15. Agrawal T, Gupta R, Dutta R, Srivastava P, Bhengraj AR, Salhan S, Mittal A (2009) Protective or pathogenic immune response to genital chlamydial infection in women—a possible role of cytokine secretion profile of cervical mucosal cells. Clin Immunol 130:347–354. doi:10.1016/j.clim.2008.10.004

    PubMed  CAS  Google Scholar 

  16. Al-Zeer MA, Al-Younes HM, Braun PR, Zerrahn J, Meyer TF (2009) IFN-gamma-inducible Irga6 mediates host resistance against Chlamydia trachomatis via autophagy. PLoS One 4:e4588. doi:10.1371/journal.pone.0004588

    PubMed  Google Scholar 

  17. Coonrod DV (2002) Chlamydial infections. Curr Womens Health Rep 2:266–275

    PubMed  Google Scholar 

  18. CDC (ed) (2003) Sexually transmitted disease surveillance 2002. Department of Health and Human Services, Atlanta, Georgia. http://www.cdc.gov/std/stats02/default.htm

  19. Miller WC, Ford CA, Morris M, Handcock MS, Schmitz JL, Hobbs MM, Cohen MS, Harris KM, Udry JR (2004) Prevalence of chlamydial and gonococcal infections among young adults in the United States. JAMA 291:2229–2236

    PubMed  CAS  Google Scholar 

  20. Gaydos CA, Howell MR, Pare B, Clark KL, Ellis DA, Hendrix RM, Gaydos JC, McKee KT Jr, Quinn TC (1998) Chlamydia trachomatis infections in female military recruits. N Engl J Med 339:739–744

    PubMed  CAS  Google Scholar 

  21. CDC (2007) National Surveillance Data for Chlamydia, Gonorrhea, and Syphilis—Trends in reportable sexually transmitted diseases in the United States, 2006

  22. ECDC (2008) Review of chlamydia control activities in EU countriesTechnical Report, Stockholm. http://data.euro.who.int/HEN/Search/SearchTitle.aspx?Healthtopic=Governance%20and%20stewardship&SourceEvidenceId=12

  23. van Valkengoed IG, Morre SA, van den Brule AJ, Meijer CJ, Deville W, Bouter LM, Boeke AJ (2000) Low diagnostic accuracy of selective screening criteria for asymptomatic Chlamydia trachomatis infections in the general population. Sex Transm Infect 76:375–380

    PubMed  Google Scholar 

  24. La Montagne DS, Patrick LE, Fine DN, Marrazzo JM (2004) Re-evaluating selective screening criteria for chlamydial infection among women in the US Pacific Northwest. Sex Transm Dis 31:283–289

    PubMed  Google Scholar 

  25. Oakeshott P, Kerry S, Hay S, Hay P (1998) Opportunistic screening for chlamydial infection at time of cervical smear testing in general practice: prevalence study. BMJ 316:351–352

    PubMed  CAS  Google Scholar 

  26. Park BJ, Stergachis A, Scholes D, Heidrich FE, Holmes KK, Stamm WE (1995) Contraceptive methods and the risk of Chlamydia trachomatis infection in young women. Am J Epidemiol 142:771–778

    PubMed  CAS  Google Scholar 

  27. Bontis J, Vavilis D, Panidis D, Theodoridis T, Konstantinidis T, Sidiropoulou A (1994) Detection of Chlamydia trachomatis in asymptomatic women: relationship to history, contraception, and cervicitis. Adv Contracept 10:309–315

    PubMed  CAS  Google Scholar 

  28. Gershman KA, Barrow JC (1996) A tale of two sexually transmitted diseases. Prevalences and predictors of chlamydia and gonorrhea in women attending Colorado family planning clinics. Sex Transm Dis 23:481–488

    PubMed  CAS  Google Scholar 

  29. Sessa R, Latino MA, Magliano EM, Nicosia R, Pustorino R, Santino I, Gordini C, Clerici P, Colombo R, Del Piano M (1994) Epidemiology of urogenital infections caused by Chlamydia trachomatis and outline of characteristic features of patients at risk. J Med Microbiol 41:168–172

    PubMed  CAS  Google Scholar 

  30. Mosure DJ, Berman S, Kleinbaum D, Halloran ME (1996) Predictors of Chlamydia trachomatis infection among female adolescents: a longitudinal analysis. Am J Epidemiol 144:997–1003

    PubMed  CAS  Google Scholar 

  31. Niccolai LM, Livingston KA, Laufer AS, Pettigrew MM (2011) Behavioural sources of repeat Chlamydia trachomatis infections: importance of different sex partners. Sex Transm Infect 87:248–253. doi:10.1136/sti.2010.045484

    PubMed  Google Scholar 

  32. Shaw E, Roberts D, Connor PD (1995) Prevalence of and risk factors for Chlamydia in a rural pregnant population. J Fam Pract 41:257–260

    PubMed  CAS  Google Scholar 

  33. Chokephaibulkit K, Patamasucon P, List M, Moore B, Rodriguez H (1997) Genital Chlamydia trachomatis infection in pregnant adolescents in east Tennessee: a 7-year case–control study. J Pediatr Adolesc Gynecol 10:95–100

    PubMed  CAS  Google Scholar 

  34. Neu NM, Grumet S, Saiman L, McMahon DJ, Westhoff C (1998) Genital chlamydial disease in an urban, primarily Hispanic, family planning clinic. Sex Transm Dis 25:317–321

    PubMed  CAS  Google Scholar 

  35. Finelli L, Nakashima AK, Hillis S, Crayne E, Spitalny KC (1996) Selective screening versus presumptive treatment criteria for identification of women with chlamydial infection in public clinics: New Jersey. Am J Obstet Gynecol 174:1527–1533

    PubMed  CAS  Google Scholar 

  36. Vonck RA, Darville T, O’Connell CM, Jerse AE (2011) Chlamydial infection increases gonococcal colonization in a novel murine coinfection model. Infect Immun 79:1566–1577. doi:10.1128/iai.01155-10

    PubMed  CAS  Google Scholar 

  37. Laga M, Manoka A, Kivuvu M, Malele B, Tuliza M, Nzila N, Goeman J, Behets F, Batter V, Alary M et al (1993) Non-ulcerative sexually transmitted diseases as risk factors for HIV-1 transmission in women: results from a cohort study. AIDS 7:95–102

    PubMed  CAS  Google Scholar 

  38. Fleming DC, Wasserheit J (1999) From epidemiological synergy to public health policy and practice: the contribution of other sexually transmitted diseases to sexual transmission of HIV infection. Sex Transm Dis 75:3–17

    CAS  Google Scholar 

  39. Venkatesh KK, van der Straten A, Mayer KH, Blanchard K, Ramjee G, Lurie MN, Chipato T, Padian NS, de Bruyn G (2011) African women recently infected with HIV-1 and HSV-2 have increased risk of acquiring Neisseria gonorrhoeae and Chlamydia trachomatis in the methods for improving reproductive health in Africa trial. Sex Transm Dis 38:562–570. doi:10.1097/OLQ.0b013e31820a8c2c

    PubMed  Google Scholar 

  40. Mosure DJ, Berman S, Fine D, DeLisle S, Cates W Jr, Boring JR 3rd (1997) Genital Chlamydia infections in sexually active female adolescents: do we really need to screen everyone? J Adolesc Health 20:6–13

    PubMed  CAS  Google Scholar 

  41. Bjartling C, Osser S, Johnsson A, Persson K (2009) Clinical manifestations and epidemiology of the new genetic variant of Chlamydia trachomatis. Sex Transm Dis 36:529–535. doi:10.1097/OLQ.0b013e3181a8cef1

    PubMed  Google Scholar 

  42. Hoffmann S, Jensen JS (2007) Mutant Chlamydia trachomatis in Denmark. Euro Surveill 12:E7–E8

    PubMed  Google Scholar 

  43. Darville T, Hiltke TJ (2010) Pathogenesis of genital tract disease due to Chlamydia trachomatis. J Infect Dis 201(Suppl 2):S114–S125

    PubMed  CAS  Google Scholar 

  44. El Hakim EA, Gordon UD, Akande VA (2010) The relationship between serum Chlamydia antibody levels and severity of disease in infertile women with tubal damage. Arch Gynecol Obstet 281:727–733. doi:10.1007/s00404-009-1225-7

    PubMed  Google Scholar 

  45. Rolfs R, Galaid EI, Zaidi A (1992) Pelvic inflammatory disease: trends in hospitalization and office visits, 1979 through 1988. Am J Obstet Gynecol 166:983–990

    PubMed  CAS  Google Scholar 

  46. Cates W Jr, Wasserheit JN (1991) Genital chlamydial infections: epidemiology and reproductive sequelae. Am J Obstet Gynecol 164:1771–1781

    PubMed  Google Scholar 

  47. Mendling W (2006) Vaginose, Vaginitis, Zervizitis and Salpingitis. Springer, Heidelberg

    Google Scholar 

  48. Westrom L, Wolner-Hanssen P (1993) Pathogenesis of pelvic inflammatory disease. Genitourin Med 69:9–17

    PubMed  CAS  Google Scholar 

  49. Cates W Jr (1999) Chlamydial infections and the risk of ectopic pregnancy. JAMA 281:117–118

    PubMed  Google Scholar 

  50. Peipert JF (2003) Clinical practice. Genital chlamydial infections. N Engl J Med 349:2424–2430. doi:10.1056/NEJMcp030542

    PubMed  CAS  Google Scholar 

  51. Paavonen J, Eggert-Kruse W (1999) Chlamydia trachomatis: impact on human reproduction. Hum Reprod Update 5:433–447

    PubMed  CAS  Google Scholar 

  52. Nyari T, Deak J, Nagy E, Vereb I, Kovacs L, Meszaros G, Orvos H, Berbik I (1998) Epidemiological study of Chlamydia trachomatis infection in pregnant women in Hungary. Sex Transm Infect 74:213–215

    PubMed  CAS  Google Scholar 

  53. McGregor JA, French JI (1991) Chlamydia trachomatis infection during pregnancy. Am J Obstet Gynecol 164:1782–1789

    PubMed  CAS  Google Scholar 

  54. Cohen I, Veille JC, Calkins BM (1990) Improved pregnancy outcome following successful treatment of chlamydial infection. JAMA 263:3160–3163

    PubMed  CAS  Google Scholar 

  55. Ryan GM Jr, Abdella TN, McNeeley SG, Baselski VS, Drummond DE (1990) Chlamydia trachomatis infection in pregnancy and effect of treatment on outcome. Am J Obstet Gynecol 162:34–39

    PubMed  Google Scholar 

  56. Harrison HR, Alexander ER, Weinstein L, Lewis M, Nash M, Sim DA (1983) Cervical Chlamydia trachomatis and mycoplasmal infections in pregnancy. Epidemiology and outcomes. JAMA 250:1721–1727

    PubMed  CAS  Google Scholar 

  57. Martius J, Krohn MA, Hillier SL, Stamm WE, Holmes KK, Eschenbach DA (1988) Relationships of vaginal Lactobacillus species, cervical Chlamydia trachomatis, and bacterial vaginosis to preterm birth. Obstet Gynecol 71:9–89

    Google Scholar 

  58. Medina M, Moya W, Hidalgo L, Calle A, Teran E, Chedraui P (2009) Molecular identification of endocervical Chlamydia trachomatis infection among gestations at risk for preterm birth in Ecuador. Arch Gynecol Obstet 279:9–10. doi:10.1007/s00404-008-0647-y

    PubMed  CAS  Google Scholar 

  59. Gravett MG, Nelson HP, DeRouen T, Critchlow C, Eschenbach DA, Holmes KK (1986) Independent associations of bacterial vaginosis and Chlamydia trachomatis infection with adverse pregnancy outcome. JAMA 256:1899–1903

    PubMed  CAS  Google Scholar 

  60. Sweet RL, Landers DV, Walker C, Schachter J (1987) Chlamydia trachomatis infection and pregnancy outcome. Am J Obstet Gynecol 156:824–833

    PubMed  CAS  Google Scholar 

  61. Alger LS, Lovchik JC, Hebel JR, Blackmon LR, Crenshaw MC (1988) The association of Chlamydia trachomatis, Neisseria gonorrhoeae, and group B streptococci with preterm rupture of the membranes and pregnancy outcome. Am J Obstet Gynecol 159:397–404

    PubMed  CAS  Google Scholar 

  62. Weissenbacher TM, Kupka MS, Kainer F, Friese K, Mylonas I (2011) Screening for Chlamydia trachomatis in pregnancy: a retrospective analysis in a German urban area. Arch Gynecol Obstet 283:1343–1347. doi:10.1007/s00404-010-1537-7

    PubMed  Google Scholar 

  63. Andrews WW, Goldenberg RL, Mercer B, Iams J, Meis P, Moawad A, Das A, Vandorsten JP, Caritis SN, Thurnau G, Miodovnik M, Roberts J, McNellis D (2000) The preterm prediction study: association of second-trimester genitourinary chlamydia infection with subsequent spontaneous preterm birth. Am J Obstet Gynecol 183:662–668

    PubMed  CAS  Google Scholar 

  64. Hammerschlag MR (1994) Chlamydia trachomatis in children. Pediatr Ann 23:349–353

    PubMed  CAS  Google Scholar 

  65. Stenberg K, Mardh PA (1986) Persistent neonatal chlamydial infection in a 6-year-old girl. Lancet 2:1278–1279

    PubMed  CAS  Google Scholar 

  66. Michel CE, Solomon AW, Magbanua JP, Massae PA, Huang L, Mosha J, West SK, Nadala EC, Bailey R, Wisniewski C, Mabey DC, Lee HH (2006) Field evaluation of a rapid point-of-care assay for targeting antibiotic treatment for trachoma control: a comparative study. Lancet 367:1585–1590. doi:10.1016/S0140-6736(06)68695-9

    PubMed  Google Scholar 

  67. Schachter J, Chernesky MA, Willis DE, Fine PM, Martin DH, Fuller D, Jordan JA, Janda W, Hook EW 3rd (2005) Vaginal swabs are the specimens of choice when screening for Chlamydia trachomatis and Neisseria gonorrhoeae: results from a multicenter evaluation of the APTIMA assays for both infections. Sex Transm Dis 32:725–728

    PubMed  Google Scholar 

  68. Black CM (1997) Current methods of laboratory diagnosis of Chlamydia trachomatis infections. Clin Microbiol Rev 10:160–184

    PubMed  CAS  Google Scholar 

  69. Persson K (2002) The role of serology, antibiotic susceptibility testing and serovar determination in genital chlamydial infections. Best Pract Res Clin Obstet Gynaecol 16:801–814

    PubMed  Google Scholar 

  70. Bax CJ, Dorr PJ, Trimbos JB, Spaargaren J, Oostvogel PM, Pena AS, Morre SA (2004) Chlamydia trachomatis heat shock protein 60 (cHSP60) antibodies in women without and with tubal pathology using a new commercially available assay. Sex Transm Infect 80:415–416

    PubMed  CAS  Google Scholar 

  71. Cappello F, Conway de Macario E, Di Felice V, Zummo G, Macario AJ (2009) Chlamydia trachomatis infection and anti-Hsp60 immunity: the two sides of the coin. PLoS Pathog 5:e1000552. doi:10.1371/journal.ppat.1000552

    PubMed  Google Scholar 

  72. Clad A, Petersen EE, Dettlaff S (2003) Antibodies to Chlamydia trachomatis heat shock protein 60 (cHSP60) and Chlamydia trachomatis major outer membrane protein (MOMP) in women with different tubal status. Clin Lab 49:269–271

    PubMed  CAS  Google Scholar 

  73. Claman P, Honey L, Peeling RW, Jessamine P, Toye B (1997) The presence of serum antibody to the chlamydial heat shock protein (CHSP60) as a diagnostic test for tubal factor infertility. Fertil Steril 67:501–504

    PubMed  CAS  Google Scholar 

  74. Anonymous (2002) Recall of LCx Neisseria gonorrhoeae assay and implications for laboratory testing for N. gonorrhoeae and Chlamydia trachomatis. MMWR Morb Mortal Wkly Rep 51:709

  75. Currie MJ, McNiven M, Yee T, Schiemer U, Bowden FJ (2004) Pooling of clinical specimens prior to testing for Chlamydia trachomatis by PCR is accurate and cost saving. J Clin Microbiol 42:4866–4867

    PubMed  Google Scholar 

  76. Bassiri M, Mardh PA, Domeika M (1997) Multiplex AMPLICOR PCR screening for Chlamydia trachomatis and Neisseria gonorrhoeae in women attending non-sexually transmitted disease clinics. The European Chlamydia Epidemiology Group. J Clin Microbiol 35:2556–2560

    PubMed  CAS  Google Scholar 

  77. Wiesenfeld HC, Heine RP, Rideout A, Macio I, DiBiasi F, Sweet RL (1996) The vaginal introitus: a novel site for Chlamydia trachomatis testing in women. Am J Obstet Gynecol 174:1542–1546

    PubMed  CAS  Google Scholar 

  78. Falk L, Coble BI, Mjornberg PA, Fredlund H (2010) Sampling for Chlamydia trachomatis infection—a comparison of vaginal, first-catch urine, combined vaginal and first-catch urine and endocervical sampling. Int J STD AIDS 21:283–287. doi:10.1258/ijsa.2009.009440

    PubMed  CAS  Google Scholar 

  79. Kissinger P, Hogben M (2011) Expedited partner treatment for sexually transmitted infections: an update. Curr Infect Dis Rep 13:188–195. doi:10.1007/s11908-010-0159-3

    PubMed  Google Scholar 

  80. Mylonas I, Friese I (2008) Infektiologische Erkrankungen in der Gynäkologie. In: Janni, Rack, Friese (eds) Facharzt Gynäkologie. Elsevier, Munich

    Google Scholar 

  81. Mylonas I (2009) Friese K (2009) Infektionen in der Gynäkologie und Geburtshilfe. Elsevier Urban & Fischer, München

    Google Scholar 

  82. Mylonas I, Kirschner W, Weissenbacher T, Gingelmaier A, Weissenbacher ER, Friese K (2007) Chlamydia trachomatis infections—a time for action? Dtsch Med Wochenschr 132:1170–1176. doi:10.1055/s-2007-979394

    PubMed  CAS  Google Scholar 

  83. Mikamo H, Sato Y, Hayasaki Y, Hua YX, Tamaya T (2000) Adequate levofloxacin treatment schedules for uterine cervicitis caused by Chlamydia trachomatis. Chemotherapy 46:150–152

    PubMed  CAS  Google Scholar 

  84. Bebear CM, de Barbeyrac B, Pereyre S, Renaudin H, Clerc M, Bebear C (2008) Activity of moxifloxacin against the urogenital mycoplasmas Ureaplasma spp., Mycoplasma hominis and Mycoplasma genitalium and Chlamydia trachomatis. Clin Microbiol Infect 14:801–805. doi:10.1111/j.1469-0691.2008.02027.x

    PubMed  CAS  Google Scholar 

  85. Heessen FW, Muytjens HL (1984) In vitro activities of ciprofloxacin, norfloxacin, pipemidic acid, cinoxacin, and nalidixic acid against Chlamydia trachomatis. Antimicrob Agents Chemother 25:123–124

    PubMed  CAS  Google Scholar 

  86. Meier-Ewert H, Weil G, Millott G (1984) In vitro activity of ciprofloxacin against clinical isolates of Chlamydia trachomatis. Eur J Clin Microbiol 3:372

    PubMed  CAS  Google Scholar 

  87. Madhavan HN, Roy S, Malathy J (1996) In vitro activities of tetracycline and ciprofloxacin against Chlamydia trachomatis isolates from conjunctivitis patients. Indian J Med Res 103:138–141

    PubMed  CAS  Google Scholar 

  88. Hooton TM, Rogers ME, Medina TG, Kuwamura LE, Ewers C, Roberts PL, Stamm WE (1990) Ciprofloxacin compared with doxycycline for nongonococcal urethritis. Ineffectiveness against Chlamydia trachomatis due to relapsing infection. JAMA 264:1418–1421

    PubMed  CAS  Google Scholar 

  89. Jeskanen L, Karppinen L, Ingervo L, Reitamo S, Happonen HP, Lassus A (1989) Ciprofloxacin versus doxycycline in the treatment of uncomplicated urogenital Chlamydia trachomatis infections. A double-blind comparative study. Scand J Infect Dis Suppl 60:62–65

    PubMed  CAS  Google Scholar 

  90. Skerk V, Schonwald S, Krhen I, Banaszak A, Begovac J, Strugar J, Strapac Z, Vrsalovic R, Vukovic J, Tomas M (2003) Comparative analysis of azithromycin and ciprofloxacin in the treatment of chronic prostatitis caused by Chlamydia trachomatis. Int J Antimicrob Agents 21:457–462

    PubMed  CAS  Google Scholar 

  91. Skerk V, Schonwald S, Krhen I, Markovinovic L, Barsic B, Marekovic I, Roglic S, Zeljko Z, Vince A, Cajic V (2002) Comparative analysis of azithromycin and clarithromycin efficacy and tolerability in the treatment of chronic prostatitis caused by Chlamydia trachomatis. J Chemother 14:384–389

    PubMed  CAS  Google Scholar 

  92. Chiarini F, Mansi A, Tomao P, Gentile V, De Marco F, Brunori S, Wongher L, Di Silverio F (1994) Chlamydia trachomatis genitourinary infections: laboratory diagnosis and therapeutic aspects. Evaluation of in vitro and in vivo effectiveness of azithromycin. J Chemother 6:238–242

    PubMed  CAS  Google Scholar 

  93. CDC (2006) Sexually transmitted disease treatment guidelines 2006. MMWR Morb Mortal Wkly Rep 51:1–78

    Google Scholar 

  94. Lau CY, Qureshi AK (2002) Azithromycin versus doxycycline for genital chlamydial infections: a meta-analysis of randomized clinical trials. Sex Transm Dis 29:497–502

    PubMed  CAS  Google Scholar 

  95. Sweet RL (2009) Treatment strategies for pelvic inflammatory disease. Expert Opin Pharmacother 10:823–837. doi:10.1517/14656560902823816

    PubMed  CAS  Google Scholar 

  96. Mourad A, Sweet RL, Sugg N, Schachter J (1980) Relative resistance to erythromycin in Chlamydia trachomatis. Antimicrob Agents Chemother 18:696–698

    PubMed  CAS  Google Scholar 

  97. Lefevre JC, Lepargneur JP (1998) Comparative in vitro susceptibility of a tetracycline-resistant Chlamydia trachomatis strain isolated in Toulouse (France). Sex Transm Dis 25:350–352

    PubMed  CAS  Google Scholar 

  98. Somani J, Bhullar VB, Workowski KA, Farshy CE, Black CM (2000) Multiple drug-resistant Chlamydia trachomatis associated with clinical treatment failure. J Infect Dis 181:1421–1427. doi:10.1086/315372

    PubMed  CAS  Google Scholar 

  99. Dreses-Werringloer U, Padubrin I, Kohler L, Hudson AP (2003) Detection of nucleotide variability in rpoB in both rifampin-sensitive and rifampin-resistant strains of Chlamydia trachomatis. Antimicrob Agents Chemother 47:2316–2318

    PubMed  CAS  Google Scholar 

  100. Dessus-Babus S, Belloc F, Bebear CM, Poutiers F, Lacombe F, Bebear C, de Barbeyrac B (1998) Antibiotic susceptibility testing for Chlamydia trachomatis using flow cytometry. Cytometry 31:37–44

    PubMed  CAS  Google Scholar 

  101. Suchland RJ, Geisler WM, Stamm WE (2003) Methodologies and cell lines used for antimicrobial susceptibility testing of Chlamydia spp. Antimicrob Agents Chemother 47:636–642

    PubMed  CAS  Google Scholar 

  102. Pitsouni E, Iavazzo C, Athanasiou S, Falagas ME (2007) Single-dose azithromycin versus erythromycin or amoxicillin for Chlamydia trachomatis infection during pregnancy: a meta-analysis of randomised controlled trials. Int J Antimicrob Agents 30:213–221. doi:10.1016/j.ijantimicag.2007.04.015

    PubMed  CAS  Google Scholar 

  103. Jones R, Boag F (2007) Screening for Chlamydia trachomatis. Bmj 334:703–704. doi:10.1136/bmj.39167.545417.80

    PubMed  Google Scholar 

  104. Gunn RA, Hillis SD, Shirey P, Waterman SH, Greenspan JR (1995) Chlamydia trachomatis infection among Hispanic women in the California–Mexico border area, 1993: establishing screening criteria in a primary care setting. Sex Transm Dis 22:329–334

    PubMed  CAS  Google Scholar 

  105. Han Y, Coles FB, Hipp S (1997) Screening criteria for Chlamydia trachomatis in family planning clinics: accounting for prevalence and clients’ characteristics. Fam Plann Perspect 29:163–166

    PubMed  CAS  Google Scholar 

  106. Nelson HD, Helfand M (2001) Screening for chlamydial infection. Am J Prev Med 20:95–107

    PubMed  CAS  Google Scholar 

  107. Marrazzo JM, Celum CL, Hillis SD, Fine D, DeLisle S, Handsfield HH (1997) Performance and cost-effectiveness of selective screening criteria for Chlamydia trachomatis infection in women. Implications for a national Chlamydia control strategy. Sex Transm Dis 24:131–141

    PubMed  CAS  Google Scholar 

  108. Miller WC, Hoffman IF, Owen-O’Dowd J, McPherson JT, Privette A, Schmitz JL, Woodlief G, Leone PA (2000) Selective screening for chlamydial infection: which criteria to use? Am J Prev Med 18:115–122

    PubMed  CAS  Google Scholar 

  109. Stergachis A, Scholes D, Heidrich FE, Sherer DM, Holmes KK, Stamm WE (1993) Selective screening for Chlamydia trachomatis infection in a primary care population of women. Am J Epidemiol 138:143–153

    PubMed  CAS  Google Scholar 

  110. Hu D, Hook EW 3rd, Goldie SJ (2004) Screening for Chlamydia trachomatis in women 15 to 29 years of age: a cost-effectiveness analysis. Ann Intern Med 141:501–513

    PubMed  Google Scholar 

  111. Howell MR, Quinn TC, Gaydos CA (1998) Screening for Chlamydia trachomatis in asymptomatic women attending family planning clinics. A cost-effectiveness analysis of three strategies. Ann Intern Med 128:277–284

    PubMed  CAS  Google Scholar 

  112. Humphreys JT, Henneberry JF, Rickard RS, Beebe JL (1992) Cost–benefit analysis of selective screening criteria for Chlamydia trachomatis infection in women attending Colorado family planning clinics. Sex Transm Dis 19:47–53

    PubMed  CAS  Google Scholar 

  113. Sellors JW, Pickard L, Gafni A, Goldsmith CH, Jang D, Mahony JB, Chernesky MA (1992) Effectiveness and efficiency of selective vs universal screening for chlamydial infection in sexually active young women. Arch Intern Med 152:1837–1844

    PubMed  CAS  Google Scholar 

  114. Genc M, Mardh A (1996) A cost-effectiveness analysis of screening and treatment for Chlamydia trachomatis infection in asymptomatic women. Ann Intern Med 124:1–7

    PubMed  CAS  Google Scholar 

  115. Mangione-Smith R, O’Leary J, McGlynn EA (1999) Health and cost–benefits of chlamydia screening in young women. Sex Transm Dis 26:309–316

    PubMed  CAS  Google Scholar 

  116. Honey E, Augood C, Templeton A, Russell I, Paavonen J, Mardh PA, Stary A, Stray-Pedersen B (2002) Cost effectiveness of screening for Chlamydia trachomatis: a review of published studies. Sex Transm Infect 78:406–412

    PubMed  CAS  Google Scholar 

  117. Howell MR, Gaydos JC, McKee KT Jr, Quinn TC, Gaydos CA (1999) Control of Chlamydia trachomatis infections in female army recruits: cost-effective screening and treatment in training cohorts to prevent pelvic inflammatory disease. Sex Transm Dis 26:519–526

    PubMed  CAS  Google Scholar 

  118. Goeree R, Jang D, Blackhouse G, Chong S, Mahony J, Sellors J, Foy A, Chernesky M (2001) Cost-effectiveness of screening swab or urine specimens for Chlamydia trachomatis from young Canadian women in Ontario. Sex Transm Dis 28:701–709

    PubMed  CAS  Google Scholar 

  119. Nettleman MD, Bell TA (1991) Cost-effectiveness of prenatal testing for Chlamydia trachomatis. Am J Obstet Gynecol 164:1289–1294

    PubMed  CAS  Google Scholar 

  120. Oakeshott P, Kerry S, Aghaizu A, Atherton H, Hay S, Taylor-Robinson D, Simms I, Hay P (2010) Randomised controlled trial of screening for Chlamydia trachomatis to prevent pelvic inflammatory disease: the POPI (Prevention of Pelvic Infection) trial. BMJ 340:c1642

    PubMed  Google Scholar 

  121. Scholes D, Stergachis A, Heidrich FE, Andrilla H, Holmes KK, Stamm WE (1996) Prevention of pelvic inflammatory disease by screening for cervical chlamydial infection. N Engl J Med 334:1362–1366

    PubMed  CAS  Google Scholar 

  122. Ostergaard L, Andersen B, Moller JK, Olesen F (2000) Home sampling versus conventional swab sampling for screening of Chlamydia trachomatis in women: a cluster-randomized 1-year follow-up study. Clin Infect Dis 31:951–957

    PubMed  CAS  Google Scholar 

  123. Bakken IJ, Ghaderi S (2009) Incidence of pelvic inflammatory disease in a large cohort of women tested for Chlamydia trachomatis: a historical follow-up study. BMC Infect Dis 9:130. doi:10.1186/1471-2334-9-130

    PubMed  Google Scholar 

  124. Aghaizu A, Adams EJ, Turner K, Kerry S, Hay P, Simms I, Oakeshott P (2011) What is the cost of pelvic inflammatory disease and how much could be prevented by screening for Chlamydia trachomatis? Cost analysis of the Prevention of Pelvic Infection (POPI) trial. Sex Transm Infect 87:312–317. doi:10.1136/sti.2010.048694

    PubMed  Google Scholar 

  125. Low N (2007) Screening programmes for chlamydial infection: when will we ever learn? BMJ 334:725–728. doi:10.1136/bmj.39154.378079.BE

    PubMed  Google Scholar 

  126. CDC (2009) Chlamydia screening among sexually active young female enrollees of health plans—United States, 2000–2007. MMWR Morb Mortal Wkly Rep 58:362–365

    Google Scholar 

  127. Anthonisz M (2009) Assessing the impact: the National Chlamydia Screening Programme. Br J Nurs 18:246–251

    PubMed  Google Scholar 

  128. Brabin L, Thomas G, Hopkins M, O’Brien K, Roberts SA (2009) Delivery of chlamydia screening to young women requesting emergency hormonal contraception at pharmacies in Manchester, UK: a prospective study. BMC Womens Health 9:7. doi:10.1186/1472-6874-9-7

    PubMed  Google Scholar 

  129. Cameron ST, Glasier A, Scott G, Young H, Melvin L, Johnstone A, Elton R (2009) Novel interventions to reduce re-infection in women with chlamydia: a randomized controlled trial. Hum Reprod 24:888–895. doi:10.1093/humrep/den475

    PubMed  CAS  Google Scholar 

  130. Graseck AS, Shih SL, Peipert JF (2011) Home versus clinic-based specimen collection for Chlamydia trachomatis and Neisseria gonorrhoeae. Expert Rev Anti Infect Ther 9:183–194. doi:10.1586/eri.10.164

    PubMed  Google Scholar 

  131. Gaydos CA, Barnes M, Aumakhan B, Quinn N, Wright C, Agreda P, Whittle P, Hogan T (2011) Chlamydia trachomatis age-specific prevalence in women who used an Internet-based self-screening program compared to women who were screened in family planning clinics. Sex Transm Dis 38:74–78. doi:10.1097/OLQ.0b013e3182039d7f

    PubMed  Google Scholar 

  132. Buhrer-Skinner M, Muller R, Buettner PG, Gordon R, Debattista J (2011) Improving Chlamydia trachomatis retesting rates by mailed self-collection kit. Sex Health 8:248–250. doi:10.1071/sh10064

    PubMed  Google Scholar 

  133. Emmerton L, Buhrer Skinner M, Gardiner E, Nissen L, Debattista J (2011) A trial of the distribution of chlamydia self-collection postal specimen kits from Australian community pharmacies. Sex Health 8:130–132. doi:10.1071/sh10068

    PubMed  Google Scholar 

  134. Buhrer-Skinner M, Muller R, Bialasiewicz S, Sloots TP, Debattista J, Gordon R, Buettner PG (2009) The check is in the mail: piloting a novel approach to Chlamydia trachomatis testing using self-collected, mailed specimen. Sex Health 6:163–169. doi:10.1071/SH08076

    PubMed  Google Scholar 

  135. Gaydos CA, Barnes M, Aumakhan B, Quinn N, Agreda P, Whittle P, Hogan T (2009) Can e-technology through the internet be used as a new tool to address the Chlamydia trachomatis epidemic by home sampling and vaginal swabs? Sex Transm Dis 36:577–580. doi:10.1097/OLQ.0b013e3181a7482f

    PubMed  Google Scholar 

  136. Gottlieb SL, Berman SM, Low N (2010) Screening and treatment to prevent sequelae in women with Chlamydia trachomatis genital infection: how much do we know? J Infect Dis 201(Suppl 2):S156–S167. doi:10.1086/652396

    PubMed  Google Scholar 

  137. Land JA, Van Bergen JE, Morre SA, Postma MJ (2010) Epidemiology of Chlamydia trachomatis infection in women and the cost-effectiveness of screening. Hum Reprod Update 16:189–204. doi:10.1093/humupd/dmp035

    PubMed  CAS  Google Scholar 

  138. Pourat N, Kominski GF, Nihalani J, Neiman R, Bolan G (2011) The role of medicaid managed care interventions in Chlamydia screening by physicians. Sex Transm Dis 38:286–292. doi:10.1097/OLQ.0b013e3181ffa90c

    PubMed  Google Scholar 

  139. Burstein GR, Gaydos CA, Diener-West M, Howell MR, Zenilman JM, Quinn TC (1998) Incident Chlamydia trachomatis infections among inner-city adolescent females. JAMA 280:521–526

    PubMed  CAS  Google Scholar 

  140. Baeten JM, Nyange PM, Richardson BA, Lavreys L, Chohan B, Martin HL Jr, Mandaliya K, Ndinya-Achola JO, Bwayo JJ, Kreiss JK (2001) Hormonal contraception and risk of sexually transmitted disease acquisition: results from a prospective study. Am J Obstet Gynecol 185:380–385

    PubMed  CAS  Google Scholar 

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Acknowledgments

The author would like to thank Mr. Dr. A. Brüning for critical reading of the manuscript, Mr. P. Fuchs for conducting the figures. I. Mylonas is funded by the German Research Foundation (Deutsche Forschungsgemeinschaft, DFG BR 3641/3-1)

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The author declares that he has no competing interests.

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  1. 1st Department of Obstetrics and Gynaecology, Head of the Division of Infectious Diseases in Gynaecology and Obstetrics, Ludwig-Maximilians-University Munich, Maistrasse 11, 80337, Munich, Germany

    Ioannis Mylonas

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Mylonas, I. Female genital Chlamydia trachomatis infection: where are we heading?. Arch Gynecol Obstet 285, 1271–1285 (2012). https://doi.org/10.1007/s00404-012-2240-7

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