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


METHODS
Prospective evaluation of an inception cohort.


METHODS
University student health clinic.


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


METHODS
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.
Workowski
K A
KA
Division of Infectious Diseases, Emory University, Atlanta, Ga 30308.
Lampe
M F
MF
Wong
K G
KG
Watts
M B
MB
Stamm
W E
WE
D000328:Adult; D000908:Antibodies, Fungal / Q000097:blood; D002690:Chlamydia Infections / Q000175:diagnosis / Q000188:drug therapy* / Q000276:immunology; D002692:Chlamydia trachomatis / Q000302:isolation & purification*; D015331:Cohort Studies; D004271:DNA, Fungal / Q000032:analysis; D004318:Doxycycline / Q000627:therapeutic use*; D005260:Female; D052776:Female Urogenital Diseases / Q000175:diagnosis / Q000188:drug therapy / Q000382:microbiology*; D006801:Humans; D016133:Polymerase Chain Reaction; D011446:Prospective Studies; D012008:Recurrence
D000908:Antibodies, Fungal; D004271:DNA, Fungal; D004318:Doxycycline